By Dr Ajay Gupta, MS
(Consultant Surgeon)
Foot infections are the most common problem in people with diabetes. These individuals are predisposed to foot infections because of a reduced blood supply secondary to diabetes. It may involve the skin or may go up to the bones.
Why do diabetics develop foot infections?
There are three factors which act in combination to produce a diabetic foot.
Poor blood circulation
Reduced sensation in the foot
Increased blood sugar
Pressure due to ill-fitting shoes or trauma, along with the above mentioned factors, compromise the local blood supply to the foot, leading to infection. The infection may involve the skin and deeper structures, such as bone, or all of them. Usually in diabetics, the big and small blood vessels get blocked. Due to the blockage of the smaller blood vessels, the infection-fighting cells and the antibiotics do not reach the site of the infection.
Due to reduced sensation in the foot, minor injuries to the foot go unnoticed, as there is a reduced ability to feel pain, heat, and cold. If these minor injuries are left untreated, complications may result and lead to ulceration and deep infection.
Owing to high blood sugar, the glucose levels at the site of infection increases, resulting in increased growth of the infection-causing germs or bacteria.
Prevention and treatment
‘Diabetic foot’ is a good example of the saying that ‘prevention is better than cure.’
The important step in diabetic foot prevention is patient education and daily foot care. Following are a few things that should be done daily:
Take care of your diabetes
Try to keep your blood sugar levels under control by proper diet, exercise and medication.
Check your feet every day
You may have a foot problem that you may not be aware of. Check your feet for cuts, sores, red spots, swelling, or infected toenails. Checking your feet should become a part of your daily routine. You can also ask a family member to help you. Be sure to call your doctor immediately if a cut, sore, blister or bruise on your foot does not heal.
Daily inspection of foot
Wash your feet every day
Wash your feet in warm water. Before bathing or showering, test the water to make sure it is not too hot. Dry your feet well. Be sure to dry between your toes. Use talcum powder to keep the skin dry between your toes.
Keep the skin soft and smooth
Rub a thin coat of skin lotion or cream on the top and bottom of your feet. Do not put any lotion between your toes, because this might cause infection.
Wear shoes and socks at all times
Wear shoes and socks at all times. Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, and nylons with your shoes to help avoid the possibility of blisters and sores developing. Always check the insides of your shoes before putting them on. Make sure the lining is smooth and there are no foreign objects in the shoe, such as pebbles. Wear shoes that fit well and protect your feet with a wide toe area.
Keep the blood flowing to your feet
Put your feet up when you are sitting. Move your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to improve blood flow to your feet and legs.
DO NOT cross your legs for long periods of time.
DO NOT wear tight socks or garters around your legs.
DO NOT smoke. Smoking reduces blood flow to your feet. Take treatment for high blood pressure and high cholesterol.
Be more active
Regular exercise will improve circulation to your legs, and will also help to stabilize your blood sugar levels.
Consult your physician before joining any exercise programme. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all activities that are hard on the feet, such as running and skipping. Wear protective walking or athletic shoes that fit well and offer good support.
Communicate withyour doctor
Ask your doctor to check sensation and pulses in your feet at least once a year.
Treatment of ulcer
The first step in the treatment of a patient with diabetes who has a foot ulcer is urgent control of blood sugar, which may require insulin injections. If the wound or ulcer on the patient’ foot is infected, antibiotics would be prescribed to treat the infection. It is very important for the patient to take the entire course of antibiotics as prescribed. For limb-threatening or life-threatening infections, the patient will be admitted to the hospital and given antibiotics by the vein.
The ulcer is kept moist and all the infected area is excised. If the bone is involved, all the dead bone tissue is excised. Daily dressings with antibiotic creams are done. Partial or major amputations may be required to save the foot or leg.
In a nutshell, if you are diabetic, you should be particularly alert to any problems with your feet. It is very important for diabetics to take necessary precautions to prevent injury and keep their feet healthy. If you have diabetes and are experiencing a foot problem, immediately consult your doctor.
