Diabetes Mellitus, or rather known simply as diabetes, is a common disease among Malaysians. According to the International Diabetes Federation, in 2015 alone, there were 3.3 million cases in Malaysia. Dr Phang Hoe Fatt is an Orthopaedic Surgeon who shared a topic on The Diabetic Foot: How to Prevent Losing Your Leg.
Diabetes mellitus can cause serious foot problems. These conditions include diabetic neuropathy (loss of normal nerve function) and peripheral vascular disease (loss of normal circulation). These two conditions can lead to:
- Diabetic foot ulcers
- Infections: skin infections (cellulitis), bone infections (osteomyelitis) and abscesses
- Gangrene: dead tissue resulting from complete loss of circulation
- Charcot arthropathy: fractures and dislocations that may result in severe deformities
- Amputation: partial foot or below-knee amputation
Neuropathy is associated with the metabolic abnormalities of diabetes. It presents as the loss of protective sensation. Patients may develop a blister, abrasion or wound but may not feel any pain. The problem affects about 60 to 70 per cent of people with diabetes. Ulcers may be caused by external pressure or rubbing from a poorly fitting shoe, an injury from walking barefoot, or a foreign object in the shoe. Infections usually are caused by the entry of bacteria directly through a break in the skin such as an ulcer, ingrown toenail or areas of skin degeneration between the toes. Infections may start in one location and spread rapidly along tendon sheaths to the ankle. Patients with infection may have fever, chills or shock.
Radiographs may show gas in the soft tissues, soft tissue swelling or defect, or changes consistent with bone infection, fracture or dislocation. Cultures of tissue are required to identify the pathogen. Vascular studies may help determine how well blood is circulating, which is important for wound healing.
There are two methods of treatment; nonsurgical and surgical. Wounds may be cleaned and treated with dressings and immobilization devices such as cast boots or total contact casts. Infections are cleaned and antibiotics are given. If infection is under control, gangrene of the toes may be treated with observation until auto-amputation or a natural separating from the foot occurs.
For surgical, severe infections such as abscesses may be treated with urgent operative removal of decaying tissue or amputation. Surgical treatment for Charcot foot may include operative stabilization (fusion) and correction of deformity. Vascular disease may be treated by vascular surgeons with arterial bypass procedures. Gangrene may be treated with partial foot amputation or below-knee amputation. Non-healing ulcers lead to amputation in 84 per cent of lower extremity amputations in diabetic patients.
To avoid losing your leg, be sure to check on every part of your feet everyday. Look for puncture wounds, bruises, redness, blisters, ulcers, cuts and nail problems. Get someone to help you, or use a mirror. Examine between your toes. Darkening or loss of hair may indicate that the blood or nerve supply has decreased. Testing for any change in sensation is important. By checking your feet daily, you can see any new wounds and monitor healing areas. If you find any injury no matter how slight, don’t try to treat it yourself. Go to a medical doctor right away.
Diabetics should wear more protective shoes, not sandals, to prevent any injuries to the feet and toes. The loss of vibrating and touch sensation is gradual and easy to ignore, but it is the single most important feature to identify with regard to avoiding amputation. Loss of pressure sensation can be established using the 10-g monofilament test and many studies have confirmed this screening test is highly predictive of subsequent ulceration.
The bottom line is take care of your feet, look at them daily and see a medical doctor if anything is suspicious. It is important to be evaluated by a medical doctor with an adequate breadth of training to determine an accurate diagnosis of your problem.
For further enquiries, appointments with Dr Phang Hoe Fatt can be made at 05 240 8777 Ext: 235 or visit KPJ Ipoh Specialist at 26, Jalan Raja Dihilir, 30350 Ipoh, Perak Darul Ridzuan.
