Diabetes prevalence in India has increased steadily since 1990, notably surging after 2000 while the 2023 ICMR INDIA B study by the Indian Council of Medical Research indicates that around 101 million people in India have diabetes. India ranks second globally in the diabetes epidemic, projected to rise to 27.5 million among those aged over 65 by 2045 as alarmingly, around 57% of diabetic cases go undiagnosed, totaling approximately 43.9 million.
Diabetes-related foot complications pose a significant morbidity risk due to social and economic factors. Additionally, delays in accessing healthcare exacerbate the issue, with many patients consulting informal providers initially.
Understanding Diabetes-Related Foot Ulcers
In an interview with HT Lifestyle, Dr Rajeev Premnath, General Laparoscopic Surgeon and Endoscopist, Minimally Invasive Proctology Department at Ramakrishna Hospital in Bengaluru, shared, “Foot ulcers are chronic open wounds that persistently resist healing or reappear over an extended period. These wounds arise from the breakdown of skin and tissues in the feet and ankles, often leading to infections. Foot ulcers can result from factors like high blood sugar, poor circulation, neuropathy and foot abnormalities.”
He cautioned, “Diabetes increases risk due to associated complications. Untreated ulcers can lead to severe complications like infections, abscesses and gangrene, often requiring amputation. Conditions like atherosclerosis and Raynaud’s phenomenon also elevate risks. Rarely, ulcers may warrant assessment for skin cancer like squamous cell carcinoma. Foot and ankle ulcers are categorized into three main types: venous ulcers affect lower legs, neurotrophic ulcers occur on diabetic feet, and arterial ulcers due to compromised circulation.”
Effects of Circulation and Neuropathy on Foot-Ulcer Development
Dr Rajeev Premnath explained, “Diabetes can result in foot ulcers through various mechanisms. Elevated blood sugar levels can induce nerve damage, reducing foot sensation and impairing injury detection. Moreover, diabetes can impede blood circulation, delaying wound healing. Coupled with compromised immune function, even minor injuries or pressure points from improperly fitting shoes can worsen the ulcer.”
He added, “Inadequately managed diabetes heightens infection risk, complicating ulcer treatment and potentially leading to severe consequences like gangrene and amputation if neglected. Consistent foot care and effective glucose management are crucial for averting diabetic foot ulcers. Additional health conditions and factors increasing foot ulcer risk include heart and kidney disease, obesity, nerve damage and alcohol and tobacco use.”
He suggested the some practical tips for individuals with diabetes to prevent foot ulcers and highlighted that to mitigate the risk of foot ulcers, particularly among individuals susceptible due to conditions like diabetes, adhering to the following guidelines is essential –
- Conduct regular foot examinations to detect any signs of irritation, fissures, or thickened skin. Utilise a mirror or enlist the help of a family member if visual impairment is a concern.
- Maintain foot hygiene by washing them daily with gentle soap and warm water. Thoroughly dry the feet, paying close attention to the spaces between the toes and apply moisturizer to prevent dryness.
- Choose properly fitting shoes and soft, moisture-absorbing socks. Before wearing, inspect shoes for foreign objects or rough edges. Change socks promptly if they become damp or sweaty.
- Trim toenails straight across using appropriate tools such as a nail clipper or emery board.
- Consult with a healthcare professional for guidance on managing corns or calluses, as they may necessitate professional intervention.
Podiatrists and Specialists: Essential for Diabetic Foot Health
Dr Rajeev Premnath said, “Doctors assess foot ulcers, especially in diabetes patients, by visually inspecting the foot, checking for infection, assessing sensation (or lack of it), vascular compromise and assessing blood sugar control and type of footwear used. With adequate circulation and medical care, healing can occur in 3 to 6 weeks, while deeper ulcers may take 12 to 20 weeks, sometimes requiring surgical intervention.”
He advised, “Adopting lifestyle modifications to effectively manage diabetes is crucial for promoting foot health. By integrating a balanced diet, regular physical activity and vigilant blood sugar monitoring, survelliance of the foot for injuries/infections early individuals can reduce the risk of complications and enhance overall well-being.”