A Diabetic Foot and Its Care

The most important effect of neuropathy (nerve damage) on the diabetic foot is the loss of sensation. The foot is vulnerable even to trivial trauma. A diabetic person can step on a tack with bare feet and feel nothing at all. Tight shoes feel comfortable while scalding water may feel merely warm. Because of this loss of sensation, people with diabetic neuropathy can hurt their feet easily, without realizing it. Doctors and patients give so much importance to long-term complications involving the eyes, kidneys, and heart that the foot problem of the diabetic is completely ignored.

Neuropathy can also cause bones to shift around, changing the shape of the foot. This causes people to walk differently, creating pressures in those parts of the foot where usually there is none. The resulting skin irritation can sometimes lead to sores. Moreover, once the sores develop they can take unusually long to heal or become seriously infected. Over and above that, if the circulation is poor, gangrene and the possibility of amputation are the likely sequels.

Amputation in people with diabetes results from something as minor as stepping on a tack or a minute and inconspicuous break in the skin. Too often this drastic measure could be avoided through good control of blood sugar, and a commitment to daily home care and regular medical check-ups, including foot examination. No other complication of diabetes can be so effectively prevented by proper patient education as the foot problems. What appears to be a superficial ulceration may be only the tip of the iceberg! There may be a penetration deep into the tissues.

Therefore, the management of a diabetic foot problem is complicated and frequently requires the attention of many specialists. It is vital that there is a close liaison between the podiatrist, diabetologist, orthotist, nurse, dietitian and surgeon in the care of the diabetic foot. The diabetic clinic is the optimal forum for this approach.

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