15/11/2021
DIABETIC FOOT ULCER AND AMPUTATION
The right leg of Iya Rashidah was amputated last week. It was a devastating experience. Two months earlier, Iya Rashidah was making amala, turning it inside a pot while using her feet against two napkins to hold the pot steady on the floor. The usual way.
Unknown to her, a right toe was touching the pot directly & got heated up. That's where the problem started. The wound did not heal, the toe became black & dead, & the death spread gradually upwards.
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On average, 1 in every 14 people in the world are diabetic. Diabetes is a deadly disease with a variety of life threatening complications if not well treated, including stroke, heart attack, blindness, kidney failure, and foot wounds that often result in amputations.
The truth is that this handicapping complication is preventable.
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The most important risk factor for developing diabetic foot wound is poor blood sugar control. Poor blood sugar control leads to a variety of abnormalities like nerve (neuropathy) and blood vessel (peripheral vascular disease) impairments. These together with weak immunity present in diabetics predispose them to foot wounds. The wounds may not heal easily & then progress to a stage when some body tissues become dead (gangrenous) and amputation becomes inevitable.
It is important to note that at this stage (when there is dead, black tissue, i.e. gangrene formation), failure to amputate puts the patient’s life at serious risk. The dead & harmful tissues will spread in the blood, cause severe sepsis & eventually the person's death.
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Prevention is better than cure.
Here are 6 things to help prevent amputation. Tell someone & share!:
1. Good blood sugar control. She must be strictly compliant with her medications (drugs or insulin injections) & dietary modifications.
2. She must ensure regular specialist clinic attendance. The specialist will help to monitor her progress & review her medications & check for complications.
3. Good foot care practices
o Daily foot inspection, including the sole of the foot (using a mirror). She must check her foot every day or ask someone else to help her if her sight is impaired.
o She must wash her foot every day and towel dry it.
o She must always wear a footwear, even when she is indoors.
o But she should avoid the following footwear: Dunlop slippers and other slippers with soft soles (sharp objects may pe*****te), high heel shoes, footwear with open front (may easily have a wound if hit her foot against something), and tight wears including socks.
o Avoid applying the foot on hot materials, eg avoid Iya Rashidah's method of making amala
4. Good nail care practices
o When she wants to trim your nails, pls do so after a bath or following brief immersion in warm water, to make them soft. Nail cutter should be used, NOT razor blade!
o Nail manipulations (fixing, etc) of any form (especially for females) should be avoided
o Use of lubricants for dry foot is encouraged
5. Early medical intervention should be sought for any foot complaints or injury.
o Seek medical care immediately!
o Don't treat at home
o Don't wait till the leg or hand turns black
o Don't put 'gbere' (traditional cuts). It introduces infections into the wound.
6. Yearly comprehensive foot examination at the hospital is highly recommended
In conclusion, diabetic foot wounds (we call them ulcers) and resultant limb amputation is a severe debilitating complication that is preventable by strict blood sugar control and good practices.
Tell someone today.
Thanks Dr Oloso Aqib Afolabi for original submission.
