Diabetes & neuropathy

More and more Indians are being diagnosed with diabetes as a result of unhealthy diets and sedentary lifestyles. According to the International Diabetes Federation, India currently has 50 million diabetics. And due to lack of awareness, almost 50000 diabetics undergo diabetic foot amputation every year. Doctors say that nearly 70% of all diabetics eventually suffer from peripheral neuropathy – nerve damage in the peripheral nervous system, caused by high blood sugar. Longstanding high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of sugar in the bloodstream, and bacterial and fungal infections can break down the skin and complicate ulcers. High blood sugar also interfered with the ability of nerve cells to transmit signals efficiently to the brain. This results in numbness, loss of sensation in the feet, loss of proprioception. Poor blood circulation to the foot can lead to a significant amount of increase in the time taken for a wound to heal. This may also cause a wound to spread. A non-healing wound may require amputation of a toe, foot or even part of the leg.

This makes it extremely important for diabetics to take care of their feet on a daily basis. There should be a two pronged approach here: daily foot care and diabetic orthotic insoles. Diabetic orthotic insoles are insoles that offload high pressure points on the soles of your feet and maintain correct structural alignment in your feet. With reduced foot sensation, a patient cannot feel if they are putting unduly high pressure at particular points on the soles of the feet as they walk. When certain areas of the foot come under excessive pressure for a prolonged period of time, the foot can develop calluses or wounds or ulcers that may take a very long time to heal, or may not heal at all, eventually needing an amputation.

In some cases, diabetes can lead to peripheral artery disease (PAD). PAD causes your blood vessels to narrow and reduces blood flow to your legs and feet. It may also cause nerve damage, known as peripheral neuropathy. This could prevent you from feeling pain. If you can’t feel pain, you may not realize you have a wound or ulcer on your feet. You may continue putting pressure on the affected area, which can cause it to grow and become infected. Reduced blood flow can slow wound healing. It can also make your body less effective at fighting infection. As a result, your wound may not heal. Tissue damage or death (gangrene) may occur, and any existing infection may spread to your bone. If the infection cannot be stopped or the damage is irreparable, amputation may be necessary. The most common amputations in people with diabetes are the toes, feet, and lower legs.

Proper footwear is an important part of an overall treatment program for people with diabetes, even for those in the earliest stages of the disease. If there is any evidence of neuropathy, or lack of sensation, wearing the right footwear is crucial. 

Orthotics can be very useful in avoiding friction and pressure sores. Podiapro designs insoles and sandals for diabetic patients using a specialized dual layered polyurethane that is designed to provide cushioning, absorb shock, stay ultra soft and not get compressed under pressure. The arch support holds up your arch and supports the foot to stay neutral. This redistributes foot pressure reducing high pressure zones.