The Growing Need for Podiatric Awareness in India: Tackling the Diabetic Foot Crisis
India is home to a staggering number of individuals living with diabetes, approximately 101 million. Among these, 50 million are affected by diabetic peripheral neuropathy, and 15 million suffer from peripheral arterial disease. The repercussions of these conditions are severe, with an estimated 1.3 million amputations occurring annually due to diabetic foot complications, and a 5 year mortality rate, meaning if 100 people undergo above knee or below knee amputations in 2024, only 30% will survive beyond 2029. Additionally, managing one diabetic foot ulcers alone incurs an annual expenditure of INR 1.3 Lakhs. These figures highlight the urgent need for improved foot care management and the critical role of trained podiatric surgeons in alleviating the burden of diabetic complications.
Diabetic patients face an increased risk of foot complications as a result of neuropathy and poor circulation, which can lead to infections and delayed wound healing. Minor injuries can escalate into serious issues such as gangrene, which are notoriously challenging to treat in diabetic individuals. Complications from diabetic foot problems are a leading cause of lower limb amputations, making the need for awareness and proper foot care even more pressing.
Podiatry, though a specialized field, plays a crucial role in addressing diabetic foot complications. It focuses on the prevention, diagnosis, treatment and rehabilitation of foot and ankle disorders. In recent years, podiatry in India has gained prominence, particularly in the realm of diabetic foot care. Despite its growing importance, the field remains underexplored and underutilized.
A significant gap exists in diabetic foot awareness and management across the Indian population. Although awareness is increasing, there is still a lack of adherence to daily foot care regimens among individuals with diabetic foot ulcers, often emerging within the first year of diabetes diagnosis. Published statistics reveal that approximately 140,000 major amputations and over 1.4 million minor and major amputations occur annually, with up to 80% of these potentially avoidable wi th timely and specialized intervention. Podiatric surgeons are essential in offering comprehensive management strategies, including wound care, biomechanical assessments, patient education, and the provision of custom footwear and orthotic devices.
Common Foot and Ankle Problems faced by Diabetics:
Nerve Damage (Neuropathy):
This includes symptoms like Numbness or tingling in the feet, Loss of sensation (inability to feel pain, temperature, or touch), Sharp, burning, or stabbing pain in the feet, and Muscle weakness
Poor Blood Flow (Peripheral Artery Disease):
This is characterised by Cold feet or legs, Pain or cramping in the legs or feet while walking (called claudication), Slow healing of cuts or sores, Hair loss on legs and feet, Weak pulse in the feet
Foot Ulcers:
These are marked by Open sore or wound on the foot that doesn’t heal, Redness, swelling, or warmth around a sore, Drainage from a sore (especially if it smells bad), Pain around the ulcer (though people with neuropathy may not feel this),
Infections:
marked by Redness and swelling around a wound, Pus or foul-smelling drainage from a wound, Warmth around the infected area, Fever or chills if the infection spreads
Foot Deformities
changes in the foot like Swelling, redness, or warmth in the foot (for Charcot foot), Changes in the shape of the foot (collapsing of the arch in Charcot foot), Visible bumps on the sides of the toes (bunions), Toes bending downward (hammertoes), Difficulty walking due to changes in foot structure are all signs of foot deformities
Diabetic patients should watch for these symptoms and seek medical help early to prevent serious complications.
How Diabetics can take care of their Foot Health:
Choosing well-fitting custom footwear or insoles plays a crucial role in managing diabetic foot conditions. Properly fitting shoes help avoid pressure points and blisters, which can otherwise lead to ulcers and complications, especially for diabetic patients. The use of pedorthosis can provide additional support and alleviate foot pressure, further reducing the risk of foot issues.
Equally important are regular checkups with healthcare providers. Scheduling routine visits to foot and ankle specialists ( Podiatrists / Podiatric Surgeons) allows for comprehensive foot exams, including Neuropathy Screening, Vasculopathy Screening, Pedogram / Plantar Pressure Scans which are essential for detecting problems early. Prompt medical attention should be sought if any signs of infection arise. Look out for change in the skin colour in the foot or the leg, increased or decreased temperature of the foot, Swelling / Oedema, and Fever. Maintaining controlled blood sugar levels is vital for preventing infections and ensuring overall foot health.
Beyond diabetic foot care, podiatry encompasses a broad range of foot and ankle conditions, including fungal infections, ingrown toenails, sports injuries, trauma, and congenital deformities. Podiatric surgeons possess the expertise to manage these diverse ailments, emphasizing the importance of this field in holistic healthcare.
The future of podiatry in India holds immense promise, yet it faces challenges such as limited awareness, inadequate infrastructure, and a shortage of specialized training programs. With the rising prevalence of chronic diseases, increasing sports participation, and a growing focus on holistic healthcare, the demand for specialized foot care is expected to escalate. Raising public awareness and expanding access to specialized podiatric care will be crucial in meeting this demand and improving foot health outcomes across the country.
