Good foot care is crucial for a diabetic because the disease affects the entire body, and this includes nerves and circulation to the feet. Experts warn that poor foot care in diabetics has serious health problems, like loss of foot or leg amputation, reports Sade Oguntola.

Our feet are our foundation, and it is important to take good care of them. But good foot care is even more crucial for a diabetic. Diabetes isn’t just a blood sugar problem; the disease affects the entire body, and this includes nerves and blood circulation to the feet.

The disease can lead to many different types of foot complications, including athlete’s foot (a fungal infection), calluses, bunions and other foot deformities, or ulcers that can range from a surface wound to deep infection. Poor foot care with diabetes has serious health problems, including possibly having to remove the foot or leg amputation.

Dr Jokotade Adeleye, a diabetes expert at the second lecture and symposium of Strategies for Improving Diabetes Care in Nigeria (SIDCAIN), a research group into diabetes education, awareness creation and capacity building, stated that foot care in people with diabetes cannot be over-emphasised or overlooked.

“A common problem in people with diabetes is foot ulcers. Foot ulcers are basically like a wound in a lay man’s term on the surface of the foot,” Dr Adeleye said. “But often times, these wounds can become infected and lead to death of the tissue as well as the death of the patient in some instances.”

Several things can put a patient with diabetes at a greater risk for foot ulcers and loss of the limbs. According to Dr Adeleye, those vulnerable to foot ulcers include “persons with diabetes who have nerve damage, which made them lose feeling in their foot; poor blood supply to the foot; poorly controlled blood sugar; foot deformities; and poor knowledge about diabetes care and foot care.”

However, foot problems should not be overlooked because when such a wound gets infected, the blood supply to the leg is poor or the wound in not properly treated, this could lead to festering of the wound, and subsequently to the death of either the limb or the patient in some instances.

It is estimated that one in five people with diabetes in developed countries who seek hospital care do so for foot problems. Despite dearth of the data on the number of diabetics with foot problem, few studies in Nigeria indicated that prevalence of diabetics with foot problem ranges from 10 per cent to 24 per cent, depending on where the study was done, stated Dr Adeleye.

Dr Adeleye, who stressed the importance of foot care in diabetics, declared that it was possible to reduce possibility of having wounds on the foot through a good foot care programme.

“With good foot care programme, if 100 people are programmed to have an ulcer or wound, at least half would be prevented. Good foot care includes the patient having a look at his feet each day for any swelling, bruises, redness and discharge on the foot.

“Where a patient cannot examine his foot by himself, a member of the family or a caregiver has to do it. It also involves washing the foot each day as well as cleaning in between the toes and having the foot moisturised.

“In addition, it involves taking good care of the nails, cutting with proper clippers or scissors. This would ensure that any uncomfortable feeling and bruises can be promptly reported to a healthcare provider,” Dr Adeleye stressed.

However, the loss of feeling could be in both the foot and the hand as well as give different signs in different diabetics. Dr Sunday Ekanem, a senior registrar at the Department of Medicine, University College Hospital (UCH), Ibadan, Oyo State who spoke on foot ulcers at SIDCAIN symposium, stated that while some people merely develop a tingling sensation or feel as if they are walking on pins and needles, others people feel as if they are walking on cotton wool or experince a numbness in the hand. In addition, others notice that they feel pain merely from a small piece of cloth touching their feet.

What is more, Dr Ekanem explained that where the hand is affected, the loss of feeling starts from the tip of the fingers, all the way to the hand.” In such an individual, he may be unable to feel the heat when he carries a hot pot or kettle. Because of the loss of sensation,in the course of their massaging with hot water, they end up with burns without knowing this.”

However, he pointed out that no less than 71 per cent of diabetes patients attended to at the UCH already had evidence of nerve damage, thus candidates for foot complications.

According to him, studies carried out in the hospital setting and involving diabetics found that the longer the duration of diabetes and the older a person the more likely such was at risk of developing a foot ulcer.

“By the time a diabetic develops an ulcer, it is an indication that the poor blood sugar control must have been on for a while,” Dr Ekanem stated.

In addition, he reasoned that poverty was a factor in developing foot ulcer since poor people were more likely to be unable to buy their diabetes medications and do all the required medical tests, thus leading to poor blood sugar control.

Similarly, Dr Ekanem stated that diabetics with other diseases such as hypertension as well as cholesterol problem stand a higher chance of developing ulcers or wounds on their foot.

Sadly, amputating a limb is the last option that a person with diabetes and the healthcare giver would want to consider. According to Dr Adeleke Ifesanya, a consultant orthopedic surgeon, the option of amputation should not arise if adequate care was taken to prevent foot ulcers becoming gangrenous (death and decay of tissue).

Widespread gangrene may require foot amputation.

In Dr Ifesanya’s opinion, individuals need to know if they are diabetic or not early enough to prevent developing complications of diabetes such as diabetes foot ulcers.

Given the findings of an ongoing study at the UCH which found that over 90 per cent of amputations that were done were in people with diabetes who were non patients, of UCH, he suggested that diabetics enure they seek treatment from specialists in the disease. According to him, with proper and adequate care, a person has the least risk of developing diabetes foot.

Meanwhile, experts have also suggested the following strategies as helpful in reducing the chances of developing foot problems.
•Quit smoking. Smoking can worsen heart and vascular problems and reduce blood circulation to the feet. 
•Avoid activities that can injure the feet, including walking barefoot or hot water bottle on the feet.
•Use care when trimming the nails. Trim the toe nails along the shape of the toe and file the nails to remove any sharp edges. Never cut the cuticles. 
•Wash and check the feet daily using lukewarm water and mild soap. Check the entire surface of both feet, including between and underneath the toes. Use a mirror if it is difficult to see all parts of the feet or ask a family member or caregiver to help.
•Choose socks and shoes carefully. Select cotton socks that fit loosely, and change the socks everyday. Select shoes that are snug but not tight.
•Ask for foot examinations. Screening for foot complications should be a routine part of most medical visits.

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