Diabetic Foot – Your questions answered by Dr Paresh Pai

On September 18, 2021, Seniors Today hosted its weekly Health Live webinar with Senior Vascular and Endovascular specialist Dr Paresh Pai who spoke on Diabetic Foot. Dr Noor Gill captures the takeaways

Dr Paresh Pai is a Senior Consultant Vascular and Endovascular Surgeon at the Breach Candy, PD Hinduja, Lilavati and Raheja Hospitals in Mumbai. With more than two  decades of experience in the management of cerebrovascular disease, distal small vessel reconstruction in atherosclerotic and diabetic limbs, venous thromboembolic disease and endoluminal treatment of aortic aneurysms, Dr Pai is a former  Treasurer and Secretary of the Vascular Society of India. He is a past Consultant Vascular Surgeon at  the Westmead Hospital in Sydney, Australia. 

Dr Paresh emphasises that the readers and viewers who are known diabetics take the information that they receive from this session and use it in their day-to-day life since everything he tells us is extremely practical and not as therapeutically/ theoretically oriented. 

3 facts about diabetes: 

1. This is a disease that not only interferes with the metabolism of sugar but also causes problems and affects the blood vessels, kidneys, nerves, eyes. 
2. According to the International Journal of Diabetes India is the diabetic capital of the world and Indians tend to develop diabetes at a much younger age. Since they also tend to run the risk of being neglected, it can lead to heart disease, limb disease, kidney disorders and thus ends up shortening the life span by about 8-10 years. 
3. 25% of diabetics have arterial involvement and 50% of hospital admissions are for treating infections or wounds in the feet, a condition that we call “diabetic foot”. 

Diabetic foot may result in the risk of loss of limb or sometimes even life if the infection gets really bad. 

Things you should know about diabetic foot: 

• It is called “diabetic” foot because diabetic individuals end up with diabetic neuropathy where the nerves are affected and this can involve either the sensory part or the motor part. 

• When the sensory part is involved you tend to lose your proprioception (sense of pain) therefore you can get injured and not realise that you’ve injured your foot. As a result of the sensory loss, there is also loss of balance, individuals tend to fall and hurt themselves.
• With motor involvement, there is a disproportionate involvement and the shape of the foot can change. 
• Patients with diabetic arterial disease have narrowing of the arteries, reduction in the blood supply and therefore when you end up with a wound, the wounds don’t heal because the blood supply is inadequate. 
• Diabetic retinopathy is the involvement of the small blood vessels in the retina and this results in reduced vision and as a result of that, people can’t see very well and therefore tend to bump into things or injure themselves more often. 

How to identify a diabetic foot: 

• Anybody who has a history of prior diabetic foot in the form of recurrent corns or calluses or if somebody has had active non healing ulcers at the moment or has had them in the past, it has healed but took a long time to do so. 

In some situations there can be blackening of the foot which is called a gangrene. 

• If the individual has a history of amputation of the toe/ toes in the past that also indicates in the direction of a diabetic foot. 
• Individuals with altered sensation/ numbness of the feet/ cotton wool sensation/ tingling sensation or typically with reduced sensation; patients have difficulty holding onto their footwear or are unaware of their footwear slipping off. 
• Altered shape of the foot is usually seen as crowding of the toes. Collapse of the arch of foot is also seen in some cases. 
• Altered sensation. People can complain of cold limbs or pain in the calf muscles due to reduced supply of blood to the calf muscles. In very severe cases, the patient might complain of burning sensation in the feet along with pain that becomes worse with lying down and is relieved when you hang your foot from the edge of the bed. 

Here are a few things that you can do: 

• Control the risk factors- these include weight control, stop tobacco use in any form, take regular exercise, always wear appropriate and good quality footwear, keep your blood pressure, blood sugar and blood cholesterol levels under control. 
• Maintain good pedal hygiene. Clean the feet and toes properly. Clean the area around the nails and pay particularly attention to the web spaces. It is important to dry the feet properly after a wash. If your feet are dry, use a moisturiser but avoid using it in the web spaces. 
• Avoid injury- mechanical, chemical or thermal injury. 
• Regular checkup with a specialist on a regular basis. 

Here are a few things your doctor/physician  can do: 

• Ensure that you come for regular checkups and when you do, check your vitals and weight, check your feet and examine the feet and legs. He must check for pulsation, reduction in sensation and review your blood sugar levels and maintain records. 
• He should refer you to a specialist if the need arises. 

When should you see a specialist: 

• When your sugar levels are poorly controlled and your HbA1c is more than 9%. 
• When there are specific problems that exist, such as heart problems, kidney problems or vascular concerns. 
• If you are an individual who is at a moderate to high risk of developing diabetic complications in the future. 

Treatment options: 

• Offloading, this means that whenever there is a pressure that is seen/ observed on a vessel, the pressure is off loaded from that area. You can do so by using diabetic gel socks or get a special type of in- soles made. 
• You can use medication to improve the sensation of the foot and you can also get medication started which helps the circulation. 
• Supervised exercise protocol: you can also go supervised walk exercise where you walk under supervision at a certain pace, and take adequate rest when a symptom arises and then start again. This is done under supervision. This helps develop collaterals and thus improves circulation. 
• An angioplasty plus/ minus the stenting can be done in case of excessive narrowing and diminishing of circulation 

You can reach out to Dr Paresh Pai at his clinic in Gamdevi where he is available  Monday to Friday between 10 am and 2pm.

The clinic numbers are 23804400 or 23804499 or you can drop a message on WhatsApp at 9869426541