diabetic foot

Diabetic Foot Care -

Diabetic Foot Care - How to protect from common mistakes made by diabetic patients that can cost them their own foot (essential things that every diabetic patient must know to avoid diabetic foot infections).

Prevention is the first step towards solving diabetic foot problems. It was estimated that every 30s, a leg is lost to diabetes somewhere in the world. A more important fact is that 85% of all amputations in diabetes are preventable by diabetic foot care. Hence, educating normal diabetic patients about the common reasons why they end up in amputation would make them take steps to avoid it when they encounter similar predisposing factors for diabetic foot infections.

Diabetes affects the foot due to diabetic neuropathy or peripheral vascular disease (poor blood flow to foot).

How does sensory neuropathy lead to diabetic foot infections?
It is loss of pain perception because of sensory neuropathy that catches many diabetic patients unaware of minor injuries due to foreign bodies. The wound then gets infected. Hence, it is essential to avoid walking barefoot since minor injuries are not noticed due to loss of pain perception. And walking with injured foot for several days without any treatment leads to diabetic foot infections and later amputations. Diabetic Foot Care tips - avoid walking barefoot

How do shoes or footwear lead to diabetic foot problems?
Since the foot of a diabetic patient swells in the evening with neuropathy, a shoe that fits well in the morning may be too tight by the end of the day. Since perception of pain is lost in diabetic neuropathy, patient continues to wear tight shoes for prolonged periods without discomfort, leading to blisters or infections at the most compressed region by the tight shoes. Those patients with loss of pain perception wear sandal with straps very tight to perceive the footwear they have worn. This sometimes leads to compression for prolonged periods leading to blisters or infections. Diabetic Foot Care tips - buy shoes at evening , use sandals with velcro strap models to prevent infection

How does motor neuropathy lead to diabetic foot infections or amputations?
Motor neuropathy causes wasting of small muscles of foot leading to bony prominences and deformity formation like high arched foot, claw toes deformity etc, leading to high pressure at these localized bone deformity sites while walking. This leads to callus (hard skin) formation. In diabetic patients with sensory loss, if callus grows hard like stone they run the risk of developing an undetected wound underneath the callus. Diabetic Foot Care tips - strict glycemic control dealys neuropathic manifestations

How does callus lead to diabetic foot infections?
Callus has 11 fold increased risk of ulceration in diabetic patients with diabetic foot neuropathy. Diabetic Foot Care tips - By using customized insole and rocker outsole modifications according to individual needs, further progression to ulceration can be prevented.

When does diabetic foot ulcer lead to infections?
Chronic diabetic foot ulcers or trophic ulcers which are not healing or not showing signs of improvement in wound size for more than 3 months have 15-20% chances of diabetic foot infection in future. These are pressure ulcers that do not heal with routine dressing or antibiotics. Diabetic Foot Care tips - trophic ulcers require either footwear customization or podiatry surgeries when they do not resolve with the former. Since 85% of amputations are preceded by poorly treated previous foot ulcer, best is to consult your foot doctor or podiatrist.

How does diabetic autonomic neuropathy lead to diabetic foot infections?
Autonomic neuropathy leads to decreased functioning of sweat glands, in turn leading to loss of sweating and dry skin. Dry skin precipitates cracks or deep fissures with hard edges which can lead to skin breakage and diabetic foot infections in patients with sensory loss, most commonly in heels. Application of moisturizing cream or lotion can solve this problem. Dry skin precipitates itching sensation and scratching too much can lead to skin breakage. Because of loss of pain perception, diabetic patients will scratch till the skin breaks and sometimes cellulitis infection can occur when immunity level is low in long standing diabetes. Diabetic Foot Care tips - Application of moisturizing cream or lotion can solve this problem.

Some patients complain of itching and persisting cracks even after applying moisturizing creams, why?
It suggests that skin is becoming dry very often in these patients. Applying moisturizer once a day will not solve the problem. Diabetic Foot Care tips - They must increase the frequency of application to three to four times a day.

Which foot swelling should be immediately treated?
Any abnormal unilateral foot swelling should raise suspicion of either Charcot foot or quiescent bone infection or cellulitis foot. Diabetic Foot Care tips - Any patient with unilateral foot swelling with redness in skin, increased warmth over swelling, pain over swelling, skin discoloration over swelling should consult with a foot doctor for emergency treatment.

How can self treatment in diabetic neuropathic pain land up in diabetic foot infections?
Patients with neuropathic pain try to do vigorous massage with ayurvedic oils or liniments till skin blister formation because of loss of pain perception in sensory neuropathy. Other modality patient adopts in neuropathic pain is hot water massaging and with sensory loss, patients do not know how much heat should be applied. So they continue to keep very hot water for prolonged periods at pain areas leading to blister formation and diabetic foot infections. Diabetic Foot Care tips - avoid self treatment .

What causes interdigital fungal infection?
Crowdie toes or tight shoes that keep toes tight retain moisture for prolonged periods and cause fungal infection, Diabetic Foot Care tips - these fungal infection can be avoided by using shoes with wide toe box or using toe separator to keep toes separated to prevent moisture retention in between toes.

Self surgery, what can happen?
Patients with poor vision tend to cut nails too deep beneath the crease line which can lead to skin breakage and major amputation in patients with poor blood flow to foot. Proper nail cutting techniques should be learnt. Toe nails should be cut straight and not beneath the crease line. Patients with callus try to remove it themselves using blade which can sometimes lead to skin cuts in adjacent areas and diabetic foot infections later. Diabetic Foot Care tips - Always approach a foot doctor for callus trimming in diabetes.

Are previous amputees at risk of future diabetic foot ulceration or infection?
Yes, biomechanics are altered in previous amputees so pressure points increase at other areas leading to callus or diabetic foot ulcer and later diabetic foot infections. Diabetic Foot Care tips - These can be avoided by proper customized footwear or proper surgical principle applied during time of amputation to prevent future pressure points. These are done by specialist diabetic foot surgeons.

Can we use oils instead of moisturizing cream in foot and leg?
Sometimes due to fragrance of oil, insects or ants are attracted. So, there is a possibility of insect bite injury which again precipitates itching and scratching, finally skin breakage and sometimes diabetic foot infection. Diabetic Foot Care tips - avoid oils

How does ingrown nail form and when can it lead to diabetic foot infection?
Because of improper nail cutting techniques like cutting nails at corners allows nail to grow deep inwards when it regrows. When the ingrown nail presses skin for prolonged periods, it can compromise blood flow to adjacent skin leading to diabetic foot infection. Diabetic Foot Care tips - These things can be avoided by learning proper nail cutting techniques.

Diabetic patients may notice new small cuts in foot or toes when they wake up from bed. What could be the reason?
Rat bite injury is common during night because rats crawl in the night and they bite. Since pain perception is lost in diabetic neuropathy, patients do not react to rat bite which makes these rats do the same repeatedly and patients present with newer cuts every day.


Know FAQs by diabetic patients regarding diabetic foot conditions at diabetic foot clinic home page.

Know FAQs by diabetic patients regarding diabetic foot ulceration and view gallery of diabetic foot conditions treated here by podiatrist Dr.P.N.Someshwara Rao


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