World Diabetes Day is celebrated annually on November 14 to raise awareness about diabetes as a critical global public health issue. Diabetic foot ulcers (DFU) are common complications of diabetes.

Also known as Diabetic Foot Disease (DFD) or Diabetic Foot Syndrome (DFS), this condition is usually caused due to neuropathy, as a result of diabetes mellitus. These ulcers are formed as a result of the skin tissue breaking down, to expose the layers underneath.

In an interview with HT Lifestyle, Dr N Kaushik, Diabetic Foot Surgeon - Podiatry Department at Rajiv Gandhi Co-operative Multi Specialty Hospital in Kerala's Palakkad, shared, “Found commonly in places where most pressure is exerted by your body, diabetic foot ulcers are found under your big toe and heel region. Incidentally, ulcers are usually formed in places on your feet that have calluses. That being said, not all people living with diabetes develop foot ulcers or foot diseases. Good foot hygiene and care can go a long way in preventing them. Let’s take a look at everything you need to know about the condition.”

Bringing his expertise to the same, Dr Rajeev Singh, Diabetic Foot Surgeon, Podiatrist and General Surgeon at SL Raheja Fortis Hospital Mumbai's Mahim, cautioned, “Diabetic foot disease is a common yet serious complication of diabetes that can lead to infections, ulcers and even amputations if left untreated. Foot ulceration is a common complication of diabetes that cannot be managed through methods such as diet, exercise, and insulin treatment. This condition affects nearly 15% of diabetic patients during their lifetime, making awareness and early intervention crucial. A proactive approach, coupled with regular check-ups and vigilant foot care, is essential for managing diabetic foot disease effectively. By doing so, individuals with diabetes can significantly reduce the risk of complications and maintain their mobility and quality of life.”

How are they caused and who is at risk?

Dr N Kaushik answered, “Foot ulceration are a common complication of diabetes that cannot be managed through methods such as diet, exercise, and insulin treatment. Foot ulcers, which can have several causes, are a risk for all diabetics. The majority of diabetic foot ulcers occur in older men.” According to him, foot ulcers are more likely as a result of some factors, such as -

• Poorly constructed or ill-fitted footwear, not using footwear
• Bad feet hygiene (not washing regularly or thoroughly or not drying the feet well after washing)
• Improper toenail grooming and low blood supply
• Obesity and smoking (inhibits blood circulation)

Dr N Kaushik added that diabetic foot ulcers are most commonly caused due to -

• Irritated region or wound on the foot due to bony deformity in foot.
• Vascular component that causes poor blood circulation leading to inefficient blood flow to your feet and may lead to a foot ulcer or cause it to heal a lot slower than normal.
• High glucose levels can also slow down the healing process of a foot ulcer, so blood sugar management is critical, especially if the foot ulcer is infected.
• Nerve damage is a long-term effect and can lead to a loss of feeling in your feet. Damaged nerves can feel tingly and painful and reduces sensitivity.

Early signs of diabetic foot disease

Dr Rajeev Singh revealed that recognising the early signs of diabetic foot disease can prevent severe complications. Here are some symptoms to watch for -

• Persistent swelling: Unexplained swelling in the feet or ankles.
• Changes in skin colour: Redness, discoloration, or bluish tints on the feet.
• Wounds that do not heal: Slow-healing sores or cuts that persist for weeks.
• Numbness or tingling: Loss of feeling or tingling sensations in the feet.
• Foul odour: Persistent unpleasant smells from the feet could indicate an infection.

Dr Rajeev Singh asserted, “Prompt detection and treatment of these signs are vital to prevent serious complications. When caught early, foot ulcers are treatable. Visiting your doctor right away if you develop a sore on your foot, can help reduce the likelihood of infection and progression into an infected diabetic foot ulcer.”

How is it diagnosed and treated?

Dr N Kaushik revealed, “Diagnosing and treating foot ulcers largely depends on a physical examination done by your doctor. Your doctor may look for any drainage from the affected area and sometimes a noticeable lump that isn’t always painful, to diagnose a foot ulcer. Further, the doctor will use the Wagner Ulcer Classification System to identify the seriousness of your ulcer on a scale of 0 to 5. It is important to remember that an infection is a serious complication and does require immediate treatment. Your doctor may advice to get X ray foot – to look for bone involvement or infection spread and blood tests to assess the sugar levels or infection counts.”

Dr N Kaushik recommended some ways to treat the ulcer -

• Staying off your feet reduces and prevents pain from ulcers. Known as off-loading, it is helpful for all forms of diabetic foot ulcers. Pressure from walking can make an infection worse and the ulcer to expand.
• You may also be asked to wear a cast, shoes specifically designed for people with diabetic foot ulcers, a foot brace, compression wraps, or shoe inserts to treat and help prevent the formation of calluses or corns.
• Your physician may also choose to remove and clean out the ulcer through debridement (removal of dead skin or foreign objects that may have caused the ulcer).

Talking about ways to manage diabetic foot disease, Dr Rajeev Singh opined that it involves a proactive approach and regular care. Here are some expert-recommended strategies -

• Daily Foot Checks: Examine your feet daily for cuts, blisters, or abnormalities.
• Proper Footwear: Wear well-fitted, comfortable shoes that do not cause friction. Special diabetic shoes can offer additional protection.
• Blood Sugar Control: Maintain blood sugar levels within the recommended range to prevent nerve and vascular damage.
• Regular Exercise: Engage in low-impact activities like walking or swimming to improve circulation.
• Foot Hygiene: Wash feet daily with warm water and apply a suitable moisturizer, avoiding the spaces between the toes to prevent fungal infections.
• Regular Medical Check-Ups: Consult with a podiatrist regularly for professional assessments and advice.
• Smoking Cessation: Quit smoking to enhance circulation and reduce the risk of vascular complications.

How can it be prevented?

Dr N Kaushik highlighted, “The best way to prevent a diabetic foot ulcer from progressing is to visit and consult your doctor at the earliest – especially if you notice any signs of infection, pain or a wound on your foot. Studies indicate that more than half of diabetic foot ulcers become infected. Indicating that preventive care is critical. When caught early, foot ulcers are treatable. Visiting your doctor right away if you develop a sore on your foot, can help reduce the likelihood of infection and progression into an infected diabetic foot ulcer.” He advised -

• Keep an eye on your blood sugar levels because when they are well managed, your risk of complications is greatly reduced.
• Wash and moisturise your feet daily
• Keeping toenails adequately trimmed. You could visit a diabetes care clinic for specialised services to help you keep your toenails in check.
• Always dry your feet thoroughly, especially the areas between your toes and change your socks frequently
• Visit a podiatrist for corn and callus removal
• Wear proper, well-fitting and supportive shoes.

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