By See Foon Chan-Koppen
We continue our series on orthopedic ailments begun in IE December 16 issue with our second interview with Dr. Suresh Sammanthamurthy Exec. Director (Operations) and Consultant Orthopedic Specialist at Kinta Medical Centre.
IE: Why is foot care important for Diabetics?
Dr. Suresh : Diabetes mellitus (DM) being so rampant in Malaysia, can cause silent damage to many organs and especially foot problems which commonly develop in people with diabetes and can quickly become serious.
With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop.
IE: So can foot sores be life threatening?
Dr. Suresh: Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening.
IE: So what preventative measures can people with diabetes take?
Dr. Suresh: People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention – including good control of blood sugar level – remains the best way to prevent diabetic complications.
IE: Is Home Care sufficient?
Dr. Suresh: People with diabetes should learn how to examine their own feet daily and how to recognize the early signs and symptoms of diabetic foot problems. They should also learn what is reasonable to manage routinely at home, how to recognize when to go to an orthopaedic doctor, and how to recognize when a problem has Diabetic implications. All this information can be obtained from their physician.
IE: Can you elaborate on what risk Factors increase the chances of a person with diabetes in developing foot problems and diabetic infections in legs and feet?
Dr. Suresh: Footwear: Poorly fitting shoes are a common cause of diabetic foot problems. If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitted footwear must be obtained as soon as possible. Orthopaedic foot wear and orthotics: If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy. Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking. A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated
hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor,
healing does not occur properly. Any trauma to the foot can increase the risk for a more serious problem to develop.
Infections: Athlete’s foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
Ingrown toenails: This should be handled right away by a foot specialist. Toenail fungus should also be treated.
Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.
Dr. Suresh: Finally, I cannot emphasise enough how important it is to consult your orthopaedic doctor on any changes you may notice on your legs and feet. Do not wait till a sore develops.
For more information on diabetic foot care, call:
Dr Suresh Sammanthamurthy’s clinic at Kinta Medical Centre: 05-2428315.
Email: firstname.lastname@example.org Website: www.kmc.com.my.