With the increase in India’s population and change in our lifestyle/ eating and exercise habits, the incidence of Diabetes in India has increased steadily. We are today the diabetic capital of the world, and the figures are only rising – from 30 million diabetics today to a projected 60 million in another 10 years. 

The statistics reveal a worrying trend: 12-14 per cent of the urban Indian population suffers from diabetes; around 2-3 per cent of this population develops foot ulcers every year; and 70- 90 per cent of amputations among diabetics start with simple foot ulcers. The reasons for the high incidence of diabetes in India are our genetic predisposition to the disease and lifestyle changes. Though it is a major health concern, it can be effectively managed with timely and regular preventive measures.

Why is diabetic foot care important?

A minor foot wound (from a simple scratch in the foot or a shoe bite) can develop into gangrene, abscess or a festering wound in a diabetic person. If left untreated, it rapidly develops into an infection with a deep and oozing wound. This can become a threat to the patient’s limb or life.

What makes diabetics prone to foot problems?

Diabetics suffer from two major complications, neuropathy and vasculopathy. 

Neuropathy, or lack of sensation in the feet, is a problem frequently associated with diabetes. A person with neuropathy will have reduced sensation in the feet. As a result of this, he will not suffer much pain even when his foot is infected or if he has an injury to his foot. Because of reduced pain sensation, he will not report to the doctor early. By the time he realises that the foot is infected, sometimes too much damage will have occurred to the tissues of the leg. As the nerves get “burnt out”, the person could also suffer from painless deformities of the feet. 

Due to the accumulation of cholesterol in the blood vessels in the body, the blood vessels become narrow. This obstructs regular blood circulation. This narrowing of blood vessels is called vasculopathy or angiopathy. The rate of narrowing of blood vessels due to age is four times faster in a diabetic compared to non- diabetics. As a result, a diabetes patient is at high risk of developing gangrene in the leg, cardiac problems or stroke. Lack of circulation in the legs is a very important cause of gangrene of the feet. Sometimes the progression of gangrene can be stopped and the limb can be saved by a bypass operation in the leg. Yes, bypass operations are done even in the legs, not only in the heart!

Why does a diabetic need specialist care for his foot problems?

Unlike what people generally believe, diabetes treatment is not just about bringing the sugar levels down. Its management requires a multi-disciplinary approach. Diabetes is associated with vascular, eye, foot, kidney and heart complications more frequently than normal people. So, a person with diabetes needs to be regularly checked for cardiac problems, circulation in the leg, neuropathy, kidney disorders and eye-sight defects ( retinopathy). He needs foot care by a podiatrist also. 

To ensure that a diabetic person doesn’t possess or develop any of these related problems, he or she should undergo regular checks. Neglect of regular checkups can result in complications of diabetes.

What measures must a diabetic take to avoid foot problems?

Associated problems of diabetes are highly preventable if timely, proper and regular care is taken. For example, a diabetic should not walk barefoot, should take good care of his or her feet and should use comfortable footwear. There is also special diabetic footwear available these days. With periodic check-ups and regular intake of medicine, one can considerably reduce the risks of developing any of these associated problems. If a wound or infection develops in the foot, it is important to take specialist advice early in order to save the foot. Neglect of foot problems is the most important cause for amputations in diabetics.