Diabetes: Early detection and management of diabetic foot complications

Pain, loss of function, redness, warmth and swelling are the 5 pillars of inflammation, which is the immediate response of body to injury and first step towards healing but long standing diabetic with poor inflammatory response and loss of sensation in both feet, there is no pain and no loss of function.

Hence, a sole injury goes unnoticed and gets complicated quickly because of repeated pressures and contact with dirt and this may lead to loss of limb and even life. In India the estimated diabetic patients are 87 million in the year 2021 and among them, 25% have risk of developing diabetic foot complications and 30% have serious infection which require hospitalization as the primary cause for foot infections is majorly due to diabetic neuropathy and vasculopathy but unfortunately, there is no cure for diabetes and neuropathy where worldwide, every half minute one leg is lost due to diabetes.

In an interview with HT Lifestyle, Dr Praveen Chandra Shetty, Podiatrics Surgeon at KMC Hospital in Mangalore, shared, “Prevention, needs understanding of management of under nourished, painless feet daily. In brief, avoid injury, look for any injury before sleeping and examine the footwear to prevent it being cause of injury. However small the injury is, clean it with antiseptic, cover with clean cloth, don’t bare weight on that part and don’t soil it in bathroom for 5 days. Consult a podiatrist if not improving.”

He recommended to follow these guidelines and save your foot, your life and your family:

• Don’t walk bare foot
• Examine the foot every night, if no injury apply moisturizer
• Examine the footwear every morning, clean it before wearing
• Avoid self-nail cutting, vigorous massage, scrubbing, hot water bath to the feet
• Measure your feet before buying a footwear/shoe, which should be slightly longer and wider than your foot
• Consult podiatrist if you are a diabetic

Dr Sandeep Reddy, Endocrinologist at Kamineni Hospitals in Hyderabad’s LB Nagar, revealed, “Diabetes patients who have diabetic foot experience nerve damage and reduced blood flow to their feet, which can result in infections, ulcers, and even amputations. The significance of early detection and management of diabetic foot complications will be covered in this article.”

He asserted, “Early detection is the first step in managing diabetic foot complications. It should inspect its feet on a regular basis for changes in skin colour or texture, blisters, sores, or cuts. They should also look for numbness or tingling in their feet, which could indicate nerve damage. Any of these signs or symptoms should make you seek emergency medical care. Early detection can aid in the prevention of foot ulcers, which can be difficult to treat and lead to infections and amputations.”

He suggested, “Foot ulcers can be avoided by keeping the feet clean and dry, wearing comfortable shoes, and avoiding wearing tight socks or stockings. Controlling blood sugar levels is also important to avoid nerve damage and reduced blood flow to the feet. Antibiotics for infections, wound care to promote healing, and, in some cases, surgery to remove infected tissue or prevent infection spread are all possible treatments. Complications should be evaluated by a foot specialist, such as a podiatrist, to ensure proper care and avoid future complications.”

He advised, “People with diabetic foot complications should seek medical attention as well as take steps to manage their condition at home. Finally, early detection and management of diabetic foot complications is critical for avoiding serious health issues such as infections and amputations. Diabetes patients should inspect their feet on a regular basis for any changes or symptoms, and seek medical attention immediately if any complications are discovered. People with diabetic foot complications can live healthy and active lives with proper care and management.”

Bringing his expertise to the same, Dr Naveen Kumar HR, HOD and Senior Consultant, Plastic and Reconstructive surgeon at BGS Gleneagles Global Hospital in Bengaluru, highlighted, “The risk of developing diabetic foot infections is common in individuals who has more than 10-year history of diabetes, diabetic nephropathy and retinopathy features. The incidence of diabetic foot infection (DFI) will start as small trivial injury to foot due to loss of sensation over sole and may progress to become chronic ulcers, spread of infection, deformity and ends up in losing toes and limbs. Therefore, in addition to controlling blood sugars, it is also most crucial to identify these high-risk individuals at initial stages and give proper care in order to avoid life and limb threating consequences.”

He pointed out, “With advanced technology, new gadgets and questionnaire program (NEUDIACAN) available it is possible now for health care professionals to identify at risk individuals who could be victim for diabetic foot infections (DFI). The principal cause for DFI is neuropathy which causes permanent damage of peripheral and autonomic nerves of legs and feet. This would result in loss of sensation over the sole which will be the first clue to develop and most often ignored or unnoticed by patients. Identifying these clues early in the disease is possible by using modern gadgets.”

He added, “The first gadget in this category is sensors integrated in footwear designed to assess the foot pressure over the sole while walking. The readings are recorded in computer data acquisition system (DAS) and the points with highest pressure can be identified which would result in ulcer formation if left untreated. The same principal used with other sensors which can pick up changes at sweat glands, vibration receptors and pain receptors level. The subtle changes in values at these receptors level would give clue about possibility of developing breakage in skin leading to ulcer formation. The next tool is NEUDIACAN. This is a DFI questionnaire screening instrument framed after considering many aspects of the disease and helps in detecting high risk individuals. This tool is most useful for patients who can visit hospital setup and analyzed by trained nursing personnel.”

Insisiting that the most advanced gadget in detecting DFI is FLIR camera integrated smartphones, he explained, “The advantage of non-invasive test, user friendly and availability has made these smart phones new tool in detecting early DFI. FLIR are infrared cameras helps in detecting the increase in temperature over the point of sole susceptible for ulcer formation. This would help in taking preventive measures and stop further progression of disease. The new advanced CAT s60 smart phones comes with built in infrared cameras which is patient friendly and will become important tool for diabetic patients who are at risk of developing DFI.”

He elaboarted, “The management of DFI depends on presentation and severity of the disease. The early manifestation like callus, callosity, toe nail infection and minor ulcers can be treated on outpatient basis. However, the severe infections like gangrene of toes, limbs, osteomyelitis and deformity corrections need hospitalization. The preventive measures involve, foot hygiene, toe nail care, offloading of pressure points using total contact cast and customized foot wear. DFI management need multi-disciplinary care. The availability of new gadgets and screening tools helps to detect DFI at early stages and take preventive measures to stop the disease progression.”