Foot is the index of the heart (Vascular complications in Diabetes)

April 15 08:51 2020 by admin Print This Article

The importance of protecting the body from hyperglycemia cannot be overstated; the direct and indirect effects on the human vascular tree are the major source of morbidity and mortality in both type 1 and type 2 diabetes. Generally, the injurious effects of hyperglycemia are separated into macrovascular complications (coronary artery disease, peripheral arterial disease, and stroke) and microvascular complications (diabetic nephropathy, neuropathy, and retinopathy). 

In this article I will be highlighting the role of diabetes in peripheral arterial disease and its impact. The presence of narrowing or blockages in the blood vessels of the leg strongly correlates with the presence of blockages in the heart which is why we state “Foot is the Index of the Heart”. The ease of identifying vascular disease in the legs helps to prevent major complications associated with heart attack and stroke. The need for highlighting peripheral arterial disease in diabetics is to reduce the poor quality of life associated with diabetic foot ulcers and the mortality associated with major amputations. 

Indian data have shown that 30% of patients with diabetes have asymptomatic or symptomatic peripheral arterial disease (i.e., narrowing or blockages of the blood vessels of legs). There is a prevailing myth that vascular complications in diabetes are confined to the smaller blood vessels (microvascular) in the foot. However, we have enough evidence across the globe to show that macrovascular disease (larger blood vessels in the leg) on its own or in combination with microvascular disease is much more common than isolated microvascular disease. 

In diabetic population , next to neuropathy (involvement of the nerves), vascular disease is an important causative factor for foot ulcers. Any foot ulcer beyond 4 weeks of non-healing needs an urgent vascular assessment. A simple clinical examination of foot pulses is often sufficient in the majority of patients. Patients need further vascular evaluation and imaging in the absence of foot pulses. When macrovascular disease is detected, it can be addressed by either angioplasty (balloon dilatation of the blood vessel) or bypass surgery depending on the patient profile. 

80% of amputations in diabetic start with an ulcer in the foot. It could be prevented by simple measures like 

1. Inspecting your foot every day.
2. Avoiding bare-foot walking.
3. Using appropriate footwear.

One of the main reasons why India is the Diabetic capital of the world is – we have forgotten the importance of physical activity in our day to day life. This has led to an alarming increase in the prevalence of diabetes and non-communicable diseases in the rural population as well. 

To conclude, the key messages for any diabetic are:

1. Strict blood sugar control
2. Good foot care and appropriate footwear
3. Engaging in a physically active lifestyle (WHO recommends 10,000 steps of walking everyday)
4. Annual assessment of the heart, eye, kidney and foot 
5. Prompt evaluation by a specialist when there is a change in the sensation of the foot, infection, appearance of an ulcer/blackish discolouration of the toes.
   Dr. Arunagiri Viruthagiri
   M.S, DNB (General Surgery), M.Ch (Vascular Surgery), IMGSS Fellowship (Birmingham, UK)
   Consultant- Vascular and Endovascular Surgery
   Kauvery Hospital, Trichy

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