By Joanna Lee
Foot infections are one of the most common complications of diabetes. According to Chuah Siok Chin, a nurse at the Sau Seng Lam Diabetes and Stroke Rehabilitation Centre, 70% of all amputation cases in Malaysia are due to diabetes.
People with diabetes are at risk of serious foot problems because poorly controlled sugar levels can harden and constrict blood vessels that reduce blood supply reaching the small nerves in your arms and feet. This damages the nerves gradually, leading to a loss of sensation which starts usually from the tip of the toes.
Decreased circulation of blood supply can lead to cold feet, skin discolouration, legs aching when walking, reddish looking feet, a lack of hair growth on the feet and lower legs, and shiny skin on the lower legs.
Symptoms of nerve damage or “peripheral vascular neuropathy” includes a burning sensation on the feet, prickly or stabbing sensations, the feet feeling ‘icy’ and even having sensations like electric shocks. The irony is that because some patients can still feel a little sensation in their feet, they do not realise that these sensations are actually signs of nerve damage.
“One patient was known to walk with a nail embedded at the sole of his feet without noticing it for 3 days. He had to spend about RM10,000 on surgery later to remove the rust from his feet,” Chuah said. Even though nerve damage can occur in the hand as well, the feet in particular, have a higher risk of wounding.
Although everyone is susceptible to foot wounding, the risks are higher in diabetic patients who suffer from nerve damage. The good news is 75 percent of amputations due to diabetes can be prevented with patient education and good foot care.
One effective prevention is foot screening to check for nerve damage at the feet using tuning forks and monofilament pressure tests. Diabetes care clinics such as Sau Seng Lum also offer foot wound care and treatment, wound dressing services and clinical advice at a subsidised rate.
One frequent patient at the SSL Diabetes Care Centre is Sivaganesan, who had two toes amputated in his 20-year battle with diabetes. The first toe was removed after an injury, while the second was due to an infection. His amputations had made him more aware about foot care now.
Patients with from foot deformities such as bunions, callouses and corns, clawed toes, charcot feet (irregular rocker bottom feet), nail deformities, infections and fissures and cracks should practise extra care as they are at higher risk of amputation.
The typical Malaysian “last minute” culture also applies to healthcare, albeit with sad yet avoidable consequences. “They present themselves at the hospital too late, whereby at that stage, some already have septicaemia,” says nurse Chuah.
Another cultural aspect that hinders preventive foot care is the tendency for patients’ preference in listening to friends’ advice, or what nurse Chuah terms as the “direct selling” culture, as well as seeking help from bomohs and sinsehs.
“When a patient is told his toe needs to be amputated, he would say ‘wait, I will think about it first’, and then seek out the bomohs. By the time he comes back, it’s too late and we may have to amputate his entire foot by then due to infection,” she said.
Footwear and exercise are also important, not only for diabetic patients. “The wear and tear (of the feet) will add more to the wounds and we need to relief this irritational pressure so, good insoles are good investments,” says nurse Theresa Kung.
“People with diabetes need to care for their feet daily,” Chuah said. “The main key is awareness because prevention is better than cure.”
Essential Foot Care
- Always examine your feet for injuries or cuts
- Keep feet dry always especially between the toes
- Wear shoes and socks that allow your feet to breathe
- Soak or clean your feet in warm water daily
- Massage your feet with creams to increase blood circulation
- Place feet higher than head level when lying down
- Avoid crossing your legs when seated
- Be careful when cutting toe nails
- Wear closed slippers or sandals for protection against injuries
Source: Health Education Unit, Ministry of Health Malaysia