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.
Keywords: Amputation, Antibiotics, Charcot neuroarthropathy, COVID-19, Diabetic foot, Diabetic foot ulcer, Diabetic foot infections, Foot care, Foot examination, Gangrene, Ischemic foot, Neuropathy, Podiatry, Psychological adaption, Self-care, Self-examination, Telemedicine, Tissue culture, Total contact cast.
