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Cardio Diabetes Medicine 2017 481

Wear proper shoes: Wear a comfortable shoe which healed, the foot deformity, calluses and increased
provides proper support for heal, arch and ball por- pressure will still be present. In addition the scar tis-
tion of foot. sue from previously healed ulcer is not a strong tis-
sue and is thus vulnerable to shear forces of walking.
Regular foot checkups: podiatrist can inspect the ear- Special measures are therefore necessary to protect
ly signs of nerve damage, poor circulation or other the vulnerable sites of previous ulceration, such as
foot problems.
education of the patients about walking and change
Keeping good control of diabetes, cholesterol and to therapeutic shoes to prevent recurrence of these
blood pressure will help to control these problems. ulcers. Intensive management and foot care educa-
tion can prevent newer foot problems and surgery in
Smoking affects blood circulation and leads to am-
putation. diabetic foot disease and the patients following strict
control develop lesser complication (9).
Identification of high risk foot: Management of diabetes and its complications in a
Most often, the at-risk foot can be identified by the rural setting poses a formidable challenge. It is also
presence of neuropathy. Sensory loss due to poly- been reported that diabetic patients who wore foot-
neuropathy can be assessed by measuring the pres- wear both inside and outside their homes developed
sure perception, vibration perception and heat and lesser foot problems than those patients who wore
cold sensation. A simple device Tip-therm and grad- footwear only when they went outside their homes
uated tuning fork can be used to detect high risk (10). The reduction of pressure peaks by providing
foot (6, special shoes turns out to be an effective tool for
managing the neuropathic foot. Findings from ran-
7). After identification of the at-risk foot, the patient domized trial showed the usefulness of therapeu-
has to be assigned to a risk category, which could tic footwear in preventing foot ulcers varies, with
guide the subsequent management (8). some studies showing benefits and a few others
not showing any beneficial effects. Several studies
Post treatment and prevention of recurrent of have shown that the regular wearing of therapeutic
diabetic foot ulcer: footwear’s, foot education and diabetic foot care
practices, prevents ulceration reduces re-ulceration
Even though the diabetic foot ulcer is healed, the
foot deformity, calluses and increased pressure are and amputation. The effectiveness of different types
still present. In addition the scar tissue from previ- of footwear insole in the diabetic neuropathy foot
ously healed ulcer is not a strong tissue and is thus showed that the therapeutic footwear is useful to
vulnerable to shear pressure during walking. Hence reduce new ulceration and consequently the am-
customized care of treatment is therefore important putation rate in diabetic population Different kinds
to protect the vulnerable sites of previous ulceration, of insoles such as molded EVA (Ethylene vinyl ace-
such as education of the patients about walking and tate), MCR (Microcellular rubber) or PU (polyurethane)
change to therapeutic shoes play a major role in pre- foam were used to develop therapeutic foot wear for
venting recurrence of these ulcers. the patients with foot ulcer. Thus the importance of
the footwear and its role in reducing ulceration and
Prevention and management: prevention of amputation has to be stressed to the
patients and their family members. Patients must be
Through proper foot care and management of di- made to wear the prescribe footwear at all times so
abetes, the lower limb amputation can be reduced as to maintain compliance in wearing and barefoot
considerably. The suitable strategy to prevent the walking must be strictly avoided.
diabetic foot complications and foot ulcer includes
appropriate diabetes management through moni- Conclusion:
toring of blood sugar, regular exercise and healthy
diet plan along with the regular intake of prescribed Diabetic foot infection and amputation can be pre-
medication. vented by ensuring good glycemic control, proper
foot care along with regular treatment of insignificant
The simple foot care management tips to the pa- foot lesions in people with diabetes. Since the risk
tients, such as how to examine feet daily, pedicure factors for diabetic foot infection is high among the
section, and usage of proper footwear can prevent diabetic patients, primary and secondary prevention
and reduce foot complications, thereby preventing programs are required to reduce the morbidity and
severe morbidity, and health care costs, particular- the cost spend towards diabetic foot complications.
ly in India. Even though the diabetic foot ulcer has

Cardio Diabetes Medicine