Diabetes & Endocrinology
Most diabetic amputations begin with a wound the patient never felt. A daily foot inspection is the single most cost-effective preventive habit in diabetes care.
Long-standing high blood sugar damages the small nerves supplying the feet, so pain, heat and pressure are no longer felt normally. A stone in the chappal, a tight shoe, a small cut from a temple visit or an unnoticed burn from a hot floor can therefore cause a wound that goes unnoticed for days.
At the same time, diabetes narrows the arteries supplying the leg, reducing the blood flow that healing requires, and impairs the immune response so infection spreads faster. The combination — no warning, poor healing, rapid infection — is what turns a trivial injury into a limb-threatening one.
Never use a blade, razor or over-the-counter corn cap on a callus or corn. Every year we treat wounds that began exactly this way.
Buy shoes in the evening, when feet are at their largest. There should be a thumb's width beyond the longest toe, a wide toe box, a soft insole and no internal seams that could rub. Break new footwear in gradually — an hour a day for the first week — and check the foot after each wear.
For patients who have already had an ulcer or who have significant deformity, custom offloading footwear made from a foot impression is worth the cost. It redistributes pressure away from the areas that ulcerate.
A painless wound is more dangerous than a painful one, not less. Absence of pain means the protective nerve supply has already been lost.
Care combines wound debridement to remove dead tissue, appropriate antibiotics guided by culture, tight blood sugar control, assessment of the arterial supply, and offloading — keeping weight off the wound so it can heal. Dressings alone rarely succeed if pressure continues on the site.
Most limbs that are lost were lost to delay rather than to diabetes itself. Coming in on day one with a small wound almost always ends differently from coming in on day fifteen with a spreading infection.
This article is general health education written and reviewed by the Department of General Medicine at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
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