“Diabetes taught me discipline.” – Sonia Sotomayor
I’m rotating through general surgery again, and I’m seeing a lot of the same types of patients I saw last year, especially patients coming in with “diabetic feet”.
“Diabetic feet” refers to the characteristic changes seen in the feet of people with diabetes. Diabetes affects the blood vessels and nerves of the feet (and everywhere else in the body) and inhibits your body’s innate capacity to heal; which to a large extent depends on blood being supplied to the wound.
Because of the nerve damage, diabetics don’t really detect pain as readily as non-diabetics. So if, for example, they stepped on something sharp and injured their foot, they mightn’t even notice the injury. And because of the reduced blood flow and the consequent reduced ability to heal, there’s a greater risk of the wound staying open and becoming infected.
Diabetes also affects your ability to fight off infections, so the infection might spread to the entire leg, and to the bone. The infection could also spread to the blood, leading to a life-threatening condition called sepsis. Since diabetes affects the blood vessels of the feet, the blood supply to the feet is compromised. And if the tissues aren’t getting enough blood, they’ll eventually die. Some people end up having to have an amputation of a toe, a foot, or even an entire leg.
People with wounds to “diabetic feet” need specialist care from doctors and nurses who are experienced with this condition. When I was in Guyana, I was happy to learn that there is a specialised unit in Guyana to deal with “diabetic feet”, since there has been an upsurge in diabetes worldwide, which I am sure has increased our already historically high rate.
So if you know that you’re diabetic, you should take care of your feet, to prevent injury and infection. You should inspect your feet daily. Check for cuts, blisters, redness, swelling, or if your nails are getting brittle and thicker. Keep your feet clean. Use a moisturizer to keep dry skin from itching or cracking. Try to avoid walking barefooted, even indoors, to avoid stepping on anything that could cause a cut or a bruise.
And one of the most important things is to keep your diabetes under control.
Prevention is always better than cure, so it’s important to take care of your feet, to prevent injury and infection. And if your foot does get injured, or if you notice an ulcer forming, you should see your doctor.
I’ve seen so many patients who come in so late with the infection spread so far that the only solution was amputation.
