Diabetic foot is a complication of diabetes mellitus. It is the commonest cause of non- traumatic amputation of the legs. Chronic leg wounds or abnormal leg feelings should be taken to hospital for doctors to examine.
A middle-aged man was brought from a rural settlement by his nephew to seek medical attention in Lagos for an injury which he sustained in the leg for over a month. According to him, the injury defied treatment and he attributed it to the charm he stepped on when he went to a neighbour’s farm.
He said he had gone to a neighbour’s farm to cut some leaves but sustained an injury when he stepped on a sharp object suspected to be a charm meant for preventing intruders.
The victim, on getting home, felt the charm was in the leg. He had used a razor blade to cut the edge of the wound, thereby enlarging it unknowingly.
He claimed the charm had dissolved in the wound, as nothing was seen. He therefore concluded it was spiritual.
He was later brought to hospital. The nurses usually do a mandatory urinalysis for all patients before they see the doctor.
The nurse had alerted the doctor by using a red ink to circle the result. She later pulled a call through to the doctor:
Nurse: Hello doctor, your patient’s urinalysis is 4+.
Doctor: Kindly do an urgent sugar check.
Nurse: I’ve done that sir.
Doctor: What was the result?
Nurse: The meter read ‘High’.
Doctor: This is a diabetic emergency. Get the patient to the observation room, and get drips, catheters and a bottle for blood samples.
Patient: I feel thirsty and weak, my leg smells.
The doctor explained to the patient that the blood sugar was extremely high and that he would need to be admitted to enable him to control the sugar.
He also explained to the patient that his high blood sugar (diabetes mellitus) was responsible for the leg not healing on time and not a charm as wrongly thought.
After two weeks, the patient was strong and healthy; the leg still smelled and a part of it was already becoming gangrenous (dead tissue).
The patient was taken to the theatre and the smelling part was cut off to save the leg, a procedure called debridement.
Chronically high blood sugar (glucose) levels can be associated with serious complications in people who have diabetes. The feet are especially at risk. Two conditions called diabetic neuropathy and peripheral vascular disease can damage the feet (and other areas of the body) in people who have diabetes.
Chronically high sugar levels associated with uncontrolled diabetes can cause nerve damage that interferes with the ability to sense pain and temperature. This so-called ‘sensory diabetic neuropathy’ increases the risk of injury for a person with diabetes, as he will not notice if he has problems with his/her feet.
Nearly 10 per cent of people with diabetes develop foot ulcers due to peripheral vascular disease and nerve damage. People with diabetes may not notice sores or cuts in the feet, which in turn can lead to an infection.
Nerve damage can also affect the function of foot muscles, leading to numbness, tingling sensation, improper alignment and injury.
Peripheral vascular disease
Diabetes is associated with poor circulation (blood flow). Inadequate blood flow increases the healing time for cuts and sores. Peripheral vascular disease refers to compromised blood flow in the arms and legs.
Poor blood flow increases the risk that infections will not heal. This, in turn, increases the risk of ulcers and gangrene, which is tissue death that occurs when there is inadequate blood supply.
Foot ulcers are dangerous wounds that can affect people with diabetes. When a minor scrape, skin break, or sore in the foot becomes infected, a sore can result. In people who have diabetes, sores heal slowly or fail to heal. Early diagnosis and treatment are necessary to reduce the risk of complications.
Living with diabetes requires people to pay special attention to their health and condition. Follow the doctor’s instructions regarding diet, exercise and medication.
Keeping the blood sugar (glucose) levels within the recommended range is one of the best things that can be done to control the condition and protect the feet.
Diabetic foot presents with nerve damage numbness, tingling sensation, leg pain, improper alignment, injury and poor circulation (blood flow). Inadequate blood flow increases the healing time for cuts and sores. When a minor skin bruise or scrape occurs, it can result in ulcers or sores. Diabetic foot requires a multidisciplinary approach involving family physicians, endocrinologists, orthopaedic surgeons and podiatrist/chiropodist.
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