By Mrs. Abiodun Osunmuyiwa
Foot problem, finger problems leading to amputation in diabetics are preventable, however most people pay more attention to diabetic foot and ulcer than the ones on the hand which most often is occupational i.e within diabetics involved in cutting business and those using sharp objects which include: diabetic fish sellers, meat sellers, saw millers, carpenters, tailors, mechanics, welders, shoe makers, the list is long including other professionals working with sharp object.
However the most commonly seen is the diabetic foot/leg problems.
Most of the time the ulcers may start as a tiny swelling and pain if care is not taken it will escalate to serious wound which can lead to amputation.
Causes of diabetic foot
- Complications of diabetes
- Peripheral vascular disease
- Immune compromise
COMPLICATIONS OF DIABETECS
One of the complication of diabetes that can increase the risk of foot problems is Neuropathy sensory neuropathy causes loss of pain and pressure sensation. This is a situation patients complain they can’t feel anything in their feet or legs if they are pinched or injured or if there is pressure on them.
- autonomic neuropathy
This causes increased dizziness and fussing of the skin as a result of decreased dryness. Thus the need for increase and adequate intake of water by diabetics.
- Motor neuropathy this is a situation whereby the muscles shrink and this leads to changes in the shape of the foot.
Diabetics must avoid uncleanliness at all cost. The need for physical and environmental hygiene cannot be over emphasized as this help in securing the health of diabetic patients. Avoidance of exposure to infected persons also help to build the immunity of the patient.
- Peripheral vascular disease: when there is poor calculation to the extremes it reduces wound healing and development of dead cells in the wound (gangrene) this is a situation the wound first become green in color then black and stinky. (This is what people in the western part of Nigeria call egbo adaijina) some people can even think this is spiritual instead of going to the hospital to access care they will be running from pillar to post!
Lowered immunity in Diabetics impairs the ability of the white blood cells known as the soldiers and defenders of the body to destroy bacteria. Thus in badly controlled diabetes there is lowered resistance to some infections.
STEPS IN THE DEVELOPMENT OF DIABTETEC FOOT ULCERS
- It begins with a soft foot injury.
- Formation of a tissue between the toes on in an area of dry skin.
- Loss of sensation when injuries are sustained from using healing pads, walking barefoot on hot concrete, testing bath water with foot.
- Injuring skin while cutting nails, walking with an undetected pin or thorn in shoe.
- Wearing ill-fitting shoes and socks.
Now if injury go unnoticed, infection may set in them,
Redness of the leg
Gangrene which may be the first sign of foot problem that the patient notices.
DIABETES WITH RISK OF DEVELOPING DIABETIC FOOT
-Duration of diabetes more than 10years
Age older than 40 years
History of smoking
Decreased peripheral pulses
Hammer toes or deformity of the foot
Patient with previous history of foot ulcers or amputation
Prevention is not only better but cheaper than cure. Like I always tell clients, visit your endocrinologist and Diabetic Nurse Educators who will give you comprehensive care and education you need to prevent complications and live a fulfilled healthy life. Diabetes is a manageable and can be dominated.
Be a member of diabetic club when effective patient education on care from head to toe of diabetic is taught.
FOOT CARE TIPS
- Take care of your diabetes, see your endocrinologist on appointment. Do not miss your hospital appointment so as to keep your blood sugar level within normal range.
- Make sure you have a personal glucometer for checking your blood sugar at home.
- Take meals as prescribed on your Diabetic meal time table to promote your health and strengthen your immunity.
- Inspect your feet daily. Look at your bare feet or ask your spouse or children to help check if you cannot bend properly to view it yourself.
- When bathing give your feet more attention dry in between toes. Do not soak your feet, use elbow to check the temperature of your bathe water.
- Do not apply creams in-between toes.
- Smooth corms gently.
- Tream your nails using nail cutter and not blade. File the edges with nail file.
- Wear shoes and socks at all times.
- Don’t walk barefooted.
- Wear comfortable fitted shoes to protect your feet. Feel inside shoe before wearing to know if there is any sharp object in it.
- Protect your feet from heat or cold.
-Wear shoes on hot pavement
Wear socks at night if your feet get cold.
- Encourage blood flowing to your feet by
-Putting your feet up when sitting, exercising your toes and ankle 2-3 times daily.
-Don’t cross your legs for long period of time.
- Have your diabetic nurse educator check your bare feet and find out if you are likely to have foot problem. Remember, you may not feel the pain of an injury.
-Notify your diabetic nurse educator right away if you have a cut or bruise on your foot that is not showing signs of healing after one day.
Avoid self-medication or self-care as a diabetic once you have a wound, notify your diabetic nurse and endocrinologist.