A simple foot problem can result in amputation for diabetic patients. KASMIAH MUSTAPHA finds out how this can be prevented
FOR diabetics, even a simple foot problem can have serious complications. Lack of proper feet management can cause injury and if left untreated, it can lead to amputation of the leg or even worse, death.
Over time, diabetics will suffer nerve damage which causes loss of sensation on their feet. As such they may not feel the pain from a wound, ulcer or calluses on their feet. Eventually, the infection may spread to other parts of their feet. Hospital Kuala Lumpur head of diabetic footcare unit Dr Harikrishna Nair says foot problems in diabetics is common and serious but it can be prevented with proper management such as proper foot care and proper foot wear.
“Our goal has always been to prevent and reduce cases of amputation. However, treatments work only if a patient notices any changes in the feet early by constantly checking them. Any wound or ulcer need to be treated immediately.
“Studies show that 85 per cent of diabetic foot problems are preventable compared to other diabetes-related illnesses.” He said 10 years ago, when diabetic foot problem was a major issue, the target was to reduce the rate of amputation within five years as one foot was being amputated in the world every 30 seconds. It was not until 2005 that new treatments and the prevention of diabetic foot problems began with help from various support system such as cardiovascular surgeons who are able to do bypass and angiograms on the patient to avoid amputation.
Today there are diabetic foot clinics that provide counselling before and after amputation, teaching better management of the illness and feet including having proper foot care and footwear. “In 2002, we adopted these new treatments which have help reduce cases of amputation. Treatments include removing the dead tissues, either surgical or biological. The Institute of Medical Research then used maggots to treat dead tissue in diabetic foot wounds. It has proven to be very effective and now many hospitals are using it.” Treatment also includes managing the infection to ensure bacteria does not return to the wound. The wound must be constantly monitored as the bacteria is able to attack again within 24 hours. “It is also important to look beyond the colour of the wound to see if it has actually spread inside. Sometimes, a small exterior wound may have actually spread to other parts of the foot inside. If we do not feel the wound, we may not notice the changes early. Then the foot has to be amputated.
Another form of treatment is to ensure there is enough moisture in the dressing. Moisture is found to be able to help in the healing. We also need to look at the edges of the wound to see if it is advancing.
Diabetes is a chronic, long term illness that causes diabetic neuropathy or damage to the nerve. Peripheral neuropathy is the most common type of diabetic neuropathy which causes pain or loss of feeling in the toes, feet, legs, hands and arms. “The loss of nerves are not due to a sudden surge of blood sugar level but happens over time. The longer someone has diabetes, the higher the risk of complications faced. If the patient is not careful about diet, the surges of sugar level will create a problem.
“Diabetics can die from foot wounds because when the infection started to spread through the blood system, you get septicemia or blood infection. That is why we have to amputate a limb — to prevent infection and cause the other organs to shut down. When that happens, it can lead to death.” He said there are many risk factors that can also affect wound healing in diabetics including metabolic disorders, respiratory disorders, smoking, dehydration, nutritional state and vitamin deficiency.
A National Health Morbidity Survey in 2006 reported that diabetes in the country was at 14.9 per cent. However, Dr Harikrishna says the figure is higher, at 20 per cent and that one in five Malaysian is diabetic and at least 25 per cent of that number will have foot problems.
Dr Harikrishna is presenting a paper on Management Of Other Risk Factors In Patients With Diabetic Foot Ulcers To Facilitate Healing at the Diabetic Foot Ulcers workshop on Oct 6. The workshop is held in conjunction with the Diabetes Asia 2010 Conference from Oct 6 to 10, organised by National Diabetes Institute (NADI).
FOR diabetics, even a simple foot problem can have serious complications. Lack of proper feet management can cause injury and if left untreated, it can lead to amputation of the leg or even worse, death.
Over time, diabetics will suffer nerve damage which causes loss of sensation on their feet. As such they may not feel the pain from a wound, ulcer or calluses on their feet. Eventually, the infection may spread to other parts of their feet. Hospital Kuala Lumpur head of diabetic footcare unit Dr Harikrishna Nair says foot problems in diabetics is common and serious but it can be prevented with proper management such as proper foot care and proper foot wear.
“Our goal has always been to prevent and reduce cases of amputation. However, treatments work only if a patient notices any changes in the feet early by constantly checking them. Any wound or ulcer need to be treated immediately.
“Studies show that 85 per cent of diabetic foot problems are preventable compared to other diabetes-related illnesses.” He said 10 years ago, when diabetic foot problem was a major issue, the target was to reduce the rate of amputation within five years as one foot was being amputated in the world every 30 seconds. It was not until 2005 that new treatments and the prevention of diabetic foot problems began with help from various support system such as cardiovascular surgeons who are able to do bypass and angiograms on the patient to avoid amputation.
Today there are diabetic foot clinics that provide counselling before and after amputation, teaching better management of the illness and feet including having proper foot care and footwear. “In 2002, we adopted these new treatments which have help reduce cases of amputation. Treatments include removing the dead tissues, either surgical or biological. The Institute of Medical Research then used maggots to treat dead tissue in diabetic foot wounds. It has proven to be very effective and now many hospitals are using it.” Treatment also includes managing the infection to ensure bacteria does not return to the wound. The wound must be constantly monitored as the bacteria is able to attack again within 24 hours. “It is also important to look beyond the colour of the wound to see if it has actually spread inside. Sometimes, a small exterior wound may have actually spread to other parts of the foot inside. If we do not feel the wound, we may not notice the changes early. Then the foot has to be amputated.
Another form of treatment is to ensure there is enough moisture in the dressing. Moisture is found to be able to help in the healing. We also need to look at the edges of the wound to see if it is advancing.
Diabetes is a chronic, long term illness that causes diabetic neuropathy or damage to the nerve. Peripheral neuropathy is the most common type of diabetic neuropathy which causes pain or loss of feeling in the toes, feet, legs, hands and arms. “The loss of nerves are not due to a sudden surge of blood sugar level but happens over time. The longer someone has diabetes, the higher the risk of complications faced. If the patient is not careful about diet, the surges of sugar level will create a problem.
“Diabetics can die from foot wounds because when the infection started to spread through the blood system, you get septicemia or blood infection. That is why we have to amputate a limb — to prevent infection and cause the other organs to shut down. When that happens, it can lead to death.” He said there are many risk factors that can also affect wound healing in diabetics including metabolic disorders, respiratory disorders, smoking, dehydration, nutritional state and vitamin deficiency.
A National Health Morbidity Survey in 2006 reported that diabetes in the country was at 14.9 per cent. However, Dr Harikrishna says the figure is higher, at 20 per cent and that one in five Malaysian is diabetic and at least 25 per cent of that number will have foot problems.
Dr Harikrishna is presenting a paper on Management Of Other Risk Factors In Patients With Diabetic Foot Ulcers To Facilitate Healing at the Diabetic Foot Ulcers workshop on Oct 6. The workshop is held in conjunction with the Diabetes Asia 2010 Conference from Oct 6 to 10, organised by National Diabetes Institute (NADI).
