ABOUT l5 PERCENTOF DIABETIC PATIENTS get foot ulcers as a complication and about six percent of these patients are hospitalized due to infection of these ulcers. Foot ulcers are slow-to-heal, open sores or wounds, usually found at the bottom of the foot. These can develop from the following:  minor scrapes, cuts, blisters dry and cracked skin, corns, calluses (thickening of the skin due to excessive rubbing or pressure on the same spot) and warts ingrown toe nails (growing of the edge of the nail into the skin) hammertoes (curling of toes under the feet due to muscle weakness) bunions (slanting of big toe slants toward the small toes and swelling of the region near the base of your big toe) fungal infections such as Athlete's foot.

Minor injuries, which fail to heal, develop into chronic ulcers in diabetic patients due to nerve damage and poor blood circulation. Nerve damage in some diabetic patients leads to their inability to feel pain, heat or cold, resulting in unawareness of their injuries and hence subjecting these areas to more pressure or friction. Poor blood circulation prolongs wound healing. In addition, high blood sugar levels in these patients allow bacteria and other microorganisms to multiply profusely at the injured site, leading to serious infections. Gangrene develops when the infection spreads and causes the surrounding tissues to die and become black and smelly. An amputation or a surgical procedure that cuts off part of the body may be necessary to prevent the spread of gangrene. Amputation is always feared by diabetic patients as it affects the patients' mobility, self esteem and quality of life.

Treat with extra care

Diabetic foot ulcers are at greater risk of acquiring infection and gangrene. Those with mild and superficial diabetic foot ulcers (with little or no signs of infection and tissue death) are usually treated as outpatients with simple wound dressing, broad-spectrum oral antibiotics to prevent infection and proper foot care (eg avoiding pressure at the area). However, if no improvement occurs in one to two weeks, advanced wound care and hospitalization are required.

Moderate to severe foot ulcers require hospitalization for advanced wound care, Dead tissues are removed to restore the injury to its healthy bleeding state, The types of bacteria causing the infection are also determined to select the most appropriate antibiotic therapy, If healing still fails to occur, surgery is required to replace the damaged blood vessels with a graft to restore blood circulation. If gangrene is severe, amputation is considered, In addition, patients should get their doctors to check the condition of the nerves and blood flow in their feet during every visit.

A complete foot examination must also be done with a podiatrist annually; Diabetic foot ulcers have serious complications. However, they can be avoided by giving the feet more care and attention.

A recommended foot care regimen includes:

- Daily checking by the patient or caregiver to detect injuries in the foot as early as possible, Watch out for any redness, cuts, bruises, sores, swelling, thickening or discoloration of toenails or skin or bad odour. Minor injuries must be cleansed properly, treated with an antiseptic cream and covered with a suitable dressing immediately, for severe injuries or minor injuries that fail to heal, seek medical assistance.

- Daily washing of feet in warm water. Avoid soaking the feet for long periods and dry the feet well, especially between the toes.

- Moisturizing the feet with lotion after washing and drying, especially if they are dry but avoid applying lotion between the toes (moisture can promote fungal growth).

- Avoid using over-the-counter preparations that remove calluses, corns, or warts as they can burn the skin and cause damage to the foot. Avoid cutting calluses with razor blade or any other instrument.  See a podiatrist for assistance in these cases.

- Cutting toenails once a week or when needed. Cut to the shape of the toe but not too short.

- Wearing of slippers or shoes to protect the feet from injuries, Avoid walking barefoot. Wear proper-fitting shoes, Avoid high heels, sandals, and shoes with pointed toes as these can put undue pressure on parts of the foot and contribute to bone and joint disorders and diabetic ulcers, therapeutic shoes to prevent ulcers may be considered. Before putting on shoes, feel the insides for any sharp edges or objects that might injure the feet.

- Wearing of socks or stockings to avoid blisters, Avoid socks or knee high stockings that are too tight below the knee as they interfere with the blood circulation to the feet.

- Avoid smoking and drinking alcohol as these may impair blood circulation, to improve blood circulation, exercise more, but with care