Are You at the Risk of Diabetic Foot?

Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. Due to arterial abnormalities and diabetic neuropathy, as well as a tendency to delayed wound healing, infection or gangrene of the foot is relatively common. Ten to Fifteen per cent of diabetic patients develop foot ulcers at some point in their lives and foot related problems are responsible for up to 50% of diabetes related hospital admissions.

Diabetic foot infection is a disease that is generally associated with damaged nerves and restricted blood supply due to diabetes, thereby causing deep sores and infections in the skin, muscles, or bones of the foot region.

Description
Diabetic patients are more vulnerable to foot infections. As the disease is often associated with low blood circulation and nervous disorders, people with high diabetes are more likely to be infected with foot diseases.

However, there is very little chance for the patient with a foot infection to realize the real importance of the situation; as he hardly gets a chance to feel any pain or discomfort in the region. In most of the cases, the ailment remains undiscovered, until, marked by some kind of weakness or fever occurring at frequent intervals.

Since, the root of the problem is related with the malfunctioning of the nerve cells, there are a number of problems that can arise due to the cause of the disease. Often it is found that the nerve cells controlling the sweating of glands do not work and as a result, the skin becomes dry, giving way to form calluses. These calluses are later on found to be the root of ulcers and other detrimental infections.

Diabetic foot disease is more commonly spread amongst those above 60 years of age. It is also found to be prominent amongst those with kidney or vascular disease, foot infections, excess and uncontrolled diabetes. People who have lost their sense of feeling or sensation or with some nervous disorder are all the more vulnerable to the effect of the disease.

Causes
One of the most predominant things behind the cause and spread of the infection is bacteria. Bacteria enter the skin conveniently through the cracks and fissures that are developed in the dry skin around the heels, corns and other regions of the foot . This in turn causes a slow and steady damage to the skin, tissue and bone in the various parts of the body. The bacterial sites may include, the blisters, corns, calluses on the skin; bunions, hammertoes, in the bones of the foot; any scar tissues from some earlier infection; and even in the ulcer affected regions of the foot.

Prevention
Prevention is by frequent podiatry review, good foot hygiene, diabetic socks and shoes, and avoiding injury.

Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions.

Footwear
All major reviews recommend special footwear for patients with a prior ulcer or with foot deformities. One review added neuropathy as an indication for special footwear. The comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear.

A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes". The date of the literature search for this review is not clear. Clinical Evidence reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customised shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option". National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided.

Treatment
Foot ulcers in diabetes require multidisciplinary assessment, usually by diabetes specialists and surgeons. Treatment consists of appropriate bandages, antibiotics (against staphylococcus, streptococcus and anaerobe strains), debridement and arterial revascularisation.

It is often 500 mg to 1000 mg of flucloxacillin, 1 g of amoxicillin and also metronidazole to tackle the putrid smelling bacteria.

Specialists are investigating the role of nitric oxide in diabetic wound healing. Nitric oxide is a powerful vasodilator, which helps to bring nutrients to the oxygen deficient wound beds. Specialists are using forms of light therapy such as LLLT to treat diabetic ulcers.

In 2004, The Cochrane review panel concluded that for people with diabetic foot ulcers, hyperbaric oxygen therapy reduced the risk of amputation and may improve the healing at 1 year. They also suggest that the availability of hyperbaric facilities and economic evaluations should be interpreted.

The appropriate treatment includes prior culture and proper detection of the infection. Then accordingly, some antibiotics are prescribed or if required, the infected tissue is removed from the site. Sometimes the doctors also make surgeries in the region of the ulcers to ensure an increase blood circulation in the region. In addition, the patients are also advised to keep a good diabetes check on their health.

Acupuncture is also practiced on the respective patient with a foot infection, in accordance with the degree of ailment. To enhance the body's ability to fight infections, doctors often prescribe several vitamin-enriched herbs and vitamin C to the concerned patients.