What is PAD? Should you be worried?

Critical limb ischemia or “leg attacks” are very high in India, but while everyone is aware of heart attacks, there is very little knowledge about leg attacks, which can be equally fatal. Occurring largely among the diabetic population in India, estimates show that around 15 per cent of people suffer from problems in their limbs. There are six crore people suffering from diabetes in the country.

Recent estimates have shown that 60,000 people per annum suffer from critical limb ischemia or leg attacks. Many patients invariably lose their limbs and sometimes if the infection spreads, also their lives. For diabetics, it is said that they must take more care of their legs than their face. The reason being, their feet are prone to arterial clogs and blocks and even infections.

No symptoms in initial stages (Dr Hari Kishan Boorugu)

Diabetes, high blood pressure, high cholesterol and smoking are the risk factors of peripheral arterial disease and, according to a study by the Chennai Urban Population Study in 2000, the prevalence among those with diabetes has increased from 3.2 per cent to 6.3 per cent.

As the problem is reduction in blood supply, pain or other symptoms like numbness and dusky discoloration appear on the legs only when it is at an advanced stage. At this point it makes walking very difficult for patients.

Dr Hari Kishan Boorugu, consultant physician at Apollo Hospitals said, “Often people with a mild form of the disease do not have any symptoms. But diabetics are advised to get their foot check-up, like Doppler studies, done once in a year so that detection can be done clinically.”

Smoking and high lipids are the culprits (Dr Rahul Agarwal)

Smoking and high-lipids are two causes where the incidence of PAD is found to be higher. Those who are heavily into smoking have higher incidence of PAD, which affect 10 years earlier as compared to non-smokers.

Similarly, those who have high levels of low-density lipoprotein, triglycerides and high cholesterol are at a positive risk of developing PAD. Dr Rahul Agarwal, senior consultant physician of internal medicine at Sunshine Superspeciality Hospitals said, “Continued smoking has shown to increase the symptoms of narrowing of arteries and in these patients there is an increase in the need for surgical intervention.

If the patient works towards reducing smoking then a marked difference is also found. Similarly, patients who continue to have high lipid profiles are advised to adopt a low-fat diet and maintain a regular exercise regime. In these patients, statins have  anti-inflammatory effects hence it is important to opt for primary drugs.” The best option for these patients is exercise, which has shown benefits.

Diabetics must not walk barefoot (Dr Prasun Deb)

Walking barefoot is an absolute no-no for diabetics. Reduced sensation for touch, pain and temperature at the feet due to less supply of blood to the limbs puts their feet at risk. There can be injuries, loss of sensation and also less pressure on the soles due to which wounds, if any, take time to heal.

Dr Prasun Deb, senior consultant, endocrinology at Krishna Institute of Medical Sciences, said, “Footwear for diabetics at home and outside is a must. It is the simplest and most effective way to protect diabetic feet. This is because apart from routine injuries, diabetics are prone to scald injuries when they walk barefoot over cement surfaces when exposed to the sun. The diabetic foot cannot feel hot and cold temperatures.”

If the sugars are uncontrolled there are changes in skin colour, infections and ulcers. Dr Deb added, “Chronic diabetic foot diseases can be arrested by glycerin control and foot care. The patient has to take a lot of care of their feet and follow the medical treatment sincerely.”

Diabetics and legs

Diabetic patients are found to suffer from narrowing of arteries in the upper and lower limbs, called Peripheral Arterial Disease (PAD). Due to the narrowing of arteries because of fat deposition, clots form in the blood vessels. This narrows the supply of blood in the legs causing pain, discoloration, gangrene and even death of the tissue. Diabetic patients are at increased risk of the disease and they often have to undergo amputation of toes, feet or limb.