During and after monsoons, one needs to be extra careful with their feet, as this is the time with high humidity and is obviously prone to several infections.
India is at the epicentre of a ‘Diabetes Quake’ that has shaken the world. At present we have 67 million confirmed diabetes patients and 35 million pre diabetes patients. Diabetes is a major public health issue. One of the most dreaded complications of diabetes is foot ulcer. 15 per cent of all diabetes patients get foot ulcers. However there is a blessing in disguise. Majority of diabetic foot ulcers in Indian patients are due to effect of high blood sugar on nerves. These are called neuropathy ulcers. These ulcers can be completely prevented with simple daily foot care and using simple footwear.
How diabetes affects the feet?
Uncontrolled blood sugar causes damage to nerve coating thereby affecting nerve function and conduction of nerve impulses. This initially causes some uncomfortable sensations like pins and needles and transient numbness. However, as the duration of diabetes increases and if blood sugar control is not optimal then nerve coating gets permanently damaged. This leads to loss of pain sensation which makes patients more prone to injury.
Human skin has 80 per cent water. Normal skin remains soft and smooth because of glands in the skin structure called sebum glands. These glands secrete oily substances which prevent evaporation of water and keep the tone and texture of the skin normal. However, the function of these glands depends on nerve supply to the skin. When nerves are damaged these glands are destroyed leading to excessive evaporation of water in the skin. This causes dryness, fissures and wounds on legs and feet. It also makes skin less resistant to excessive water absorption, called maceration. Foot skin in diabetes, when nerves are damaged, loses its integrity, flexibility, texture and tone. Simultaneously nerve damage also affects the muscles and bones of the feet leading to weakness in muscles and deformities of various joints of feet. Thus feet become more prone to injuries and infections.
How monsoon affects feet in diabetes patients?
Maintaining skin integrity, texture and tone is vital to prevent injuries and damage to feet in diabetes. Excessive moisture, skin remaining wet for long time due to wet shoes or socks can start the process of maceration in foot/leg skin. Also, as already discussed, the patient loses major sensations like that of pain. This along with stiffness of toe joints makes the feet vulnerable to web space fungal infections. Such infections are the major causes of damage to feet during rainy seasons. Webspace infections can spread through the leg causing necrotising fasciitis which is a very serious problem requiring multiple surgical procedures and hospitalisation. Foot and leg skin remaining wet is a precursor to further damage to the feet.
Care of feet in diabetes after Monsoon
During monsoon feet are exposed to higher humidity and moisture stress. This causes damage to the skin of feet in diabetes especially in patients who have damage to their nerves. After monsoon the skin needs to be looked after properly by reducing the moisture stress. This can be done by keeping the feet dry especially in web spaces. During monsoon many patients use special footwear which has usually hard plastic straps. This can cause friction blisters and calluses. This needs immediate treatment from a recognised center. Similarly nails are also affected by moisture stress and this needs care after monsoon by moisturising the nails regularly. Footwears need to be changed. Monsoon footwear should not be used after the weather changes