Diabetic patients should know how to take care of their feet ? (1)
Surprisingly in African subcontinent, problem of diabetes is widely prevalent. According to one estimate the diabetic population in Africa, is the second highest in the world after Indian subcontinent. A drastic change in the life style, lack of exercise, avoidance of regular daily morning walk and no control over diet are some of the reasons, […]
Surprisingly in African subcontinent, problem of diabetes is widely prevalent. According to one estimate the diabetic population in Africa, is the second highest in the world after Indian subcontinent. A drastic change in the life style, lack of exercise, avoidance of regular daily morning walk and no control over diet are some of the reasons, which are responsible for rapid rise in the number of diabetic patients in this region. In diabetic patients, the leg becomes the commonest casualty due to disease itself.
Why a diabetic patient should not ignore his foot ulcer ?
Quite often a diabetic patient takes no notice of small scratches, small blisters, small injury which do occur to his leg in day-to-day life. This small scratch gets converted into a full-fledged ulcer if not treated properly in time. Normally in a non-diabetic person these leg ulcers heal well after repeated dressings and antibiotics applications. But in diabetic patients, these foot ulcers generally do not respond to such treatment. Because of ignorance of this fact, a diabetic patient does not take his leg ulcer, which otherwise look simple, seriously and this results into a serious and complicated condition of the leg. Lack of timely care in its early stage causes later on, loss of money, time and leg as well. Therefore always remember a diabetic patient must take his simple leg or foot ulcer very seriously and instead of consulting a general or an orthopaedic surgeon he should consult a vascular or a cardiovascular surgeon and get the ulcer treated under his supervision. A diabetic patient must understand that the inadequate blood supply to lower limb and loss of sensitivity of leg skin are the two most important factors, which make leg ulcer complicated in any diabetic patient.
Why a diabetic patient has problems of leg ulcer the most?
In diabetic patients due to diabetic neuropathy, the sensitivity of leg and foot skin is considerably decreased. Because of reduced skin sensitivity, a diabetic patient never feels the sensation of pain, which a normal non-diabetic person otherwise feels in case of pressure abrasion and a superficial simple injury. If a diabetic patient does not pay attention at this stage, this small abrasion later on turns into a big ulcer. Diabetic neuropathy also causes weakness and partial paralysis of muscles of the foot resulting into constriction of the muscles. With the result, bones of the foot become more prominent and bulgy, and therefore are subjected to undue pressure and the end result is that a superficial ulcer in the foot becomes deep. One more reason of development of pus and gangrene in foot ulcer of a diabetic person is the inadequate blood supply to foot due to narrowing of arteries of lower limb, which carry pure blood to feet. In such a situation where blood supply to the foot as well as sensitivity of the skin of the foot are reduced, any kind of infection even minor one, caught by the foot ulcer in a diabetic patient, spreads very fast and reaches to a dangerous proportion.
Where to go if a diabetic person develops a foot ulcer?
If a diabetic patient develops a small superficial foot ulcer, he instead of a general or an orthopaedic surgeon must consult a vascular or a cardiovascular surgeon and receive treatment under his supervision. Generally, these ulcers most of the time do not respond to simple antibiotics and dressing. For the treatment of such ulcers in a diabetic patient, the proper assessment of blood supply to the foot is of utmost importance. The cause of inadequate blood supply to the foot is generally narrowing of the lower limb arteries (blood pipes`) due to deposition of fat, calcium and cholesterol in the inner wall of the artery. Due to deposition of these undesirable elements in the arterial wall, the arteries get narrowed that results into a considerably decreased supply of pure blood. That is why the investigation of lower limb arteries is a must for the successful treatment of foot ulcers. For this, special investigations like Doppler Study, Multislide CT Angio, MR Angio, and Digital Subtraction Angiography are required.
Dr. K. K. Pandey is a Senior Consultant in the Department of Cardiothoracic & Vascular Surgery at Indraprastha Apollo Hospital, New Delhi.
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