subject: Diabetic foot | Diabetic foot,Diabetes Foot Care [print this page] Diabetic foot | Diabetic foot,Diabetes Foot Care
Diabetes mellitus is rather a systemic disease with far reaching adverse effects on most of the systems of body. More often diabetics get foot ulcers, and if neglected, end up in losing the foot. Diabetic foot care is a vast subject for discussion. Here is only the gist. Diabetes, especially if, un-controlled or under controlled, invariably affects the nervous system and vascular system in preference to other systems. When the nerves carrying pain sensation are affected the patient does not get pain from a trivial or un-noticed injury, and the injury or wound remains un-noticed for long. It gets infected and infection spreads. If the vascular system is also affected less or no blood reaches the wound, which affects wound healing adversely. This occurs due to the pathology called macroangiopathy, where the blood vessels are gradually blocked by deposit of bad fats. It may soon grow out of proportion and end up in gangrene of the part.
Lack of insulin in diabetics adversely affects the migration of bactericidal cells, the white blood cells responsible for the defense of body against invading organisms. A relatively anaerobic environment due to poor oxygen delivery to the site due to the blocked blood vessels allows the growth of organisms those grow faster in this situation. Those cause sepsis which spreads undisturbed.
Other important factors those contribute to the foot ulcer are collapse of the arch of foot. Because of the neuropathy the natural arch of foot collapses. If we notice carefully, it will be apparent that the shape of foot is like an arch and is maintained by the collagen string called spring ligament. So, the foot becomes flat and the heads of metatarsal bones of foot come in contact with the ground, and bear the weight of body during walking and standing. There-fore, callosities develop over the heads. Gradually there is infection in the callosities and the lack of blood supply aids in spread of infection leading to gangrene of foot. As antibiotics also do not reach there the infection grows unabated.
So, it is advised to prevent the process:
(1) Adequate control of blood sugar can be achieved by regular self monitoring of blood sugar in home by a good quality glucometer. It should remain within 110 mgs% in an overnight fasting state and within 126 mgs% in a 2 hour post lunch or dinner sample of blood. Any discrepancy should be informed to the treating physician at the earliest and get doubly checked in a hospital setting. A glycosylated hemoglobin level in the blood should ideally remain around 7 which is also a good indicator of blood glucose level in past three months. (2) Use of fitting and soft foot wear even in the residence will go a long way in preventing the foot from getting injury. Hard and ill fitting shoes cause friction and injure foot which may go unnoticed. Never to go outside bare footed. In India, many in rural population and even a section of urban population never afford to purchase foot wear, where a good chunk of daily earning goes in providing food to the family. Foot wear is considered as a luxury here. But, they should be emphasized to go for foot wear which may work, what is said "a stitch in time saves nine".
