Diabetes, a prevalent chronic condition affecting millions worldwide, brings with it a host of complications among which diabetic foot infections (DFIs) stand as a significant concern. Every 20 seconds, someone somewhere in the world undergoes a foot amputation.

According to recent studies, individuals with diabetes have a markedly higher risk of developing foot infections compared to the general population. This alarming trend underscores the importance of proactive management and adherence to foot care guidelines.

Prevalence and the Rule of 50

Recent epidemiological data reveals that approximately 15% of diabetic individuals will develop a foot ulcer during their lifetime and the reported prevalence of diabetic peripheral neuropathy ranges from 16% to as high as 66% in various studies. Diabetic neuropathy, where a person loses the ability to feel any sensation in their feet, further increases the chances of injuries and therefore the risk of amputation.

About 80% of diabetic foot ulcers with non-healing wounds are a result of diabetic neuropathy and alarmingly, up to 50% of these ulcers may become infected, leading to severe complications such as gangrene and, in worst cases, lower limb amputation. This stark reality is encapsulated in the "Rule of 50," emphasising the critical need for vigilant foot care among diabetic patients.

Causes and Mortality

In an interview with HT Lifestyle, Dr Rajiv Kovil, head of diabetology at Zandra Healthcare and co-founder of Rang De Neela initiative, shared, “The causes of DFIs are multifactorial, stemming primarily from peripheral neuropathy, poor circulation, and impaired immune response—all common complications of diabetes. These factors contribute to a higher susceptibility to minor injuries that can escalate into severe infections if not promptly treated. Research indicates that the five-year mortality rate following a diabetic foot amputation can reach as high as 50%, underlining the life-threatening nature of these infections.”

Foot Care Guidelines and Early Warning Signs

Dr Rajiv Kovil revealed, “Early warning signs such as swelling of the foot or ankle, very cold feet or legs, colour changes (red, blue or blackish discoloration of feet or toes), pain in the legs at rest or after walking, open sores (no matter how small), non-healing wounds, ingrown toenails, corns and calluses, and lack of hair growth on the foot warrant immediate foot examination and corrective measures.” Here are some essential foot care tips -

1. Wash Your Feet Regularly: Keep your feet clean by washing them every day with warm soapy water.

2. Dry Your Feet Well: It’s extremely important to dry your feet thoroughly, especially between the toes where fungal infections like athlete's foot can develop. If you have constantly wet skin between the toes, applying surgical alcohol with a cotton bud can help dry out the area.

3. Moisturise Regularly: If your skin is dry, apply moisturizing cream all over the foot except between the toes. Steer clear of products with a high mineral oil content as they don’t soak into the skin as well as natural-based emollients.

4. Cut Nails Carefully and Regularly: Trim your nails regularly with a good, clean pair of nail clippers. Avoid picking your nails or cutting down the sides of the nails to prevent painful ingrown toenails, which is especially important for those with diabetes or other chronic diseases.

5. Be Careful with Hard Skin: If you need to remove hard skin on your feet, do so gently with a wet pumice stone. Avoid trying to cut hard skin or corns, as this can lead to painful complications.

6. Clean Socks Every Day: Change into a clean pair of socks every day.

7. Wear Good Shoes: Choose shoes that have the correct length, width, and depth, providing plenty of support. If you need to wear high heels for work, try to wear comfortable shoes to and from work or whenever possible throughout the day.

8. Get Moving: Exercise regularly to maintain and improve circulation in the feet. At least 30 minutes of activity per day is beneficial.

9. Seek Medical Advice: Do not allow foot problems to progress and worsen. If you experience any foot pain or discomfort, consult a podiatrist.

As the prevalence of diabetes continues to rise globally, so too does the incidence of diabetic foot infections. By prioritising preventative measures and prompt treatment, we can mitigate the devastating impact of DFIs on individuals' lives. Proactive foot care remains paramount in preserving mobility and improving the overall quality of life for diabetic patients.

In the battle against diabetic foot infections, awareness, education, and adherence to guidelines are our strongest allies. It is imperative that both healthcare providers and patients remain vigilant in the fight against this pervasive threat.