Apples and foot care – what’s the link? (21 Oct. International Apple Day)

apple foot care

October 21st 2020 is International Apple Day. At Podiatry International we were wondering if there is a link between apples and foot care?

During the first wave of the coronavirus, many medical interventions were postponed to avoid pressure on hospitals. Postponing surgery can have serious consequences, especially for people with diabetes or another systemic disease.

An Apple a day keeps the doctor away.

But never delay wound/foot care during COVID times if you have diabetes

Marcel from Belgium:

Marcel from Belgium has diabetes. When in March during the first wave of COVID-19 he got a blister on his right big toe, he didn’t go to the hospital for further examination. He tried to do self-care and he waited until the beginning of August to make an appointment in the foot clinic. From there all went very fast that in October he has had an amputation of his toe with all problems that arise from there (in one study, research showed that following an amputation, up to 50% of people with diabetes will die within 2 years. [1])

Marcel was very afraid to go to the hospital. He couldn’t see his granddaughter for 2 months because she could transmit COVID-19, he didn’t want to go to a breeding ground. 

Researches done:

At this point, there is not a lot of research regarding the effects of the delayed foot care and amputations but podiatrists, endocrinologists, and vascular surgeons confirm that delayed care will have/has an impact on the number of amputations.

Moreover, according to a study published online July 23 in Diabetes Care[2], Patients with diabetes admitted to a center for diabetic foot ulceration (DFU) during the COVID-19 lockdown in Italy in the spring had a more than threefold risk for amputation versus patients seen in 2019. “The higher risk of amputation observed during COVID-19 lockdown confirms the need for proper and timely management of DFU patients to prevent dramatic outcomes responsible for a reduction of quality of life and increased morbidity and mortality,” the authors write.[3]

In another study regarding diabetic foot ulceration in COVID‐19 lockdown in the UK, the authors say a reduction in patients with new diabetic foot ulcer events is seen in their service. It is of immediate interest and needs further investigation to determine whether the reduction seen is reflected across the country. It is important to determine whether the apparent reduction in ulceration is due to advised sedentary behavior or whether there is a large cohort of patients delaying seeking foot care, with the potential for significant preventable harm.[4]

Don’t, by any mean, delay foot care due to the pandemic.

[1] Brownrigg, J.R.W., Apelqvist, J., Bakker, K., Schaper, N.C., and Hinchliffe, R.J., Evidence-based managed of PAD & the Diabetic Foot. Euro J Vasc and Endovascular Surg, 2013. 45(6): p. 673-681.
[2] https://care.diabetesjournals.org/content/early/2020/07/21/dc20-1347
[3] Several authors disclosed financial ties to the pharmaceutical industry.
[4] Diabetic foot ulceration in COVID-19 lockdown: cause for concern or unexpected benefit?
Lipscomb D, Smith AS, Adamson S, Rezazadeh EM.
Diabet Med. 2020 Aug;37(8):1409-1410. doi: 10.1111/dme.14340. Epub 2020 Jun 28.

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