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Diabetic Foot


Diabetic Foot
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Complications of Diabetes

Written by Dr Rajesh Kesari MD

  
Diabetic Foot is a complex condition of the foot caused due to many simultaneously occuring complications of Diabetes. It finally leads to formation of wounds or ulcers in the affected legs which may not heal quikcly or even require amputation of the affected part. The two important complications are Diabetic Neuropathy and Peripheral Vascular disease. Neuropathy affects the nerves carrying sensation of pain, touch and pressure from he feet to brain as well as supplying the blood vessels , increasing or decreasing blood flow in parts of the legs.Blood vessels may become constricted due to atherosclerosis and calcification leading to decreased blood flow to soles and other part of feet.

Role of microtrauma

Small or even microscopic trauma to the soles or even sometimes severe burns may go unnoticed by the patient whose nerves carrying sensation of pain have been damaged due to diabetes, unknowingly the damage persists and forms into a wound when it becomes visible.Healing of wounds require increased blood supply to the affected area to bring nutrients for repair of the damaged tissue. Clogged blood vessels of the legs are unable to cope up and such wounds do not heal easily, they get infected, if high blood sugar levels persist body is not able to fight off the bacterias and the infection may spread to bones as well, healing of such wounds may take months even in normal persons. Subsequently the tissue which is not getting sufficinet blood supply and has been infected Dies and ghas to be cut off this is called amputation.

Autonomic Neuropathy

In Charcots Foot' the nerves of Autonomic Nervous System are damaged- they unnecessarily increase the blood flow to lges leading to excessive dissolution of calcium from bones of the foot which makes them weak, such bones easily get deformed, fractured and infected, again leading to the same vicious cycle and amputations and deformity of the foot.

Footcare

Proper footcare is very essential for avoiding this devastating complication of Diabetes. Choice of footwear is very important, shoes should be comfortable without any areas of excessive pressure, insoles or custom made shoes should be used if theres any difficulty in finding adequate footwear.Feet should be inspected daily , if there are any cracks, wounds etc. they should be taken care of. A Diabetologist or foot specialist must inspect the feet and conduct testing to ascertain the status of nerves.

Treatment of Diabetic Foot

If foot infections do happen they require good nursing, cleaning and dressing- preferably done in clean settings by a professional, rest and antibiotics are also helpful. Non healing wounds may be helped by Hyperbaric Oxygenation, in which the affected part is kept under pressurised oxygen, this promotes healing. Laser therapy involving exposure of the affected wound to low power laser is also very effective.Blood Sugar should be strictly controlled in any infection.

 

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