Once the diagnosis of diabetes is made, we start worrying about the complications i.e. heart, kidney, stroke, blindness and foot amputation.

For many reasons, Foot Infection in legs from Diabetes and Amputation is dreaded by everyone. It is an obvious loss of body parts. It indicates a loss of freedom and autonomy and some people feel that personality and identity have taken a severe toll.

Fortunately, this can be avoided by many simple measures. Before talking about how to avoid foot complications, it is useful to try to understand why they happen in diabetes.

Uncontrolled diabetes with high sugar levels for many years results in the following changes in the body-

1. Loss of sensation and nerve damage, mainly in feet (peripheral neuropathy).

By far this is the commonest reason for getting diabetic foot problems. Loss of sensation (neuropathy) results in many injuries to the foot unknowingly. Also because of loss of sensation, the walking pattern is no more normal (this is because our brain is not getting the regular sensation and feedback from the feet and their position, so it doesn’t know how to keep adjusting feet). Because of this, some areas get unnecessary high pressure. Shoe bites, insect bites, burns, pieces of glass and stone go unnoticed.

Nerve damage also makes changes in the shape of the foot creating pointed areas, which keep on rubbing and skin breaks.

If the injury to the skin is mild but repeated frequently, the skin becomes thick and hard (callosity) in that area. Now the soft tissue of our foot gets trapped between our bones and hardened skin and gets crushed. Here the ulcer starts from inside.

2. Blood flow changes

Diabetes causes narrowing of blood vessels. The furthest part i.e. toes are first affected and this can result in gangrene or infection. Because of reduced blood flow, skin also becomes very delicate and some parts may even die or become gangrenous. Smallest of the injuries that we get regularly, don’t heal. Tobacco products like cigarette, bidi, tobacco in raw form will further narrow the blood vessels and reduce the blood flow.

Strangely in some areas especially skin, the blood supply can increase making the skin dry. This causes crack in the skin and infection enters inside.

3. Immunity and general health

Diabetes results in reduced immunity that is, our fighting power against any infection. In normal circumstances we get mild infections and injuries on foot regularly but we can fight it off with our immunity. But in diabetes not only the injuries happen more often (loss of sensation), but also the wounds don’t heal properly because of poor circulation. On top of that the bugs that enter inside get a free field because of low immunity. Such people catch infections easily, especially in the following situations-

1. Shoe bites, mosquito bites, other insect bites.
2. Infection between the toes especially when they are wet for a long time.
3. Skin getting cut during cutting the nails in the corners.
4. Getting burnt and not noticing it.

4. Poor general health in addition to uncontrolled diabetes

If the person has complications of the heart or kidney, it has effect on the general health and foot infections are easy to catch in general.

Once we have understood these basic reasons why diabetics get wounds and infections more often, it becomes easier to follow certain measures that help in preventing foot problems.

In the next blog   “Diabetes and foot infections and amputations – Part 2 (How to prevent them from happening).” we will discuss simple tips and home measures that we can take to keep our feet protected and safe. This will not only avoid injuries and infections but reduce the risk of amputations significantly. Remember, more than 85% of foot problems and amputations can be prevented by taking these simple measures. These measures are more important for people who have already had some sort of amputations on one foot.

“85% foot amputations in diabetes are preventable”.

To read answers to certain common questions on diabetic foot, please check our FAQ section.

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