Popular Indian TV actor Lokendra Singh Rajawat, 55, has lost acting opportunities and is facing a financial crunch after his diabetic feet led to amputation of his right leg, up to the knee in 2021. He had developed a corn in his right foot in 2018 due to uncontrolled diabetes but didn’t take it that seriously since he did not have any other symptoms like pain. Rajawat believed everything would be fine and did not realise the internal damage that it could cause. Without proper care the wound got infected and it manifested into diabetic foot ulcer.
The actor, who is known for his roles in Hindi television shows such as as CID, Jodhaa Akbar and Yeh Hai Mohabbatein, got a reality check only when he slowly started losing sensation in his feet and visited the hospital. The doctor told him that his leg would have to be amputated because gangrene had set in, following the infection. The infection percolated into the bone marrow and was fast spreading in his body.
“I was stressed, and my sugar level shot up,” Rajawat says. “I got an artificial limb but I’m unable to wear it due to swelling. My left leg is also getting affected. There’s low blood flow to my left leg and it’s swollen too.”
Dr Ramesh Reddy G, director, Dalvkot Wound Care Centre, Bengaluru, adds that diabetes can lead to disability and amputation in case a diabetic does not care properly for his or her feet,” he says. “Diabetes is a costly disease. It will affect their professional lives as they and their caretaker will be forced to miss out on work due to multiple hospital visits.”
Singer Ella Fitzgerald, referred to as the Queen of Jazz and a recipient of 14 Grammy Awards, had to have her legs amputated after developing some complications due to diabetes in 1993. However, further details were not shared by her spokesperson Mary Jane Outwater, according to Associated Press.
Diabetes and foot care
The World Health Organisation defines diabetic foot as “ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection”.
According to the study ‘Association between peripheral arterial disease and diabetic foot ulcers in patients with diabetes mellitus type 2’ — done by A García Rojas and MÁ Tresierra-Ayala and published in the journal Medicina Universitaria in 2017 — peripheral arterial disease (PAD) is an important predictor of diabetic foot ulcer.
Therefore, the physician who examines the patient should also check for the vascular status of lower limbs and signs of ischemia (inadequate blood supply to a part of the body), since up to 50 per cent of these patients have PAD.
Dr Ramesh says in cases of diabetic foot, a person loses sensation in the feet and does not feel a thing when pricked. “Feet are the more vulnerable part when you are diabetic, and cleaning and taking care of the feet is equally — if not more — important as cleaning your face,” he says. “Diabetes affects the nerves and blood vessels and can further lead to atherosclerosis (build-up of plaque on the arteries of the legs and feet) and thrombosis (blocking of veins or arteries, causing pain and swelling in one leg).”
Several studies show that diabetic patients are not well aware of the foot problems and do not take adequate care of their feet. A 2020 study — ‘Diabetic Foot Self-Care Practices Among Adult Diabetic Patients: A Descriptive Cross-Sectional Study’ by Namo Hirpha, Ramanjireddy Tatiparthi and Temesgen Mulugeta, and published in the journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy – found that patients were not adequately self-inspecting and washing their feet, drying their feet after wash and moisturising the dry skin. They also walked barefoot, in sandals or slippers, and in shoes without socks.
Therefore, clinicians should counsel every diabetic patient about the importance of foot self-inspection and foot hygiene.
Dr Ashok Damir, medical director, Diabetes, Foot & Wound Care Centre, New Delhi, says foot problems are not uncommon in diabetics. He says 15 to 25 per cent diabetics develop foot ulcers once in their lifetime and since they lose sensation in the feet, they don’t realise that they have developed blisters or calluses.
“People are less aware of the importance of foot care,” he says. “In India especially, many walk barefoot in the house or religious places and get infected. The dust leads to infections, which further leads to gangrene and, ultimately, amputations. People with diabetes are prone to develop infections faster than non-diabetics due to poor immunity.”
The risk of amputation, where a part of the body is removed so that the infection does not spread, is the most serious problem in diabetic foot problems. “It can spread from one toe to another, to feet, leg and then up to the thigh before spreading through body and leading to death,” says Dr Damir.
Older people with diabetes for over a decade are more prone to developing foot problems. “Diabetes reduces the life expectancy of a person by 10 years on an average,” he says.
Diabetic feet symptoms
There are different signs and symptoms for foot problems if you are diabetic. Dr Ashok and Dr Ramesh list the following signs that a diabetic should look out for and visit the doctor immediately in case they develop any symptoms.
- Tingling sensation
- Deformed nails or nail infections
- Fungal infections in between toes
- High blood sugar
- Poor wound healing
Precautions against diabetic foot ulcers
Dr Ashok says around 85 per cent of foot ulcers lead to severe infection, gangrene and then ultimately amputations, which can be prevented. “If one takes care of their feet, contacts doctors on time and follow their instructions, they can probably avoid amputations,” he says.
He lists a few precautionary measures to ensure proper foot care:
- Check for sensation on the feet every fortnight. Keep your eyes closed and ask someone to use cotton to touch your feet
- Keep blood sugar levels, blood pressure and cholesterol under check
- Regular check-ups with the healthcare provider
- Include feet examination during routine check-ups
Diabetic foot care at home
Dr Ashok gives a few tips that diabetics can follow to prevent foot problems:
- Wash the feet regularly and thoroughly
- Dry your feet well, particularly in between the toes since dampness can cause fungal infections
- Apply powder on feet
- Use moisturiser as your feet tends to get dry, but never apply it between the toes as moisture can cause infections
- Wear socks even with chappals since infections can be caused by dust
- Avoid tight socks and shoes
- Wear shoes (since they cover the front side of the feet and heels) rather than chappals or sandals
- It is better to purchase shoes in the evenings as the feet might be swollen in the evenings
- Avoid open sandals