Ill-fitting shoes common cause of diabetic foot

By Martin Kanyegirire

The prevalence rate of diabetes is increasing in Uganda. One of the factors responsible for this is fast uncontrolled urbanisation and changes in standards of living. 

According to a 2010 report by the World Health Organisation the increase presents a substantial public health and socio-economic burden in the face of scarce resources.

“About 15% of all people living with diabetes develop foot problems related to the disease and if not treated in time, one in six patients with diabetic foot ulcer require amputation.”

Prevalence

Epidemiological studies have indicated that between 40% and 70% of all lower amputations are related to diabetes.

“In Uganda, 10% to 15% of diabetic patients develop foot ulcers. In addition, nearly 50% of all diabetes-related admissions are due to diabetic foot problems,” Ephraim Dafiewhare, a researcher and senior lecturer in the Department of Internal Medicine at Kampala international University, argues.

This means that the prevalence of undiagnosed diabetes mellitus could still be high and individuals, who are unaware they have the disease are at a high risk of chronic complications, the most common being diabetic foot infection, he explains.

What are diabetic foot infections?

According to experts, diabetes mellitus represents several diseases in which high blood glucose levels, over time, can damage the nerves, kidneys, eyes and blood vessels.

“Diabetes can decrease the body’s ability to fight infection. Therefore, if it is not well-controlled, damage to the organs and impairment of the immune system is likely to occur,” Dr. Innocent Mugume explains.

Usually, sweat secretion and oil production, which lubricate the skin of the foot, are impaired in patients with diabetes. These factors, together, can lead to abnormal pressure on the skin, bones and joints of the foot during walking and can lead to breakdown of the skin of the foot. The patient may also develop sores.

“Damage to the blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Consequently, bacterial infection of the skin, connective tissues, muscles and bones may occur.

“Furthermore, these infections can develop into gangrene (localised death of living cells). Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment is amputation of the foot, or leg.

If the infection spreads to the bloodstream, this process can be life-threatening,” Mugume, a clinician at Kabwohe Clinical Research Centre, explains.

Cause and symptoms

Medical practitioners cite ill-fitting shoes as the most common cause of diabetic foot problems. 
“One must replace his shoes if he has red spots, sore spots, blisters, corns, calluses, foot abnormalities such as flat feet, bunions, hammertoes, or consistent pain associated with wearing shoes,” Mugume says.

Poor circulation of blood due to accelerated hardening of the arteries, trauma to the feet, fungal infections on the skin and ingrown toe nails are some of the other factors that can lead to diabetic foot ulcers if not handled early by a medical practitioner.

Smoking should not also be ignored. Dafiewhare emphasises that any form of tobacco causes damage to the small blood vessels in the feet and legs. “This damage can disrupt the healing process and is a major risk factor for infections and amputations.”

Ezera Agwu of the Department of Microbiology at Kampala International University says persistent pain, redness, hard shiny skin and swelling of the feet, or legs are some of the signs of underlying inflammation or infection as well as improperly fitting shoes, or poor blood circulation.

Agwau says other signs of poor circulation include; localised warmth, hair no longer growing on the legs, difficulty in walking, drainage of pus or fever and chills associated with a wound.

He cautions that patients should seek medical care immediately in case of trauma to the feet or legs, no matter how minor.

Also persistent mild-to-moderate pain in the feet or legs, new blisters, wounds, or ulcers and any new areas of warmth, redness, or swelling on the feet or legs are frequently early signs of infection or inflammation that easily result in diabetic foot infections.  “Addressing them early may, therefore, help prevent more serious problems,” Agwau counsels.

Treatment

Medical experts say antibiotics are prescribed to treat infection or potential infection if the diabetes patient has a wound. “It is very important that the patient takes the entire course of antibiotics as prescribed. Generally, the patient should see some improvement in the wound in two to three days,” Mugume advises.

For limb-threatening or life-threatening infections, the patient is admitted to hospital and given intravenous (through the veins) antibiotics as he is being watched, Mugume says.

However, treatment may also include surgical removal of the wound, improvement of circulation through surgery or therapy, special dressings and/or amputation, depending on the severity of the wound.

Prevention

Mugume cites good diabetes control, regular leg and foot self-examinations, knowledge on how to recognise problems, choosing proper footwear and regular exercise.

Others are;  keeping footpaths clear to prevent injury, having a doctor examine a diabetic patient’s feet at least twice or thrice a year and maintaining hygiene.