Guarding Your Steps: Diabetic Foot Ulcers Need Proactive Management

Diabetes impacts four key organs - the heart, kidneys, eyes, and the foot. While many people may not realise the extent of the impact, Diabetes significantly affects foot health, making it a crucial organ system to prioritise for preventive care and management. Regular assessments are carried out for parameters like blood sugar, eye health, and ECG, the foot is often overlooked.

According to the Indian Council of Medical Research (ICMR), there are 100 million diabetic patients. On average 15 per cent of them will get a foot problem out of that 1 per cent may require amputation. Out of these 100 million patients, more than 50 per cent are in the age group of 30 to 50 years. 'Diabetic Asia' study revealed that in all Asian countries, individuals diagnosed with diabetes have often been living with the condition for approximately seven years by the time it is first detected. 

Government statistics indicate that gradually younger people are becoming diabetic. For anyone who has type 2 Diabetes at a young age, the onset of nerve complications tends to occur within five to seven years. If these complications are not effectively managed, they can lead to foot-related issues. The incidence of Diabetes in rural areas over the last 15 to 20 years has increased from 3 per cent to 11 per cent. Global average statistics over the years consistently reveal that around 15 per cent of diabetic patients encounter foot problems. The prevalence of diabetic foot issues in rural areas is on the rise due to inadequate awareness and limited access to medical facilities. 

The common complications linked to diabetic foot comprise Peripheral Neuropathy, Peripheral Arterial Disease, Foot Ulcers, Charcot Foot, and Gangrene. Some common signs of neuropathy and reduced blood supply include tingling, numbness, sharp pain, muscle weakness, change in skin etc. Individuals diagnosed with diabetes typically manifest symptoms over five to seven years, with many already displaying signs of the condition When blood sugar levels rise, indicated by an HbA1c level exceeding 7, the sugar coats the peripheral and other nerves. This disrupts the usual Myelin shape that covers and safeguards nerve conduction, resulting in pain.

 Some key observations and trends on Diabetic Foot made at SL Raheja Hospital, Mahim:

• 55 per cent of males and 45 per cent of females suffer from Diabetic Foot.

• Almost 60 to 70 per cent of patients come to the hospital at an early stage of a problem, so the amputation rates are very low, therefore foot salvage rates are almost 90 to 92 per cent.

• 7 to 8 per cent of patients have to undergo amputation for a variety of reasons such as infected wounds, cardiac problems, and kidney problems. These patients commonly exhibit high or poorly controlled blood sugar levels, and hypertension; a significant number of them also experience kidney issues. Among this patient group, around 30 to 35 per cent are found to have kidney problems

• Out of all the patients who come for Diabetic Foot treatment, only 10 to 20 per cent of these patients have insurance

• Almost 95 per cent of people have poor or limited knowledge about Diabetic Foot and are unaware of the process to take care of their Feet. When they realise the seriousness of the wounds and the potential risk of losing a toe, they actively care for their feet

Management of Diabetic Foot holds significant importance. It entails careful monitoring, foot hygiene, proper footwear, regular check-ups and prompt referrals to specialised facilities - a practice commonly observed in Western countries. These facilities conduct regular foot examinations for diabetic patients, ensuring at least an annual check and more frequent assessments, if necessary, to address any emerging concerns. 

Regular exercise, maintaining a healthy diet, and managing blood sugar levels are also important components of Diabetes management to reduce the risk of complications like Diabetic Foot.
 

The author is Director-Diabetic Foot Management, SL Raheja Hospital, Mahim -  A Fortis Associate 

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Dr Arun Bal

Guest Author