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The prevalence of diabetes in India has increased steadily since 1990, with a particularly significant increase after 2000, while the 2023 ICMR India B study by the Indian Council of Medical Research indicates that approximately 101 million people in India have diabetes. India ranks second globally in diabetes epidemic, with the number of people above 65 years of age estimated to increase to 27.5 million by 2045, as worryingly, about 57% of diabetes cases go undiagnosed. Which is a total of about 43.9 million.
Diabetes-related foot complications pose a significant morbidity risk due to social and economic factors. Additionally, the problem is compounded by delays in accessing health care, with many patients initially consulting informal providers.
Understanding Diabetes-Related Foot Ulcers
In an interview with HT Lifestyle, Dr. Rajeev Premnath, General Laparoscopic Surgeon and Endoscopist, Department of Minimally Invasive Proctology at Ramakrishna Hospital, Bengaluru, shared, “Foot ulcers are chronic open wounds that tend to hinder healing or take a long time. Till they emerge again. These wounds result from breaks in the skin and tissue in the feet and ankles, which often lead to infection. Factors such as high blood sugar, poor circulation, neuropathy and foot abnormalities can lead to foot ulcers.
“The risk increases due to the complications associated with diabetes,” he cautioned. Untreated ulcers can lead to serious complications such as infection, abscesses, and gangrene, often requiring amputation. Conditions such as atherosclerosis and Raynaud’s phenomenon also increase the risk. Rarely, ulcers may warrant evaluation for a skin cancer such as squamous cell carcinoma. Foot and ankle ulcers are classified into three main types: venous ulcers affecting the lower legs, neurotrophic ulcers occurring on diabetic feet, and arterial ulcers caused by impaired circulation.
Effect of circulation and neuropathy on foot-ulcer development.
Dr. Rajiv Premnath said, “Diabetes can cause foot ulcers in various ways. Elevated blood sugar levels can induce nerve damage, reducing sensation in the legs and hindering injury detection. Additionally, diabetes can hinder blood circulation, which can delay wound healing. With weakened immune function, even minor injuries or pressure points from improperly fitting shoes can worsen ulcers.
He added, “Inadequately managed diabetes increases the risk of infection, complicates ulcer treatment and, if neglected, can potentially lead to serious consequences such as gangrene and amputation. Consistent foot care and effective glucose management are important to avoid diabetic foot ulcers. Additional health conditions and factors that increase the risk of foot ulcers include heart and kidney disease, obesity, nerve damage, and alcohol and tobacco use.
They suggested some practical tips to prevent foot ulcers for individuals with diabetes and highlighted that to reduce the risk of foot ulcers, especially in individuals susceptible to conditions such as diabetes, the following guidelines It is necessary to follow –
- Get your feet examined regularly to detect any signs of irritation, cracks or thickened skin. If visual impairment is a concern, use a mirror or seek help from a family member.
- Maintain hygiene by washing feet daily with mild soap and warm water. Dry feet thoroughly, pay close attention to the areas between the toes, and apply moisturizer to prevent dryness.
- Choose well-fitting shoes and soft, moisture-wicking socks. Before wearing, inspect shoes for foreign objects or rough edges. If socks become wet or sweaty, change them immediately.
- Cut the toenails straight using appropriate tools like nail clippers or emery board.
- Consult a health care professional for guidance on managing corns or calluses, as they may require professional intervention.
Podiatrists and Specialists: Essentials for Diabetic Foot Health
Dr. Rajeev Premnath said, “Doctors assess foot ulcers, especially in diabetic patients, by inspecting the foot, checking for infection, sensation (or lack thereof), vascular compromise and blood sugar control and the medications used. By assessing the type of shoes worn. With adequate circulation and medical care, healing can occur in 3 to 6 weeks, while deeper ulcers may take 12 to 20 weeks, sometimes requiring surgical intervention.
He advised, “Adopting lifestyle changes to effectively manage diabetes is important to promote foot health. By integrating a balanced diet, regular physical activity, and vigilant blood glucose monitoring, foot protection for injuries/infections in teething individuals can reduce the risk of complications and enhance overall well-being.
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