Today diabetes  is an epidemic with more than 60 million diabetics in India. Every single minute, a toe or foot is lost to uncontrolled diabetes in India. Six to 8% of diabetics have neuropathy out of which 15-20% will have an ulcer the most dreaded complication of diabetes. Complications of diabetes include neuropathy (involvement of nerves of the feet). Neuropathy with loss of sensation is the prime cause foot ulceration and loss of toes due to gangrene.

Why do diabetics develop loss of sensation in the feet?

High sugars in a diabetic lead to damage of the nerves-called neuropathy. This is manifested initially by pins and needles sensation, and later by total loss of sensation. This loss of sensation is the danger sign. Our body protects itself from injuries when there is sensation, and loss of sensation leads to injury more commonly. In a diabetic injury is fraught with non-healing, chronicity and infection.

Why does it take long for wounds/ulcers to heal in diabetes? 

High sugars lead to slowing of our body defenses which delays wound healing. Added to this, bacteria thrive on high sugars, making it difficult to eradicate infection. Narrow blood vessels in the foot get blocked (called microangiopathy). Healing is also slowed due to poor blood supply.

How do you treat foot ulcers?

  • We have various treatments for treating foot ulcers.
  • If the wound is heavily infected then dead tissue requires to be cleared, usually surgically, called debridement. 
  • Appropriate antibiotics are used. Antibiotics work only when dead material is removed. 
  • The wound might require skin closure. Based on size and location, a wound might require closure with local skin adjustment-called local rotation flaps, or split skin grafting- taken from the thigh area. 
  • If the toe is dead due to infection, then the toe has to be removed-by amputation. 

What should I do to avoid F

oot ulcers?

First and foremost is control of high blood sugars. You have to use the right kind of medicines-insulin alone (many varieties around), tablets or both.

Do’s

  • Use mild soap
  • Use a soft cloth to dry-between toes as well
  • Moisturize the foot after bath
  • Cutting nails straight  
  • MCP-polymer soft footwear
  • Customizing footwear
  • SELF EXAMINE FEET AT BEDTIME                                                                

Don’ts

  • Keeping feet dirty
  • Not wearing footwear at home
  • Repeated washing of feet
  • Cutting nails curved
  • Using hot water to wash feet
  • Smoking
  • Alcohol

Things to look for are:

  • Redness
  • Blisters
  • Corns
  • Soft soggy skin.

Is there a way to treat neuropathy?

Yes. Only few doctors in India do this kind of surgery. We are one of them. Three or four nerves are released in the leg. Most early cases of neuropathy recover very well with restoration to almost normal sensation in the foot.

I have noticed that my father’s foot is flat and almost getting twisted? What is it and how can you treat it?

This is called Charcot’s foot. It is almost as dangerous as a foot ulcer if not more. The joints in the body have a certain spatial orientation towards one another. In diabetes, nerve damage and lack of sensation can cause joints to be twisted relative to each other giving rise to dislocations and foot fractures-which are painless and seldom heal.

Hope this helps!