Diabetic foot is a major cause of I’ll health in patients with diabetes. Uncontrolled diabetes and poor diabetes control can lead to serious problems. Most of the organ damage (Eye, kidney, heart) is taken care of by diabetic specialist but often ignored is the musculoskeletal or bones and joints. Diabetic foot is a consequence of poor control and high sugar levels in blood which lead to damage to micro nerves of the muscles and joints.
Nerve damage causes the sensory delay of perception abnormal movements at joints and muscles. This delayed response to abnormal joint position and muscles stretch leads to micro injury to joints specially the foot joints as they are major weight bearing structures. Also the damage to nerves causes’ loss of pain sensation and this leads to lack of knowledge of micro injury to joints and muscles. Thus leading to slow damage of joints and shape of foot.
- High sugar leads to nerve damage
- Nerve damage leads to loss of pain and vibrations
- Loss of pain and vibration sense leads to inability to feel abnormal joints position
- Inability to feel abnormal joint position leads to micro injury
- Repeated micro injury over a period of time causes joint destruction and abnormal shape of foot
We however can prevent or halt this by
- By strict sugar control.
- Take regular follow ups for check up with orthopaedic foot specialist
- Take regular self care of foot
- Use better shoe wear and keep foot clean
- Avoid walking on uneven surfaces
- Taking right medications as prescribed by your doctor
Gradual destruction of joints is not notices immediately by patient and tend to neglect. The shape of the foot is slowly changed leading to ulcers and infection which if not treated at the right time may lead to deep infection/ gangrene and even amputation.
This condition is otherwise called a Charcot joint where putting the leg elevated and not putting any weight on it is the best way to avoid any complications when the foot is red warm and swollen often mimicking an infection or cellulitis.
We wait for the foot to settle down and temperature and swelling to come down and then we can plan a definitive management.
For best management of charcot foot or diabetic neuropathic foot consult and foot ankle orthopedic surgeon.