Varanasi: Diabetes being termed as one of the silent killers, if left
uncontrolled for a while, attribute to multi-organ damage. One of the most
common complications associated with people with diabetes is the diabetic foot,
a condition where the minutest wound on the legs would take months to recover
and sometimes results in foot amputation as well.
Despite being preventable and manageable, this
condition over the years has played havoc with its triple attack on the legs of
millions of diabetics. It is estimated that every year over 10% of the diabetic
patients develop ulcers in their feet which may take upto several months to
heal. Losing a toe due to diabetic foot is a first event, which often leads to
surgeries after surgeries landing in removal of complete legs, and sometimes
claims life as well.
“During the initial stages, increased glucose
levels in the blood leads to gradual weakening of the muscles causing changes
in the shape of the feet, resulting in exerting excess pressure while walking.
Various foot movements happen as multiple muscle and tendons move small joints
in proportionate degrees, and with gradual weakening, the foot structure
changes. These changes create various pressure points, where skin and
subcutaneous tissue gets crushed between bony prominence and shoe
surface.” Said Dr Himanshu Verma, Senior Consultant, Vascular and Endo
Vascular Surgery, Fortis Memorial Research Institute, Gurugram
In the next stage the sugar deposition in the
nerves over a period of time results in loss of sensation, and even a small
wound, shoe bite or a faulty nail cut may be missed out due to no-pain
sensation. And even when this stage is left uncontrolled, the blood vessels get
blocked and the poor blood supply doesn’t let the ulcers heal. Further the
uncontrolled diabetes, assist in flourishing the bacteria causing rapid spread
of infections.
Various studies show that 20-30% of patients with
diabetic foot complications might have arterial occlusion and when present,
these blockages compromises blood flow to skin, toes and pressure points in
feet. People usually experience a warning pain, known as claudication, in the
foot/calf/thighs on walking, which gets relieved on taking rest. But the arterial
occlusion precipitates the onset of spontaneous gangrene.
“Diabetic foot is a collective damage to foot due to one or more of the above factors. However, just like silent heart attacks, leg attacks are also often silent in diabetics, and many often do not appreciate this warning pain. Frank gangrene is preceded with few days of severe pain and reddish/ bluish discoloration of toes, which is called pre-gangrene. If identified in this stage, condition could be reversible after correcting blood flow. Often gangrene is noticed when an infected toe is removed without assessment of blood flow. Margins of the amputated toe start becoming black. Adequacy of blood flow assessment is mandatory before jumping off to remove any toe surgically.” He added.
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