विवरण
Diabetic foot refers to a range of foot complications that occur as a result of diabetes, including ulcers, infections, and neuropathy. Prevention is crucial in managing diabetic foot, starting with maintaining good blood sugar control through proper medication, diet, and exercise. Regular foot care is essential, including daily washing, drying, and inspection for any signs of injury, redness, or swelling. Diabetic individuals should wear well-fitting, comfortable shoes and avoid going barefoot to reduce the risk of foot injuries. Checking the feet daily for blisters, sores, or cuts, especially in hard-to-see areas, such as between the toes, is crucial for timely intervention.
Avoiding smoking and managing diabetes-related conditions, such as high blood pressure and high cholesterol, can contribute to overall foot health. Managing weight through a healthy diet and exercise can reduce the risk of foot problems associated with diabetes.
सारांश
- Diabetic foot is a significant problem affecting 15% of diabetic patients, with active ulcer prevalence varying from 1-10%. It leads to frequent hospitalizations, and diabetes is a leading cause of non-traumatic lower limb amputation. A substantial 70% of amputations are due to neuro-ischemic feet with secondary infections, potentially preventable.
- Predisposing factors include large and small vessel disease, chronic neuropathy, uncontrolled diabetes, susceptibility to infection, and autonomic neuropathy causing dryness. Neuropathy leads to lack of protective sensation, motor weakness causing deformities, and reduced sweating leading to dry skin and fissures.
- Diabetic foot is an amalgamation of macrovascular and microvascular complications, an extended form of peripheral arterial disease. Calluses develop on pressure points due to improper footwear, potentially leading to ulceration and tissue necrosis.
- Charcot foot, a progressive degenerative arthropathy, results from neurologic defects caused by diabetes. It presents in acute and chronic stages, with hot, swollen, and deformed feet, often involving bony crepitus and mild pain.
- Peripheral arterial disease, a macrovascular complication, decreases oxygen and nutrient delivery, causing intermittent claudication, atrophy of skin, and ulceration. Ischemic foot can lead to black toe and gangrene, often requiring amputation.
- Neuropathic and ischemic feet have distinct characteristics. Neuropathic feet have ulcers on pressure points, may have good pulses, and require pressure redistribution. Ischemic feet have ulcers on the dorsum or tip, absent pulses, and require revascularization.
- Foot examination involves general appearance, monofilament testing, ankle jerk reflexes, vibration sense, and evaluation of ulcers. Investigations include X-rays, biothesiometry, and vascular studies.
- Diabetic foot classification includes neuropathic and neuro-ischemic categories. Management includes a multidisciplinary approach, prevention of risk factors, glycemic control, and proper foot care practices.
- Foot management involves immobilization, offloading, IV bisphosphonates, special footwear, and addressing recurrent ulceration. Surgical and vascular interventions may be necessary.
- Management of infected foot involves microbiological control based on culture results, using appropriate antibiotics. Necrotic foot management includes surgical options, but larval therapy can also be beneficial in certain cases.
- Therapeutic footwear interventions include offloading pressure with soft, comfortable, padded shoes. Custom-made footwear with pressure distribution measurement can be necessary.
- Ten commandments of footwear and foot care emphasize avoiding barefoot walking, inspecting feet daily, using correct footwear, regular nail trimming, and proper foot hygiene. Early diagnosis, evaluation, and management are crucial for reducing amputations.
नमूना प्रमाण पत्र
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डॉ. अक्षत खांडेकर
Family Medicine & Geriatric,AMAR CLINIC
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