COVID-19 and Diabetic Foot

Abstract

The COVID-19 pandemic is an unprecedented event that has taken a toll on the care of people with chronic illness, especially diabetes and its complications. Foot complications in diabetes encompass the whole spectrum from “at-risk foot to”, neuropathic foot ulcer, diabetic foot infections, claudication, gangrene, and Charcot neuroarthropathy. Guidelines suggest annual foot examination in people with diabetes and more frequently in those with foot ulcers or vasculopathy. COVID-19 pandemic has necessitated a lack of face-to-face consultations or examination and reliance on telemedicine or video call facilities for interaction with the patients. We provide a useful guide for the physicians regarding the examination of the foot and early recognition of risk factors for foot ulcers, signs of foot infections, ischemic changes, and active Charcot foot. Diabetic foot infections (DFI) and infected foot ulcers carry poor prognoses as they may culminate in amputation and mortality. Hence, triage of patients to recognize the signs of life-threatening infections that mandate hospitalization is discussed. The serological tests, tissue culture, radiological imaging for the diagnosis of DFI, along with the choice of antibiotics for the treatment of DFI, are detailed. The diagnosis of Charcot foot is altogether difficult, but early identification of telltale signs through video consultation and appropriate offloading total contact cast will help these patients to prevent deformities and amputations. Overall, continued communication with video calls, telemedicine facility, and group chats, including Whatsapp, will encourage patients for self-examination of foot and aid in better management of diabetic foot during these testing times.