Step in the Right Direction: How Regular Exercise Cuts Diabetic Foot Amputations in Half

▲ Diabetic feet

November 14th is “World Diabetes Day”.

It was established by the World Health Organization (WHO) and the International Diabetes Federation (IDF) to raise awareness about diabetes, which is rapidly increasing around the world.

Diabetes is also increasing in Korea due to aging.

According to the “Fact Sheet on Diabetes in Korea” released on the 2nd by the Korea Diabetes Association, the number of diabetes patients aged 30 years and older in Korea was 6.05 million in 2020.

This is almost double the number of diabetes patients in 2010, 10 years ago, when there were 3.12 million.

Additionally, the number of diabetes patients was 30 years ahead of the 5.91 million people the company expected to reach in 2050 when it was analyzed in 2012.

The reason why diabetes is scary is because it involves more serious complications than the disease itself.

Among these, the most representative one is the “diabetic foot”, which has various names such as diabetic foot, diabetic wound and diabetic foot ulcer.

The problem is that the endpoint of a diabetic foot can be amputation.

High sugar levels in the blood vessels along with poor blood circulation kill nerve cells, dulling the senses in the feet, causing injuries to go unnoticed. If this develops into inflammation and worsens, amputation is inevitable.

Statistically, 15 to 25% of diabetic patients worldwide develop diabetic feet.

If one leg is amputated due to diabetic foot, there is a 50% chance that the other leg will be amputated within two years.

A diabetic patient who has had his leg amputated has at least a 39% chance of dying five years later.

The first symptom of diabetic foot is abnormal sensation due to neuropathy.

Initial symptoms are cold, numb and burning feet.

Depending on the individual, the patient may complain of a strange sensation, such as feeling as if something is stuck to the foot or when stepping on it, as if walking on sand or beads.

Some patients suffer from insomnia due to abnormal sensations and pain.

When the nerve is completely destroyed, the sensation in the feet becomes dull.

In this case, even if your foot is bruised, injured or filled with pus, you remain unaware of the pain and only become aware of the problem when the wound enlarges and becomes more severe.

Additionally, the feet often swell and the skin does not sweat, causing the skin to dry and crack, resulting in wounds.

Symptoms caused by motor nerve abnormalities include toe deformity, which occurs when the small muscles in the toes become paralyzed.

In this case the shoes do not fit well and calluses or scars easily form.

On the other hand, symptoms of cold or painful feet and toes that suddenly turn black are due to blood circulation problems caused by diabetes.

People who have had diabetes for a long time, smoke, or have poorly controlled blood sugar levels are at greater risk of developing diabetic foot complications.

If your feet become red or black or have small changes such as blisters or ulcers, it is advisable to see a doctor.

Treatment for diabetic feet can be largely divided into conservative treatment and surgical intervention.

Conservative treatment uses dressings to help create granulation tissue and blood vessels.

Furthermore, the wound healing process is promoted through vasodilators, epithelial growth factor (EGF) which aids tissue regeneration and high pressure oxygen treatment.

Nowadays, a method has also emerged to regenerate ulcers by applying a patch made by bioprinting using artificial intelligence (AI) technology.

Surgical methods include resection, in which infected and dead tissue is surgically removed and wound healing begins from healthy tissue, and reconstructive surgery, in which large, deep scar tissue is covered with flesh from another area .

However, since most diabetic feet are caused by very small problems, serious conditions can be prevented if managed properly in the early stages.

Experts advise diabetic patients to carefully monitor their blood sugar levels, monitor the condition of their feet daily, and pay special attention to hygiene and protection of their feet.

This is because many diabetic feet are caused by minor injuries, such as cuts from cutting toenails or blisters or calluses from wearing tight shoes.

A recent national study found that diabetic patients who exercise have a lower risk of amputation due to diabetic foot.

In the latest issue of the international journal “Journal of Diabetes”, the research team of professors Yunjae Lee and Jaewon Kim from the Department of Plastic Surgery at Yeouido St. Mary’s Hospital interviewed 1,923,483 people diagnosed with diabetes between 2009 and 2012 and examined the incidence of leg amputation based on physical activity level. The analysis revealed that this correlation was observed.

In this study, 4,454 (0.23%) patients underwent amputation for diabetic feet.

The study found that those who engaged in regular physical activity had a significantly lower risk of amputation than those who did not.

Regular exercise was defined here as vigorous activity for at least 20 minutes per day on 3 or more days per week or moderate activity for at least 30 minutes per day on 5 or more days per week.

Specifically, those who continued to engage in high-intensity physical activity (such as carrying heavy objects, running, aerobic exercise, or fast cycling) had a 50% lower risk of leg amputation than those who did not engage in physical activity.

Even in the group that performed only moderate intensity physical activity (carrying light objects, cycling at normal speed, playing tennis, etc.) or walking, this effect was calculated to be 45% and 38%, respectively.

Furthermore, in the group of patients who changed their physical activity from inactivity to activity, the risk of lower limb amputation was reduced by 29%.

Professor Yunjae Lee explained: “In the past, physical activity itself was thought to increase the risk of ulcers in diabetic patients with reduced foot sensation, but as it has recently been revealed that this is not the case, the paradigm is changing for strengthen physical activity. activity.”

Professor Lee said: “Regular physical activity appears to improve foot pressure distribution and peripheral sensory function in diabetic patients, thereby reducing the risk of developing ulcers and delaying the progression of diabetic peripheral neuropathy, which is an important factor of risk for skin damage and amputation. “These benefits from physical activity may be especially important for older adults and patients with existing diabetes complications,” he said.

(Photo = Yonhap News)