Thursday, November 24, 2011

Diabetes and Foot Care

The current incidence of diabetes in Malaysian is about 23 percent – 1 in 5 Malaysian is a diabetic – this does not include the numbers undiagnosed.
Diabetes affects multiple organ systems – even the musculoskeletal system is not spared. The feet in particular are at risk increasing the potential for infection, gangrene and limb loss – amputation. Diabetes may cause nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection.
Amputations reduce mobility and increase morbidity and mortality rates. To put it simply, having an amputated limb increase the risk of having other problems due to reduced ambulatory capacity and does reduce lifespan.
As always, prevention is better than cure and there are simple preventive measures to reduce chance of diabetic foot infection.
First – Have good sugar control. This has always been a key requirement and will always be so.
Inspect you feet daily – Easy to do but most don’t. Check for cuts or blisters – this may indicate areas suggesting ill-fitting footwear. Skin redness and swelling are also areas for concern particularly if the area of redness does not blanch with pressure. Always give your nail and the spaces between the toes a good look – these are usually the initial sites of infection. Don’t forget the skin of the sole. Using a hand mirror simplifies looking at the bottom of your feet. Get worried and do see your doctor if things don’t look normal.
Clean and wash feet with lukewarm water – Keep in mind that diabetics have reduced sensation over the feet due to nerve damage. Test water temperature either by dipping the points of your elbow in or ask someone else to do this. Keep your feet clean by washing them daily. Be gentle - wash them using a soft cloth or sponge. Ensure that you dry the feet well after wash.
Moisturize your feet – Use a moisturizer daily to keep dry skin from itching or cracking. But DON’T moisturize between the toes – this could cause a fungal infection.
Nail care – Cut nails straight and not in a curve. Never cut them too short. This can cause in growing nails with possible infection and worse. Cut them straight across and file the edges.
Corns and Calluses – Please don’t self treat these conditions. You are not the doctor – I am - ;)
Wear clean, dry socks – I qualify this with this additional important instruction - change your socks daily. Ideally use cotton socks. Synthetic sock usually are less breathable. Avoid tight bands and thicker kinds of socks, which usually fit poorly. An ill fitting sock will cause shear and make your feet prone to injury
Shake out your shoes before wearing them - Diabetics may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.
Avoid walking barefoot – Try practicing this even at home. Wear a soft shoe or slipper. You will be able to avoid unnecessary injury.
Don’t smoke – Duh…. Smoking restricts blood flow and slows healing
Get periodic foot exams - Get regular input from your friendly Orthopaedic Surgeon on foot care with periodic updates and assessment.