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Sunday November 10, 2013 MYT 12:00:00 AM
Sunday November 10, 2013 MYT 9:27:23 AM
by tan shiow chin
A model of a foot with two gangrenous toes and a deep ulcer. – ONG SOON HIN/The Star
Here are five tips to help avoid losing your toes or feet to diabetes.
IT starts with a small puncture or wound in the sole of your foot. But you don’t even notice it at first because it doesn’t hurt, thanks to the damage to the nerves of your feet caused by the high sugar levels in your blood (i.e. diabetic neuropathy).
Perhaps you know you’re diabetic, perhaps you don’t.
After all, according to the 2011 National Health and Morbidity Survey (NHMS), 20% of Malaysians are diabetic, and about half of them are undiagnosed.
In addition, wound care specialist Dr Harikrishna KR Nair says that by the time of diagnosis, the majority of Malaysian diabetics would have already had at least five years of uncontrolled sugar levels, with some sort of complication already manifesting.
One of these complications is the diabetic foot.
According to Dr Harikrishna, who is Hospital Kuala Lumpur’s Wound Care Unit head, around one-quarter of diabetics will develop foot-related complications.
Six percent of these will eventually have their foot amputated.
“Diabetics with poorly controlled sugar levels will experience a lot of changes.
“It’s called the three ‘-pathies’: sensory neuropathy, where you become very numb; autonomic neuropathy, where you have decreased moisture and decreased hair; and motor neuropathy, where the muscles of the foot shrink,” he says.
Because of these changes, diabetics are more prone to injuring their feet without being aware of it.
And although the wound or ulcer may look small, the Malaysian Society of Wound Care Professionals president explains that once it gets infected, the infection can easily travel up the tendons and bones of the foot into the leg, potentially resulting in a below-knee amputation!
The tragedy is that about 85% of diabetic foot complications can be prevented, according to Dr Harikrishna.
All diabetics – and even non-diabetics, he adds – have to do are the following:
Control sugar levels
This one is a no-brainer. If your blood glucose levels are controlled, that means there is less chance of excess glucose floating around your bloodstream causing damage to your peripheral nerves.
Healthy nerves will help prevent the development of foot wounds or ulcers, and the infections that can come with them.
Regular foot assessment
Once every day – preferably at the same time, so that it is easier to remember – you need to check your feet for any redness, cuts, cracks, blisters, swelling, sores or other abnormalities.
Remember that you might not be able to feel it, so you need to see it.
If you have trouble looking at the bottom of your feet, use a mirror or ask someone to help check it for you.
Clean and trim
Another compulsory daily activity is to properly wash and dry your feet gently, especially between the toes.
Don’t forget to apply moisturiser on the top and bottom of your feet, but not between the toes, which must be kept dry.
Trim your toenails regularly straight across, and file away any sharp edges,
Wear proper socks
Ensure that your socks can “breathe”, i.e. absorb sweat and keep the moisture out. Cotton socks are usually the best.
Avoid nylon socks and those with tight elastic bands, as these can reduce your circulation.
Choose the right shoes
Buy shoes that are comfortable and provide proper support to the heels, arches and balls of your feet.
High heels and narrow shoes that squeeze your toes together should be avoided.
If your feet are of different sizes, buy the larger size.
Specially-designed orthopaedic shoes are also an option to consider.
It is advisable to avoid going barefooted at all, even around the house, so house slippers or shoes are recommended.
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