Articles on diseases of the foot

10 Easy Tips for Heel Pain

Dr. Yogesh Kumar, Ayurveda
Women have been wearing high heel sandals to look good but this fashion fad could give rise to Back and Heel problems.Heel and back problems can occur in men also .This problem in medical terms called "The Painful Heel Syndrome".Women with Progressive age, Arthritis, Overweight women are more prone to this problem.The heel pain could be different according to the age groups.Young men tend to have Bursitis while older men have Plantar Fasciitis. Due to increased overload on Foot , Stress fracture, and Osteoporosis, heel pain can occur. Besides that,Foot Pain could be due to Nerve damaging Diseases like Diabetes and Peripheral Neuritis.Below the heel bone, there is a bedding of fat, there lies  some fat in between nervous fibers.In progressing age,the fat layer of the nerves reduces and the nerve fibers deteriorate and because of that the whole weight of the body falls on the heel and heel pain occurs.The Mainstay of the Heel Pain is Physiotherapy.It uses Hot and Cold Fomentation,Short Wave Diathermy,Strengthening and Mobilizing exercises.The Patient should follow the dietary advice ,Eat fat-free diet,Should not consume fried and spicy food and Excess Sugar-containing food. If still, the problem persists,medical help should be taken.Some Useful Tips for Heel PainHot Fomentation For 10 minutes Daily.Use Pain Reveling Gel,Spray or Cream.Use Ice Fomentation For 10 minutes after injury.Exercise for Joint and Heel.Soak the feet in  warm salt water daily three to four times.Oil Massage of the feet daily.Use special footwear with extra padding on a heel. Pull the fingers of the feet first inwards than outwards.For feet, exercise uses the tennis ball.Place the tennis ball under the feet and roll.It increases the blood flow in the feet.Take Sessions of Acupressure from the expert,it reduces the pain by increasing the blood flow.

Diabetic Foot -What You Need to Know

Dr. Purushottam Reddy Padala, Orthopedist
Today diabetes  is an epidemic with more than 60 million diabetics in India. Every single minute, a toe or foot is lost to uncontrolled diabetes in India. Six to 8% of diabetics have neuropathy out of which 15-20% will have an ulcer the most dreaded complication of diabetes. Complications of diabetes include neuropathy (involvement of nerves of the feet). Neuropathy with loss of sensation is the prime cause foot ulceration and loss of toes due to gangrene.Why do diabetics develop loss of sensation in the feet?High sugars in a diabetic lead to damage of the nerves-called neuropathy. This is manifested initially by pins and needles sensation, and later by total loss of sensation. This loss of sensation is the danger sign. Our body protects itself from injuries when there is sensation, and loss of sensation leads to injury more commonly. In a diabetic injury is fraught with non-healing, chronicity and infection.Why does it take long for wounds/ulcers to heal in diabetes? High sugars lead to slowing of our body defenses which delays wound healing. Added to this, bacteria thrive on high sugars, making it difficult to eradicate infection. Narrow blood vessels in the foot get blocked (called microangiopathy). Healing is also slowed due to poor blood supply.How do you treat foot ulcers?We have various treatments for treating foot ulcers.If the wound is heavily infected then dead tissue requires to be cleared, usually surgically, called debridement. Appropriate antibiotics are used. Antibiotics work only when dead material is removed. The wound might require skin closure. Based on size and location, a wound might require closure with local skin adjustment-called local rotation flaps, or split skin grafting- taken from the thigh area. If the toe is dead due to infection, then the toe has to be removed-by amputation. What should I do to avoid Foot ulcers?First and foremost is control of high blood sugars. You have to use the right kind of medicines-insulin alone (many varieties around), tablets or both.Do’s Use mild soap Use a soft cloth to dry-between toes as wellMoisturize the foot after bathCutting nails straight  MCP-polymer soft footwearCustomizing footwear SELF EXAMINE FEET AT BEDTIME                                                                Don’tsKeeping feet dirtyNot wearing footwear at homeRepeated washing of feetCutting nails curvedUsing hot water to wash feetSmokingAlcoholThings to look for are:RednessBlistersCornsSoft soggy skin.Is there a way to treat neuropathy?Yes. Only few doctors in India do this kind of surgery. We are one of them. Three or four nerves are released in the leg. Most early cases of neuropathy recover very well with restoration to almost normal sensation in the foot.I have noticed that my father’s foot is flat and almost getting twisted? What is it and how can you treat it?This is called Charcot’s foot. It is almost as dangerous as a foot ulcer if not more. The joints in the body have a certain spatial orientation towards one another. In diabetes, nerve damage and lack of sensation can cause joints to be twisted relative to each other giving rise to dislocations and foot fractures-which are painless and seldom heal.Hope this helps!  

