World Diabetes Day is around the corner, and this year’s theme is “Women and Diabetes – Our right to a healthy future”. Since women are the child bearers, the impact of diabetes in newborns is a legitimate concern. As well, the many roles women perform tend to put them at a greater risk of self neglect, especially when they have to be both nurturers and breadwinners. A few articles would be done regarding diabetes from a podiatric (lower limbs) perspective, to further highlight the disease process.

Key Facts Regarding Women and Diabetes

According to the International Diabetes Federation (IDF), all women with diabetes require affordable and equitable access to care and education to better manage their diabetes and improve their health outcomes. These are the supporting facts:

• There are currently over 199 million women living with diabetes. This total is projected to increase to 313 million by 2040.
• Two out of every five women with diabetes are of reproductive age, accounting for over 60 million women worldwide.
• Diabetes is the ninth leading cause of death in women globally, causing 2.1 million deaths per year.
• Women with type 2 diabetes are almost 10 times more likely to have coronary heart disease than women without the condition.
• Women with type 1 diabetes have an increased risk of early miscarriage or having a baby with malformations.

Overview of Diabetes

Diabetes mellitus represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. It can also decrease the body’s ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop too and can quickly become serious.

 Factors that Increase the Risk of Developing Foot Problems

• Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.
  • If the patient has red spots, sore spots, blisters, corns,  calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
  • If there are common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
• Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.

• • Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
  • A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, and remove it immediately. A person who has diabetes, may not be able to perceive a stone. Its constant rubbing can easily create a sore.
• Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteriesor atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
• Trauma to the foot:Any trauma to the foot can increase the risk for a more serious problem to develop.
• Infections:

• • Athlete’s foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
  • Ingrown toenails should be handled right away by a Podiatrist. Toenail fungus should also be treated.
• Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasised.

Symptoms

• Persistent pain can be a symptom of sprain, strain, bruise, overuse, improperly fitting shoes, or underlying infection.
• Redness can be a sign of infection, especially when surrounding a wound, or from abnormal rubbing of shoes or socks.
• Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation. Other signs of poor circulation include the following:

• • Pain in the legs or buttocks that increases with walking but improves with rest (claudication)
  • Hair no longer growing on the lower legs and feet
  • Hard shiny skin on the legs

• Localised warmth can be a sign of infection or inflammation, perhaps from wounds that won’t heal or that heal slowly.

• Any break in the skin is serious and can result from abnormal wear and tear, injury, or infection. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete’s foot, and ingrown toenails may lead to more serious bacterial infections.
• Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
• A limp or difficulty walking can be a sign of joint problems, serious infection, or improperly fitting shoes.
• Red streaking away from a wound, or redness spreading out from a wound, is a sign of a progressively worsening infection.
• New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a person’s risk for leg and foot problems.

This article would be continued next week. The focus would be on when medical attention is required; which diagnostics may be needed; along with home and medical treatments.

Your feet mirror your general health . . . cherish them!