Podiatry/ Diabetic Foot Care

What is Diabetes and Foot Care

Podiatry is a specialized field of medicine and surgery that focuses on examining, diagnosing, and treating the conditions that affect the foot, ankle, and lower limb. Medical professionals who treat injuries and disorders within the lower extremities, including the feet and ankles, are known as podiatrists or foot doctors. 

Diabetes and Foot Care

Several health conditions lead to podiatric issues, with diabetes emerging as the foremost concern for foot care. Here are some key points to consider:

• Diabetes Prevalence in India: As per the International Diabetes Federation (IDF), India holds the second-highest global ranking for diabetes prevalence. In 2021 alone, the country recorded approximately 74 million individuals living with diabetes, making it the top country in Southeast Asia for this condition.
• Diabetic Foot Ulcers (DFUs) and Amputation Rates: Within the diabetic population, 25% develop DFUs, a complication that can lead to severe consequences. Shockingly, 50% of these DFUs become infected, often necessitating hospitalization for treatment. Additionally, a troubling 20% of DFU patients ultimately require amputation because of these complications.
• Leg Amputations Due to Diabetes: The gravity of the situation is underscored by the stark reality of 100,000 leg amputations per year attributed to diabetes-related issues in India alone.

Given these concerning statistics and the potential severity of diabetes-related foot complications, regular foot examinations are imperative. These examinations serve as crucial preventative measures, aiding in the early detection of abnormalities and effective management of podiatric conditions. 

Symptoms

Symptoms related to the feet can vary among individuals with diabetes. Some of them include:

• Loss of Feeling: A common symptom is a loss of sensation in the feet, known as neuropathy.
• Numbness or Tingling: Many individuals with diabetes experience tingling or numbness in their feet, often due to nerve damage.
• Painless Wounds or Blisters: Wounds or blisters that appear without pain are concerning, as decreased sensation might prevent the person from feeling these injuries.
• Skin Discoloration and Temperature Changes: Skin color or temperature changes, such as the foot feeling unusually warm or cold, can indicate circulation issues.
• Appearance of Red Streaks: Red streaks on the skin, especially if they are warm to the touch, might signal an infection.
• Wounds With or Without Drainage: Open wounds that do not heal or drain might indicate an infection or poor circulation.
• Painful Tingling Sensations: Some individuals experience painful tingling sensations, particularly at night or when resting.
• Staining on Socks: Blood stains on socks can be an ongoing foot issue.

If an infection occurs, additional symptoms might include:

• Fever and chills
• Feeling sick or lethargic
• Uncontrollable blood sugar
• Shock
• Redness

Individuals with diabetes should seek immediate medical consultation if they observe such symptoms or signs of foot infection to prevent complications.

Diagnosis

After reviewing the medical history of the patient and conducting a foot assessment, a comprehensive diabetic foot examination is performed, which includes the following evaluations:

Neurological Testing

• Monofilament Test: It involves using a soft nylon filament to assess foot sensation. 
• Vibration Testing: A tuning fork or a similar device may be used to test the ability to sense vibration. This helps detect neuropathy, a common diabetic complication affecting nerve function.
• Pinprick Test: Your provider may gently prick the skin with a pin, usually on the big toe, to check for pain sensation. A lack of feeling could indicate nerve damage.
• Reflex Examination: It includes tapping the ankle’s Achilles tendon to observe the reflex response.

Vascular Assessment

• Doppler Ultrasound: This noninvasive test is sometimes used to obtain detailed images of the blood flow, which can detect blockages or narrowing of the arteries.
• Gait and Balance Evaluation: Observing one’s gait and balance provides insight into potential foot problems, revealing abnormalities that might indicate nerve or musculoskeletal issues.
• X-rays or Imaging Studies: These are recommended in cases suspected of bone deformities, fractures, or joint issues.

Depending on the findings, healthcare providers might involve other specialists, such as podiatrists, vascular surgeons, or infectious disease specialists, for further evaluation and treatment.

Treatment

Treating diabetes-related foot pain often involves a podiatrist specializing in foot care. Treatment may vary based on severity. Some of the critical points of treatment include:

• Thoroughly cleansing the wound and draining any fluid or pus from ulcers
• Removing dead or infected tissue
• Applying specialized bandages and ointments for healing and protection
• Offloading with a wheelchair or crutches to reduce foot pressure
• Giving oral or IV antibiotics to manage infection
• Hospitalization for severe infections
• Amputation to prevent the spread of infection

Prevention and Lifestyle Modifications

• Examine your feet for cuts, redness, swelling, sores, blisters, or skin or nail changes.
• Maintain foot hygiene, including washing feet daily in warm water, avoiding soaking, and thoroughly drying them afterward.
• Apply lotion to the tops and bottoms of feet, excluding between toes, to prevent infections.
• Avoid being barefoot, and wear shoes or slippers indoors and outdoors. 
• Trim nails straight across and file sharp edges gently.
• Visit a podiatrist if unable to see or reach feet for trimming.
• Do not remove corn or calluses; seek professional care to prevent skin damage.
• Elevate feet while sitting and wiggle toes regularly throughout the day.
• Engage in foot-friendly exercises such as walking, biking, or swimming.
• For a comprehensive exam, visit a podiatrist annually (more frequently if you have nerve damage).

Managing diabetic foot requires a proactive approach to prevent complications. Regular foot examinations, prompt medical attention for symptoms, and proper treatment are crucial. By understanding the risks, recognizing symptoms early, and following preventive measures, individuals with diabetes can maintain optimal foot health and improve their overall quality of life.