Foot Pressure and Sensitivity – A must-read for Diabetics

by admin | April 25, 2021 5:31 am

Patients who suffer from either Type-1 or Type-2 diabetes[1] are vulnerable to a range of foot problems such as corns, calluses, bunions, hammertoes[2], fungal infection of the nails, in-growing toe-nails, dry skin, increased sensitivity in the feet, ulcers, blisters, etc. Complications include gangrene, which can lead to amputation.

But what are the reasons?

Causes

Two conditions are primarily responsible for foot problems in patients with Diabetes.

Peripheral Artery Disease[3] (PAD): Cholesterol deposits in blood vessels can harden over time into plaque and narrow down blood-flow, the condition being called Atherosclerosis. Atherosclerosis in the arteries of the heart can trigger a heart attack eventually. But when the same condition happens in peripheral blood vessels of the hands and legs, it’s called Peripheral Artery/Vascular Disease (PAD/PVD). The condition causes reduced oxygen supply to the lower part of the leg (calves and feet). This can trigger ulcers and tissue-death (gangrene). If not detected or reversed in time, it can lead to amputation of the affected area.

Diabetic Neuropathy (DN): Consistently high blood-sugar levels can damage nerves in different parts of the body. Lifestyle factors such as alcohol consumption and smoking, cardiovascular conditions such as atherosclerosis and mechanical injuries such as carpal tunnel syndrome[4] increase the risk of developing this condition. Diabetic Neuropathy is not a single condition. DN is of four types:

1. Peripheral Neuropathy: This affects nerves in the arms and legs and causes a range of symptoms such as insensitivity to heat and cold, numbness, sharp pain, cramping, tingling or burning sensation in the feet especially at night, muscle weakness, muscle wasting, extreme sensitivity to touch, loss of balance or coordination. Such people may not be able to feel a sore or injury on their feet. For patients, this can be dangerous.
2. Autonomic Neuropathy: Here, the damage to nerves happens in the autonomous nervous system which controls the cardiovascular and digestive systems, sex organs, bladder and sweat glands. This causes nausea, vomiting, diarrhoea, constipation, urinary incontinence[5], vaginal dryness, erectile dysfunction, urinary retention, excessive or inadequate sweating and triggers cardiovascular symptoms similar to that of a heart attack. Inability to sense low blood-sugar can trigger a hypoglycaemic emergency.
3. Proximal Neuropathy: Also called Diabetic Amyoptrophy: Here, the damage to nerves can happen in the hips, buttocks and thighs, causing severe leg pain on one side of the body. The person may find sitting on a chair painful and feel dizziness while standing up.
4. Focal Neuropathy: Here, the damage to nerves is focused in one particular part of the body like a hand, a leg, the torso or the brain. This causes aching behind the eyes, double vision, an inability to focus, pain, numbness and tingling in fingers, facial (Bell’s) palsy and pain in isolated parts of the body.

Warning signs of foot problems in Diabetes

• Loss of sensation to heat, cold, or touch
• Even the bed-sheet feels heavy during sleep, disturbing sleep
• Burning, tingling, or painful feet
• Loss of hair on the lower legs, feet and toes
• Change in colour or shape of either or both feet
• Toe-nails becoming thick or yellow in colour
• In-grown toenails, blisters, red spots, sores, ulcers, infected corns; and you may not feel any of these

Diagnosis and Treatment

A diabetologist[8], a podiatrist or an orthopaedic doctor[9] who specialises in diabetes-induced foot problems will diagnose your condition.

• General assessment: The specialist will review your diabetic history and problems specific to the feet. He/she will also check if your footwear fits properly and looks for signs of cramped feet.
• Dermatological assessment: The doctor will examine the feet for blisters, ulcers, calluses, cracking and dryness. Toe-nails and skin between the toes will be examined for fungal infection.
• Neurological assessments: To assess the extent of nerve damage
  • Monofilament test: a soft, thin nylon fibre is rubbed on your feet and toes and your sensitivity observed
  • Joint and vibration sense test: The doctor will strike a tuning fork and place it on bones of your foot to check vibration sense. Joint and vibration senses are deep sensations
  • Pinprick test: A pin is gently pricked on different parts of the soles of your feet to test for integrity of superficial sensations.
  • Ankle reflexes: The doctor will tap your feet gently with a light hammer to observe your tendon reflexes.
• Skeleto-muscular assessment: The doctor will observe your feet for abnormal shape or structure
• Vascular assessment: A Doppler ultrasound is done to detect the level of blood flow in blood-vessels of the feet.

Treatment options vary and depend on several parameters unique to the patient. The doctor will decide the best course of treatment after conducting the above, and any other tests required.

Preventive Care

Diabetic Neuropathy[10] has no cure, while PAD may or not may not be curable depending on the case. This means, diabetics are always at risk from foot problems and resulting complications such as gangrene and amputation. A little care can delay or prevent the onset of foot problems.

1. Check your feet daily for blisters or sores, and fungal infection on the nails or between toes.
2. Wash your feet everyday with warm water and mild soap. Do not use hot water or strong soaps.
3. The shoes you use must be proper or slightly loose-fitting to prevent any sores from forming
4. Do not walk barefoot, not even at home
5. Quit smoking and cut down alcohol consumption
6. Use moisturizer on dry areas of the feet, except between toes
7. Seek a doctor’s help to heal corns, calluses, blisters and sores and avoid self-medication
8. Trim toe-nails straight across, not at angles, and do not round off the corners
9. Eat a nutritious diet rich in vitamins
10. Get a diabetic foot-examination by a doctor every year
11. Exercise and stay active always to maintain blood circulation to the feet

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

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