Our feet are the area which bears the total weight of the body. The surface area of feet is very small and hence the pressure over feet is tremendous. Over heel area the pressure is as high as 400 kpa ad over toe joint area around 100-130 kpa.The feet are well adapted to withstand such enormous pressure so long as it is healthy.
DIABETES affects feet in many ways if uncontrolled. DIABETES may cause micro vascular disease (i.e. the very small vessels supplying blood are blocked) leading to decreased blood flow to skin, muscles and bones. This leads to weak skin, dryness and loss of skin hair. The muscles become weak and ligaments holding the bones become frail. Hence bones are not supported that well. The nerves supplying feet may develop DIABETIC PERIPHERAL NEUROPATHY and hence sensations of feet may become less. This makes feet more prone to injuries as person does not get pain. The blood flow in small arteries is compromised due to peripheral vascular disease leading to blockages of arteries. This decrease blood supply causes tissue injury.
All the above factors coupled with a high blood sugar may cause a very trivial injury with breach of skin to get infected. And the infection will spread rapidly to surrounding tissues. Within a few hours to few days it can cause gangrene involving the skin, ligaments, muscles and bones(DIABETIC FOOT).since blood flow is poor the antibiotics given may not reach the concerned tissues properly. And hence healing can be very prolonged and delayed. Sometimes if bacteria are too virulent and there is a danger of infection spreading through blood and causing sepsis,or there is lot of tissue, muscles and bone destruction, amputation may be needed.
Having read all this you would realize that FOOT CARE is very important. Following are some suggestions.
- Keep feet skin smooth and soft
- Examine feet daily for dryness, callosities, corns, cracks, in growing toe nails, areas of redness, tender spots .as well as tingling , numbness or loss of sensations, black discoloration , swelling of feet , swelling of joints, shoe bites , skin texture and softness, loss of hair, flat foot .
- Clean feet daily with mild soap and water
- Apply small amounts of Vaseline (petrolatum jelly) at night with gentle massage.
- Trim nails carefully
- Wear comfortable footwear(canvas shoes) or special footwear if needed ( as advised by your doctor)
- Keep blood sugars under good control
- Exercise daily. This improves skin blood flow.
- Take prompt treatment for any feet problem like infection, etc.
- Doing pedicure may help however aggressive skin callosity trimming can leading to pinpoint bleeding and infection.
Dr JACOB THOMAS.