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Diabetic Foot in Singapore – Wound Care, Insoles & Diabetic Footwear


Diabetes occurrence hit an all-time high in 2016 when health minister Gan Kim Yong launched a ‘War on Diabetes’. Diabetes mellitus is increasing year by year in Singapore; it affects 1 in 10 Singaporeans.  Foot-related complications are a major cause of morbidity and mortality in diabetics. Recent medical research reveals that SE Asians are especially vulnerable to severe diabetic complications due to genetics and rapidly-evolving lifestyle.

 

Diabetes mellitus is the inability for a person to manufacture or use insulin within their body.  This impairs the body from coverting sugars, starches and some other foods into energy.  Blood sugar levels (glucose) then rise, depositing the excess glucose to various areas of the body.

 

Never ignore a foot injury, foot concern or foot pain if you are diabetic.

Why diabetic patients should see a podiatrist?

 

Podiatrists manage diabetic patients’ feet in several ways: prevention, maintenance, and salvage.  Not following up with your podiatrist can result in damage to the feet, pressure ulcers, wound infections, Charcot osteoarthropathy (foot deformation), and foot/ leg amputation.

 

Podiatrists have a long history of holistically managing diabetic foot risk. Not only are we skilled at healing diabetic ulcers, we also pioneered in diabetic limb salvage strategies before “coordinated care” and “multidisciplinary team approach” became buzzwords in healthcare.  Podiatrists perform comprehensive foot examinations for patients that should be undertaken on a yearly or 3-monthly basis depending on the risk status of the feet.

 

High and/or fluctuating levels of blood glucose can damage nerve endings across the body; this leads to sensation loss in the extremities, commonly known as peripheral neuropathy.  Specifically, patients lose the protective sensation that alerts them to pain and injury.

 

Cuts, bruises and wounds can fester into something more dangerous if they go unnoticed

 

Poorly-controlled blood glucose levels lead to neurovascular problems.  Diabetic patients with these conditions are classified as having high diabetic foot risk; they should see Podatrsts regularly for maintenance foot care.

Vascular problems such as atherosclerosis, where arteries in the body narrow and harden, lead to an increased risk of heart attack, stroke or peripheral vascular disease (PVD).  The direct manifestation of PVD is poor circulation to the legs and feet.  A lack of blood flow through the lower limbs results in tissue ischemia and even tissue death (gangrene); this risk is multiplied when there is a wound on the affected limb.  Ulcerations and wounds on ischemic limbs take a long time to heal, as blood flow is what provides nutrients and oxygen for tissue healing.  Wounds which heal slowly and poorly are prone to devastating infection.

 

Peripheral neuropathy or nerve damage is associated with poor microvascular supply; nerves receive less nutrients, causing gradual degeneration and desensitisation.  Patients with nerve damage may feel numbness, tingling or burning sensations, which can be extremely painful and irritating.  Peripheral neuropathy poses an imminent danger to patients, as the loss of protective sensation in the lower extremities results in the development of high pressure areas.  Peripheral neuropathy exposes a diabetic to the high risk of foot ulcers, a major diabetic complication.

Diabetes-associated vascular disease such as atherosclerosis, where arteries in the body narrow and harden, lead to an increased risk of heart attack, stroke or peripheral vascular disease (PVD).  The direct manifestation of PVD is poor circulation to the legs and feet.  A lack of blood flow through the lower limbs results in tissue ischemia and even tissue death (gangrene); this risk is multiplied when there is a wound on the affected limb.  Ulcerations and wounds on ischemic limbs take a long time to heal, as blood flow is what provides nutrients and oxygen for tissue healing.  Wounds which heal slowly and poorly are prone to devastating infection.

 

Peripheral neuropathy or nerve damage is associated with poor microvascular supply; nerves receive less nutrients, causing gradual degeneration and desensitisation.  Patients with nerve damage may feel numbness, tingling or burning sensations, which can be extremely painful and irritating.  Peripheral neuropathy poses an imminent danger to patients, as the loss of protective sensation in the lower extremities results in the development of high pressure areas.  Peripheral neuropathy exposes a diabetic to the high risk of foot ulcers, a major diabetic complication.

 

Diabetes often masks the signs and symptoms of infection as the neurovascular system is compromised; normal signs of soft tissue infection such as pain and inflammation may become delayed or muted in a diabetic individual.  Podiatrists are experienced in treating patients with neuropathy, vascular disease, and altered walking patterns; we are well-trained in the diagnosis of infection and other changes in the lower limbs which are potentially life-threatening.  Due to all the increased risks faced by a diabetic, the changes which should be addressed promptly are:

 

  • skin colour changes such as redness or streaks
  • swelling of foot / leg
  • increased skin temperature
  • pain
  • new wounds or deterioration in existing wounds
  • ingrown toenail
  • bacterial or fungal skin or nail infections
  • corns and callus
  • trauma, bruising, blistering
  • burns from heat, scalding, or caustic chemical

All diabetics should use properly made custom foot orthotics in their shoes, for the purposes of offloading and accommodation.  These in-shoe devices can help to prevent diabetic foot problems which occur in a setting of neurovascular deficiency, i.e. calluses, ulcers, joint degeneration, and stress fractures.  The best course of action would be to wear the custom-designed orthotics before the foot deformities and structural damage start to set in.  Wearing generic off-the-shelf insoles is not advised for diabetics; generic designs will not fit accurately, and can worsen the situation for patients with already compromised feet.

In Singapore, one of the most overlooked aspects of diabetes is foot complications.

 

Medical research from Western countries have shown that Podiatrists can reduce amputation rates by up to 85%, lower hospital admissions for foot-related complications by 24%, and lower medical expenses for patients with diabetes.

 

Amputation of 1 leg causes a diabetic to have a 50% chance of amputation of the other leg within 5 years.  Prevention is an integral part of diabetes care.

 

 

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