From a Small Foot Wound to Gangrene: Doctors' Warning Through Diabetic Patient Sultana Bibi's Experience

Sultana Bibi was diagnosed with diabetes in 2022, after a nail pierced her foot. She lives in the Metiabruz area of Kolkata. The infection from that foot wound spread so far that she had to undergo surgery on the sole of her foot. Yet within a few days, two of her toes fell off while the foot was being dressed.

Every year, like Sultana Bibi, millions of people with diabetes around the world develop serious foot problems. In diabetes, even a minor foot wound can turn into a major danger. The condition is called diabetic foot disease. If the situation worsens further, gangrene can set in. Sometimes the infection or ulcer grows so severe that part of the foot, or even the whole foot, has to be amputated.

Sitting on her bed with her wounded foot stretched out in front of her, Sultana Bibi said the pain after the nail pierced her foot was so severe that she could not walk. A doctor gave her medicine, she said, but even after taking it for about 15 days there was no improvement; blood and pus kept coming out of her foot. She was then taken to a senior doctor, who said an operation was necessary.

Sultana Bibi added that after the operation on the sole of her foot, two toes of that foot turned black. During dressing, the two toes fell off on their own and did not have to be removed, she said, adding that she cried a great deal at the time.

Sultana Bibi's husband, Ebadullah Molla, earns between 1,000 and 2,500 rupees a week from tailoring work. He lives with his wife and two children in a single room measuring 10 feet by 10 feet in Metiabruz. Borrowing money, he has so far spent about 120,000 rupees on his wife's treatment. Treatment continues to cost at least another 1,000 rupees every month. The family also says it cannot place its trust in the local government healthcare system.

Dr Anupam Golas, a well-known reconstructive surgeon, or plastic surgeon, in Kolkata, has special experience in diabetic foot surgery. He said that people who have lived with diabetes for many years — especially those who do not keep it under control, do not take proper treatment or are irregular with their medicine, and whose blood sugar stays high — gradually begin to develop problems in their feet. Blood circulation decreases and the nerves are affected.

Dr Golas added that people who do not take care of their feet, do not keep them clean and walk barefoot first develop something like a callus on the foot. Infection then forms underneath it and an ulcer develops. That ulcer and infection keep growing and move towards gangrene.

One of the first signs of diabetic foot disease is the skin of the foot becoming hard, Dr Golas said. Skin on part of the foot becoming very hard, fluid oozing from that spot or pain caused by a callus, a change in the colour of the toes, or pus coming out of part of the foot all mean that an infection or problem has developed in the foot.

The surgeon said a situation requiring amputation of the foot or part of it can arise mainly in two cases. First, when blood circulation in the foot falls so low that a condition like dry gangrene develops; that part of the foot then dries up, turns black and loses sensation. Second, when an ulcer or infection grows so severe that pus comes out of it or that part of the foot begins to rot. In that case, if the part is not amputated, there is a risk of the infection spreading further up. Alongside cutting off the toes and draining the pus, he said, antibiotic medicine must be given so the infection does not spread any further.

Dr Golas said many people take off their shoes at pilgrimage sites and walk barefoot over hot floors or roads. People with diabetes have reduced sensation in their feet, so they feel no pain at that moment. Later, however, they come to doctors with burn wounds on their feet, and infections, ulcers and various other problems can develop from there.

To prevent diabetes-related foot problems, Dr Anupam Golas offered several pieces of advice. People with diabetes must pay close attention to foot hygiene and clean their feet well and regularly. Moisturiser or emollient cream should be applied to the feet regularly so the skin stays soft; if the skin becomes dry and cracks, the risk of infection there rises. If any problem appears in the foot, a doctor should be consulted without delay. Diabetes must be kept under control, and regular health check-ups should be done with a doctor.

The advice also includes not walking barefoot. Even at home, one should walk in comfortable shoes or slippers, and suitable footwear should be worn when going outside. Those whose feet have already become deformed, or who repeatedly develop ulcers at a few specific pressure points on the foot, or whose skin has hardened, can wear a special type of shoe called offloading footwear. Such shoes are made so that less pressure falls on the specific pressure points of the foot.

Dr Golas also warned that if shoes are too tight, or a wound forms from friction between the shoe's interior and the foot, the risk of infection can rise from there as well. Aniruddha Chowdhury, a specialist in making footwear for diabetic foot and the founder of a shoe-making company called Peditech, said many people think special diabetic-foot shoes need to be worn only after a foot problem has developed, but footwear can also play a role in preventing the disease.

In Aniruddha Chowdhury's view, shoes should match the size of the foot. Preventive shoes have good cushioning and a soft inner lining. Care must also be taken that excess pressure does not fall on any one specific spot of the foot; if the foot rubs, the chance of ulcers and infection increases. People who have diabetes but have not yet faced any foot problem can wear shoes that will give their feet comfort and keep them protected. His advice is that suitable shoes should be wide in fit with a raised front, so the toes have enough room. An anti-skid, lightweight sole will help reduce the risk of falling. To make sure the foot is not cut by rubbing, there are no stitches inside the shoe. Those who already have diabetic foot problems need shoes that help reduce pressure on the sensitive parts of the foot, avoid friction and lower the risk of new wounds forming.