What is Diabetes?
Diabetes is the most rapidly progressing, non-communicable disease of the 21st century Diabetes affects 422 million people worldwide, with a dramatic increase in developing countries. In India, about 6 percent of the population suffer from diabetes. By 2025 it is estimated that every fifth diabetic in the world would be an Indian.
Diabetes is also known as the Iceberg Disease or Silent Disease as the clinical presentation is only a fraction compared to the totality of the disease. It is associated with variable clinical manifestations and many complications. Diabetic foot is one such serious problem. The term diabetic foot comprises a group of ailments ranging from neurological, blood circulatory problems and complications arising from injuries or infections.
- Diabetic foot is the most common complication associated with the disease, leading to hospitalization. According to a clinical survey, diabetic foot accounts for 6 percent of all hospital discharges. Also, the average hospital stay is around 13-14 days. Foot problems are the most common cause of admission to hospital for people with diabetes.
- Foot problems account for up to 15% of healthcare costs and 40% of the total available resources in developed countries. By early identification, diagnosis, early intervention and patient education for proper care of the foot and footwear the costs can be drastically reduced. In developing countries, foot problems related to diabetes are thought to be even more common.
- About 60-70 percent of people with diabetes have mild to severe forms of nerve damage. People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. It is also called peripheral neuropathy. Symptoms include numbness, tingling, stinging pain, loss of sensation or weakness in the foot. A person with diabetes may not properly sense minor injuries such as cuts, scrapes and blisters, leading to serious complications.
- Damage to large blood vessels [Macro Vascular Disease] leads to poor blood circulation in the diabetic. This occurs due to hardening of walls of the arteries [atherosclerosis]. This is more likely to affect the extremities of the body, especially the feet. When blood flow to injured tissues is poor, healing does not occur properly. People with damaged blood vessels may face the prospect of amputations. People are also advised to avoid sitting cross-legged for long periods as this may further reduce the blood flow to the lower leg.
- Damage to small blood vessels such as capillaries [Micro Vascular Disease]. Thickening of the capillary walls coupled with elevated blood glucose level reduces blood circulation to the feet. Extreme cases may progress to gangrene.
- Higher Risk of Infections. These include bacterial skin infections (cellulitis), bone infections (osteomyelitis), and Athlete’s foot [a fungal infection]. Minor cuts or injuries can lead to serious infections and should be treated promptly.
- About 15-25% of people with diabetes have foot ulceration. In fact, a non-healing or slow healing ulcer is the first indication of diabetes. It is estimated that one in every six people with diabetes will have a foot ulcer during their lifetime. If coupled with nerve damage it can turn into a medical emergency. With a diabetic foot, even a small blister from wearing shoes that are ill fitting can cause a lot of damage. In fact, many foot ulcers can be prevented with proper information.
- Up to 70% of all leg amputations happen to people with diabetes. In fact, people with diabetes are 25 times more likely to lose a leg than people without the condition. Uncontrolled diabetes especially in the elderly is the leading cause for loss of leg. Statistics indicate that every 30 seconds a leg is lost to diabetes. About 80-85% of diabetes-related lower extremity amputations are preceded by a foot ulcer.
- Up to 85% of all amputations due to diabetic foot can be prevented. After an amputation, if the blood sugar is not effectively controlled, the chance of another amputation within 5 years is as high as 50 %.
- Diabetics are at high risk for developing gangrene [dead tissue] in the feet. This is due to the degenerative changes like atherosclerosis or thrombosis [a clot in a blood vessel] associated with chronic diabetes. In such cases, the blood flow is completely cut off resulting in necrosis or tissue death.
- Charcot Arthropathy is a rare complication of diabetes. It causes weakening of the bones resulting in fractures, dislocations and severe deformities. In most cases, charcot foot occurs after the age of 50. Also such patients have been suffering from diabetes for at least 15 to 20 years.
- Smoking accelerates damage to the small blood vessels in the feet and legs. This damage coupled with high glucose levels can disrupt the healing process and increase the chances of infections and amputations.
- Poorly fitting shoes are a common cause of diabetic foot problems. They cause common problems like blisters, corns, calluses, which if neglected can lead to serious medical conditions. For foot abnormalities such as flat feet, hammertoes and bunions, specially designed shoes may be necessary.
- It is advised to wear proper and comfortable footwear. Shoes with broad square toes along with seamless socks are considered best. Narrow tipped shoes and high heels are to be avoided. The expertise of a Pedorthist [a certified footwear specialist] can play a very important role in preventing diabetic foot complications especially when there is evidence of neuropathy.
- Comprehensive foot care programs can reduce amputation rates by 45% to 85%, according to the National Diabetes Education Program (NDEP). This is a partnership among premium institutes such as National Institute of Health, The Center for Disease Control and Prevention, The American Podiatric Medical Association and over 200 organizations]. Providing accurate and comprehensive health information to the masses along with regular check-ups are the key to reigning in the global pandemic of diabetic foot. After all prevention is better than cure.
- Diabetes And The Foot - (https://www.idf.org/webdata/docs/Diabetes_and_foot.pdf)
- Facts On Diabetes And The Foot - (https://www.podiatrists.org/visitors/foothealth/faqs/diabetes)
- The Diabetic Foot - (http://www.aofas.org/footcaremd/conditions/diabetic-foot/Pages/default.aspx)
- Foot Complications - (http://www.diabetes.org/living-with-diabetes/complications/foot-complications/)
- Diabetes & Foot Problems - (https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems)