Look At Your Feet And Listen To Them

A three day Amrita Endocrinology, Diabetes and Diabetic Foot Conference (AEDFC 2012) was recently held in Kochi at the Amrita Institute of Medical Sciences (AIMS). It brought together clinicians, surgeons and researchers from across the country and the world to re energize the grey cells and deliberate upon various problems related to endocrinology and diabetes, with special emphasis on the management of diabetic foot infections, which could so often be life/limb threatening and yet are largely misunderstood and/or ignored by the public as well as medical fraternity.  

Inaugurating the conference, the Health Minister of Kerala blamed the increasing obesity, consumption of calorie dense food and an unhealthy life style as trigger factors for increasing the incidence of diabetes in India where the number of people living with diabetes is estimated to rise to 101.2 million by 2030. He said that the Kerala government is committed to promote healthy living and physical exercise in schools, and also to have awareness programmes on hazards of diabetes by integrating it with the public health system. Incidentally, incidence of diabetes in Kerala is about 17.5% against the national average of 9%.

In 2011, India had 61.3 million people living with type 2 diabetes, according to the 5th edition of the IDF Diabetes Atlas. This is the second highest in the world after China. The amputation rate for diabetic foot problems in India is about 45%, with around 50,000 amputations occurring per year due to diabetes related foot problems. Diabetes is an immune compromised disease resulting in nerve damage and poor blood supply of the foot, due to which various deformities of the toes and feet occur. It causes areas of raised pressures in the soles of the feet, where ulcers develop. These ulcers act as portals for the entry for bacteria leading to serious infections, which can result in amputations or even death. 

What are the reasons for such high rates of amputation? 
Both, Professor Harish Kumar, Head of the Department of Endocrinology and Podiatric Surgery, AIMS and Dr Ajit Kumar Varma a renowned Podiatric Surgeon at AIMS agree that, “Basically it is due to lack of awareness of the seriousness of diabetic foot problems, both in the public as well as in the doctors. Although there has been some increase in the general level of knowledge about the health hazards of diabetes, it needs to improve more and conferences like this help in circulating that message to the doctors. A large number of patients come to us very late when nothing much can be done, short of an amputation. They do not realize how serious a small lesion can become if left untreated. So they simply neglect it and do not see a doctor early enough. So one of the main messages is that patients should come early to see their doctor before it is too late to take proper action.”

According to Dr Varma, “All persons living with diabetes must have a proper medical checkup of their feet at least once a year, in addition to that of other organs like the eyes, kidneys. Those who are on high risk should take more precautions like wearing proper footwear and having a proper foot check up every 3 to 6 months. The earliest sign a patient should look for in a diabetic foot is redness and/or any pain. They should look with a mirror to check the plantar spaces. It is recommended that the patient examines the feet morning and evening to see the inter-digital areas for any infection; examine the shoes before wearing them, for any tiny stones, which can cause injury. These are small things but can go a long way in preventing amputations. If the diabetes is very well controlled then ulcers and neuropathic problems are not likely to develop. Diabetic neuropathy can also lead to swelling of the feet and if not treated this swelling can cause infection because when the feet are swollen the skin is stretched and a small cut can easily occur because of slight superficial abrasions. This is enough for bacteria to enter the tissues and cause wide spread infections in these immune compromised patients. So if there is edema it is important to keep it in check by compression crepe bandages or compression stockings which should be worn in early morning when there is or minimal edema, and then worn throughout the day, and could be removed at night.”

Dr Varma advices that, “We can bring about simple life style changes like healthy food habits, physical exercise, reducing stress in daily life (through meditation, music, playing a game,) to reduce the incidence of diabetes. Those who are living with the disease should take good care of it by medication and by change of life style. It is very important to understand the seriousness of diabetic foot problems and try to prevent them. Prevention is always better than cure and if one notices even the smallest problem in the feet one must immediately see a qualified medical practitioner who can manage it. Seeking early medical intervention is crucial. One must never try any self foot surgery or self treatment. The medical curriculum should include diabetic foot care as its part.”

The take home messages from the conference were very clear. One of the main aims of the conference was to have a better understanding of the disease in order to be able to deal with it.    

Diabetes is on the rise and unless massive and coordinated prevention programmes for all life style diseases, are undertaken by the government at the national level, the epidemic of diabetes will crush us. Also there has to be more awareness, both amongst physicians as well as the general public, about diabetes in general and the diabetic foot in particular. Patients need to see their doctor early before it is too late to take proper action. If they wait till the infection grows into a big abscess, not only will the expenses mount but treatment outcomes will also not be very good.

The grace of Maa Amritanandmayi, who is affectionately called Amma (mother) and is the inspiration behind AIMS, seemed to flow throughout the conference as her blessings were invoked by everyone. She believes that spirituality and materialism are two sides of the same coin. “When you become a giver you become spiritual and when you take more you become material. Healthcare professionals have the unique opportunity to relieve the pain and pain suffering of people, through both—the treatment itself and through loving and compassionate care.”

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She received her editing training in Singapore, has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org) 

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