Diabetic Foot Q&A by Dr Arun Bal
Dr. Arun Bal is one of the most prominent diabetologists in India. He is a diabetic foot surgeon at Raheja Hospital, Mumbai. He is also the President of Diabetic Foot Society of India.
The following Q&A dates back to 2007; however the issues addressed are equally relevant today.
Q I am a 55 year-old man and Type 2 diabetic. Can I get diabetic foot?
A Even when you have managed to keep your blood sugar level in check, diabetes affects the nerves and blood vessels of your body, especially in the lower limbs. Nerve dysfunction starts after about three to five years of the onset of diabetes when sensation in the feet reduces. The patient does not feel injury, pain, heat, cold or any other sensation. As the nerves are not functioning properly, the muscles in the feet swell up. This causes a change in the shape of the feet (deformities) and exposes the feet to injury. Thus, it is very important for a diabetic to take basic care of the feet (see next answer). Damage to the nerves is inevitable so, right now, medical care is the only preventive remedy. Taking good care of your blood sugar reduces the progression of nerve damage significantly.
Q I was diagnosed with diabetes last year at the age of 62. My friends are already advising me on appropriate footwear. Why is it so important to take care of your feet even when you are not suffering from diabetic foot?
A All diabetic patients must undergo annual tests to find out the actual level of nerve and blood vessel function in their feet. These can be done in most diabetes clinics. As nerves weaken over the years, they cannot function properly and this leads to the reduction of sweat and sebum glands in the lower limbs, especially the feet. The skin becomes dry and fissures are formed. Dry skin leads to itching and this causes injury. Therefore, diabetic patients should regularly apply moisturiser or a lanolin-based lotion after cleaning their feet twice a day. Never walk barefoot, always wear socks with footwear even indoors and while sleeping. Fissures on the skin of the sole can be dangerous, leading to infection. The type of footwear and size should be selected after consulting your doctor.
Q My friend’s father recently had to undergo surgery that left part of his foot amputated owing to an infection that had turned gangrenous. He was 69 and diabetic. Is there no alternative to amputation when it comes to diabetic foot injury?
A Once the blood vessels are blocked, infection is difficult to control. Early diagnosis is necessary and quick angiography (a test that uses an injection of a dye to make the arteries easily visible on X-ray) and vein bypass can help save the foot. Diabetics must remember to take care of even the slightest foot injury. They must not bear any weight on the foot till the wound heals. Usually, infection spreads because the patient keeps walking, leading to irreversible damage.
Q I am a 51 year-old woman. I have diabetes but it is under control. Of late, my feet are often swollen and blistered. My nails have turned hard and discoloured though I keep my feet clean and dry. Will regular pedicures help?
A Visit your doctor and check if you are suffering from diabetic foot. The skin becomes delicate owing to nerve damage and loses resistance to trauma. Even walking barefoot indoors can cause blisters and swellings. A pedicure in a beauty parlour is dangerous for diabetic patients as they already suffer from complete or partial loss of sensation. Follow your doctor’s advice for cleaning feet and use thigh-length pressure stockings to prevent swelling.
Q I am a 63 year-old housewife. I bathe with hot water during winter. Although the water feels hot on the rest of my body, my feet don’t feel a thing. Is this a symptom of loss of sensation?
A You have not mentioned whether you are diabetic. For a diabetic, the first sign of nerve dysfunction is loss of sensation. Therefore, a test for nerve damage should be done immediately. Also, rule out diabetes by checking your blood sugar.