What is meant when you hear the term Diabetic Foot?
A diabetic foot is a condition when the health of the foot is at risk caused by chronic elevated sugar levels in the blood.
Why is Diabetic Foot a concern?
“When I came to work at the St. Maarten Medical Center, my very first patient was a young man in his late 30s who had been admitted in the hospital for two weeks with a severe diabetic foot condition. To put it simply, the bone of his foot was exposed,” Dr. Misset begins. “Since then I have seen more diabetic foot conditions in a month than I have seen in five years in Holland.”
In Holland, Dr. Misset worked on the hospital care team for Diabetic Foot conditions. When he came to the SMMC in 2014 he was taken aback by to the large volume of diabetic foot conditions he would treat on a regular basis. With diabetes as one of the largest health problems globally, and on St. Maarten in particular, this problem need attention by the local community, especially the diabetic.
Is the diabetic foot a symptom of diabetes or a result of diabetes?
In the majority of cases, an individual with a diabetic foot condition has been diagnosed with diabetes. If an individual present with such a condition and is unaware of having diabetes, there may have been other symptoms. Diabetes symptoms include:
- Excess thirst and frequent urination
- Increased hunger
- Fatigue
- Sexual dysfunction
- Tingling hands and feet
- Blurred vision
Are all diabetics at risk of having diabetic foot? Yes!
A diabetic can be at risk to a diabetic foot condition if his or her diabetes is untreated. Too high sugar levels in the blood can cause serious complications and the feet are at risk to diabetic neuropathy and peripheral vascular disease.
What is Diabetic neuropathy?
Chronically high sugar levels damages the nerves and this affects the ability to feel pain and temperatures. As such, someone may not notice a wound or other problem with his or her foot. Nerve damage also affects the muscles in the feet and this can cause changes in the alignment of the foot.
What is peripheral vascular disease?
Diabetes is also associated with insufficient blood flow. Continued elevated sugar levels destroy the blood vessels. This hinders the quick healing of wounds. As a result, foot ulcers can develop and sometimes this gets worse and lead to terrible conditions such as gangrene, a severe infection.
What are some diabetic foot conditions?
The foot conditions that a diabetic may have are conditions that anyone can get. However, in the diabetic, these conditions can lead to serious complications. Some conditions are:
- Calluses-dry, hard skin
- Fungal infections
- Poor circulation and
- Ulcers
What treatment is provided by the general surgeon at the SMMC?
The first step in treating a diabetic foot condition is to treat the diabetes by getting the sugar level under control. The patient should comply with taking medication; this is especially necessary at this stage.
The goal is to help the patient regain the best use of his or her feet. In order to heal, the wound-as this is usually the case, must be cleaned. Daily foot care is necessary; cleaning and dressing.
The patient is taught to do this on his or her own; some patients have support from the White and Yellow Cross and in the SMMC, nurses in the general surgery outpatient clinic provide wound care if the foot needs special attention.
If there is an abscess, the abscess can be drained in the clinic, or in the operating room.
Wound debridement is one of the most common diabetic foot procedures performed in the operating room. With this procedure, the dead tissue is removed to optimize healing.
If the infection is severe and the wound cannot be healed than an aggressive course of action must be taken to prevent infection from spreading throughout the body. This would mean amputation-cutting of a toe, forefoot, below the knee or above the knee.
Statistics from 2015 shows that at the St. Maarten Medical Center there were 2 amputations above the knee, 10 amputations performed below the knee, and 26 amputations of the toe/forefoot. Furthermore every week wound debridement. These are high numbers for our patient population!
Can a diabetic foot recover? How long does this take?
With on-time treatment a severe diabetic foot condition can recover. The process is long and difficult and requires a lot of effort by the patient. My first diabetic foot patient at the SMMC (with the bone exposed) did eventually have full recovery of his foot after almost two years.
The key to managing a diabetic foot condition is regular management and keeping the sugar levels within an acceptable range.
What can someone with diabetes do to prevent a diabetic foot conditions?
- The first step in prevention of any illness is awareness. Persons living with diabetes should be aware of diabetic foot conditions.
- Every day, persons with diabetes should check their feet. This needs to be done every day because a small cut can get bigger very quickly and unknowingly to the individual.
- The feet should be washed daily to prevent dirt from staying between the toes and entering any cuts or scrapes.
- Toenails should be trimmed regularly.
- Wear socks and shoes-special footwear can give better protection.
- Protect your feet from too hot or too cold temperatures.