We are seeing an increased number of lower limb amputations during the lockdown period among people with diabetes. The reasons given by the people who underwent these amputations were that they were not able to get proper wound care and access to their regular doctors who were attending to their ‘diabetic foot’ infection.
In the last one week, we had 5 patients who required a major below or above knee amputation due to diabetic foot infection. Before the lockdown we used to get some 5 patients in 2 months who required a major lower limb amputation.
The warning signs that should alert someone with diabetes to seek immediate help and avoid a major amputation are as follows:
- High fever
- Redness and warmth in one foot compared to the other foot
- A foot ulcer that changes colour and becomes discoloured or appears yellow due to pus formation
- Pain in the foot
- Past history of reduced blood flow in the foot (peripheral arterial disease)
- Swelling in one foot (indicating damage to the joints or bones of the foot)
- Increased white cell count (WBC) in blood tests
- People with a foot ulcer whose blood sugar is not getting under control
What should people do to prevent a major lower limb amputation:
- In people who have loss of sensation in their feet (neuropathy), it is very necessary to take utmost care of their feet
- Daily foot examination is necessary to detect any minor injury which may go unnoticed
- Avoid dry feet by applying a moisturiser cream on the feet but avoid in the space between the toes
- Look for fungal infection in between the toes
- Do not cut nails with scissors and cause injury, but use a nail filer to file the nails
- In case someone gets a small cut or injury on the feet, treat it with an antiseptic and contact a doctor if the warning signs mentioned above are present
- If the warning signs are present, an immediate consultation with the doctor is required
- People who have a foot ulcer must examine and dress the wound regularly with the help of a local nurse
- Use moist wound dressings which are available that will help the patient to avoid daily dressing. It may be possible for a patient with a foot ulcer to do dressing on their own with these modern moist wound dressings which are available
- Avoid putting pressure on the foot ulcer which will create more damage to the ulcer. Proper offloading with a cast may be recommended for some people
- Start antibiotics after consulting the doctor if there are signs of infection because this will help to contain the infection and help to avoid spread of the infection upto the knee level
- Visit the surgeon regularly if there is an active foot infection and take intravenous antibiotics, if necessary
- Control diabetes well with oral medications and use insulin, if necessary, especially if there is evidence of foot infection
- Check the blood sugar both before and after meals on a regular basis and keep the fasting blood sugar between 110 and 120 mg% and the after meal blood sugar between 160 and 180 mg%. This will help to prevent a serious foot infection
Therefore, proper foot care during this period will help to avoid many lower limb amputations.
Dr. Vijay Viswanathan is a Senior Diabetologist
