Care for the feet

Diabetes miletus, commonly known as diabetes, is a metabolic disease that is caused due to rise in the blood sugar levels. It is fast gaining the status of a potential epidemic in India, with more than 62 million individuals currently diagnosed with the disease.

The prominent symptoms of hyperglycemia (an excess of glucose in the bloodstream) are frequent urination, thirst and increased appetite. If uncared for, chronic hyperglycemia can lead to long-term damage like dysfunction and failure of different organs, especially the eyes, kidneys, nerves, heart, blood vessels, and also foot problems. Diabetic patients are predisposed to foot infections.

Understanding the problem

Diabetes causes two major problems which affect the feet — diabetic neuropathy and peripheral artery disease. Foot-related problems are common among diabetics; even the simplest of problems can worsen and lead to serious complications. Common problems faced by diabetics include foot ulcers, calluses and skin changes.

Peripheral artery disease is similar to coronary artery disease and carotid artery disease.  However, what differentiates the former from the latter is that these arteries are located in the lower part of the limbs. The fat gets clogged in the inner lines of arterial walls of the legs which hinders blood flow. Both big and small blood vessels can be affected by
diabetes in the case of diabetic peripheral artery disease. If it is mild, the disease may not exhibit any symptoms.

However, as blood supply becomes progressively inadequate, it can cause artery ulceration. Early recognition and management of independent risk factors for ulcers can prevent or delay the onset of adverse outcomes. Risk identification is fundamental for effective preventive management of the foot in people with diabetes.

All individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions. Negligence to treatment can complicate the issues like gangrene and claudications, which might lead to amputation.

Other viable options for the treatment of peripheral arterial disease are angioplasty and arterial bypass graft. In angioplasty, a small tube with a balloon attached is inserted and threaded into an artery; then the balloon is inflated, opening the narrowed artery. A wire tube known as a stent may be left in place to help keep the artery open. In arterial bypass graft, a blood vessel is taken from another part of the body and is attached to bypass a blocked artery.

(The author is consultant vascular &
endovascular surgeon, Fortis Hospital,

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