Foot note: message from Pakistan

Simple foot care advice can save many legs 

To share with you, I have stories of three people with diabetes, visiting the foot clinic of Baqai Institute of diabetology and endocrinology, Karachi, Pakistan for the very first time.

Muhammad Yameen, a 60 years old man living in the suburbs of Karachi has diabetes for 7 years and has no sensation in his feet for the last one year. He has been under care of a local GP since 2 years. This summer, out of his religious veneration, Yameen visited the holy shrine of Shah Aqeeq located in a desert area of Sindh province, where temperature peaks high in that part of the year. During the pilgrimage, he walked bare footed without noticing what is happening to his feet.

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Similar is the story of Syed Haider Ali, a 56 years old gentleman, living in Karachi. He was diagnosed to have type 2 diabetes in 2010. He was advised to walk daily to help control his diabetes. He walked bare footed in a hot summer evening. After the walk, while washing his feet, he noticed ulcers and widespread breach of skin.

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Somewhat identical happened to Muhammad Hashim, a 50 years old gentleman, living in Hayderabad,. He is diabetic since 2002 and his feet are numb for the last 3 years. Once, while travelling from his home town to Karachi, he stuck in a traffic jam. Sitting on the rear seat of his car, for the sake of comfort he had taken off his shoes. Just to see what is happening in the surrounding, he put his left bare foot out on the road for a while. Subsequently, he noticed  blisters on his left foot.

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In certain areas of Pakistan, during mid summer, the temperature approaches 50 degree centigrade (122 F). It is therefore extremely important for people with diabetes not to walk bare footed. Unfortunately, in our society bare foot walking is not uncommon. Moreover, people wear slippers or sandals with thin soles which are not protective enough.

It took about four to eight weeks for healing of foot ulcers in the three gentlemen, described above, although these lesions were preventable, had they been educated on foot care. Foot care education and advice is one of the most important ways to prevent the people with diabetes from walking bare foot and to avoid occurrence of foot problems.

Many studies have shown that comprehensive foot care education programmes can reduce the occurrence of foot lesions in up to 50% of the patients. According to consensus guidelines of International Working Group on the Diabetic Foot, foot care education should be simple, relevant, consistent, and repeated. The purpose of education is to change the self-care behavior of the person with diabetes and to enhance adherence to foot care advice.


Assistant Professor of Medicine
Baqai Medical University /
Baqai Institute of Diabetology and Endocrinology

July 2013