Diabetes is not just a single-effect problem. It can be systemic in its effects. Apart from the kidneys and blood vessels, the disease has a significant bearing on multiple organ systems in the human body, extending from the retina in the eyes to the skin, the kidneys and the foot. Depending on the system that is affected, specialists may be required to intervene and take care of the problems exacerbated by diabetes.

Today, in the 21st century, it can be difficult for physicians and other health professionals to understand why diabetics who suffer wounds on their feet do not turn up early to hospitals when the problems present themselves. One can understand when people from inaccessible areas, low socio-economic status and uneducated groups forgo hospital visits, but the fact that even those from urban areas and belonging to the affluent strata neglect the problem—showing no interest or inclination to visit doctors about the wounds—makes it quite inexplicable. “It was a small innocuous looking wound in the beginning, and I thought it would heal naturally, as there was no pain,” is the usual justification given to us by those diabetics silently suffering such wounds to their feet. Unfortunately, by the time the hospital visit happens, the wound would likely have increased in size because of bacterial contamination. All this means that the foot would then require a surgical toilet, prolonged dressings day by day, amputation (removal) of the toe or the foot, and in some dreadful situations, it may even be life threatening.

The objective of this article is to let readers know that even a trivial trauma can become problematic for diabetics if it is left unattended. The healing is impaired because the infection spreads faster in diabetics due to their impaired host-defence mechanisms.  

The mechanism

In diabetics who suffer wounds on their feet, there is a vicious cycle created by their high glucose-level and the infection. At some point in time, the damage to the blood vessels and the peripheral nerves inhibits the blood supply to the feet: you do not have sensations in the affected area; the area gets numb because the sensations do not register; and you may not even realise that you had an injury. The initial injury can happen during something as routine as a nail paring or can even occur because of the friction created by a shoe; or the injury could start out as a blister on the foot.

The bottomline

We must keep our feet as clean as we do our face.

The advantages of an early hospital visit

It’s cheaper in the long run, and you’ll avoid psychological setbacks.

Do not wait until you have disabling pain; by then it is too late to save the foot or the limb:

you are fifteen times more likely to have the toe or limb amputated if you have diabetes and suffer such infections.

Safety precautions

Blood pressure and serum cholesterol levels need to be checked along with blood- sugar levels.

Give up smoking.

Regularly inspect the toes, the interdigital areas and the soles of your feet.

Seek a consultation if there are ulcers, blisters or even redness.

Use seamless diabetic socks: They reduce constriction and allow free blood-circulation.

It is always a prudent idea to buy shoes in the evening because the feet are slightly swollen then; the shoes should fit properly and there should be ample space inside for the toes to move, which will help prevent skin breakdowns and improve your feet’s mobility.

Adhikary is Professor of Surgery at the BP Koirala Institute of Health Sciences, Dharan