Q: My father has diabetes since 28 years and now he is now 58 years old. I have heard that diabetics affects different body organs. My father has a diabetic foot. His liver, heart, kidneys, eyesight and digestive tract are normal. He often gets hurt on his toe, which leads to pus and forcing him to bed for a week or 10 days. He says that he is not aware when his foot gets hurt. He takes Dianuron capsules daily at night, Lopirin, Esam and Losar. Occasionally due to variation in pressure he has Tenol 50mg. The mixtard level he consumes as insulin is 20-0-20 units. Why does he have swelling on his feet (from toe to ankle)? Is this due to the medicines? How can he take care of his feet effectively?

A:I am sorry to hear that your father is having recurrent infections of his toe. First of all, I note that he may not feel the injury which causes the problem, and if this is the case it probably means that he has lost some of the sensation in his feet from a sensory neuropathy which can affect some long-standing diabetic patients. This represents a serious hazard and means that he must take exceptional care of both his feet to avoid injury, and this includes his good foot which obviously needs to be preserved at all costs. These measures of protection include good hygiene with regular washing and drying the feet every day; ensuring that his shoes fit his feet properly; that he should inspect the inside of his shoes for nails or stones; and that he should not walk around barefoot. Clearly if his toe becomes infected then he needs rest and antibiotics, and it sounds as if he has had such treatment. If the infection re-occurs without further injury then he needs further investigation by a specialist including x-rays of the foot. I am afraid that I cannot elucidate the cause of swelling in the foot without examination of the patient which obviously cannot be done by e-mail. I do hope this advice will be of some help to him.