Causes and Symptoms of Heel Pain and 5 Tips That Help!

Rhea Lakhiani
The heel bone, referred to as the ‘calcaneus’ is the largest bone in the foot and serves as an attachment point to several muscles and tendons that help in walking, running and jumping.Heel pain can be very disabling as most people suffering from it, complain of discomfort on weight bearing, which causes them to limit basic activities like standing and walking.Heel pain can be categorized as pain under the heel or behind the heel. It can arise from a number of structures, but biomechanical faults or improper mechanics that load some areas in the foot more than others, tends to be a major contributor to heel pain.In this article, we will explore the spectrum of causes that can be responsible for heel pain:-PlantarfascitisThis is one of the most common causes of heel pain. The plantar fascia is a dense, fibrous connective tissue structure extending from the medial tuberosity of the calcaneus through the medial longitudinal arch inserting into the base of each of the toes. It is an important static support for the longitudinal arch of the foot.Over pronation or flat foot, strains the longitudinal arch which causes the plantarfascia to stretch excessively. This exerts a pull on the plantar fascia, especially at its origin on the medial process of the calcaneal tuberosity, thereby putting strain on its attachment at the heel.Patients typically complain of pain that is worse in the mornings especially when they take the first few steps after long periods of rest or inactivity.Fat pad syndrome/ Fat pad degeneration There is a cushion of fat which is made up of elastic fibrous tissue that acts as a shock absorber and protects the heel. Fat pad syndrome may develop either suddenly after a fall onto the heels or gradually due to thinning out from excessive loading and poor cushioning. Patients often complain of heel pain that is particularly felt during weight- bearing, mainly in the outer portion of the heel.Calcaneal (Heel) spurCalcium deposits may accumulate and build up on the under surface of the heel. This happens over time and is often caused by strains of muscles and ligaments of the foot or excessive stretching of the plantar fascia. Running or jogging on hard surfaces, excess body weight or improper footwear can cause repeated tearing of the membrane that covers the heel bone. This places excessive stress on the heel. Heel spur with no other associated abnormality may not be symptomatic. However, excessive repeated wear and tear can result in inflammation which may then lead to pain.Calcaneal Stress fractureAlthough a rare occurrence, it can be seen in athletes or people with overuse history and repetitive high impact activity, like runners, dancers or jumpers. There is diffuse pain over the entire heel, which tends to aggravate with loading activities. An X-ray or MRI is needed to confirm diagnosis.Achilles tendonitis, Haglund’s deformity and Retro calcaneal bursitis Haglund’s deformity also known as ‘pump bump’ is characterised by a prominence or tenderness over the back of the heel, and often causes it to rub against the tendon.This may predispose the bursa or tendon to mechanical irritation. Constant irritation causes inflammation of the fluid-like sac situated behind the heel between the tendon and heel bone. Inflammation of this bursa is called Retro calcaneal bursitis.The tendon connecting the calf muscles to the calcaneus also known as the Achilles tendon attaches to the back of the heel bone. Achilles tendonitis is commonly associated with repetitive impact loading due to running and jumping. Achilles dysfunction can also be related to postural problems (e.g.high arches, fallen arches), poor footwear, or tight calf muscles. These postural and biomechanical faults may alter the alignment of the tendon and cause rotation of the heel. This rotation of heel (inward or outward) may cause grinding or friction of the calcaneus against the tendon. Eventually, due to this constant irritation, a bony protrusion may develop and the bursa may become inflamed.Since the Achilles tendon insertion, the retro calcaneal bursa and the calcaneus are so intimately related, dysfunction in one area, commonly affects the other.Symptoms include pain, swelling, a noticeable bump and redness at the back of the heel which intensifies on walking, as the bony enlargement rubs against the heel counter of the shoe.As discussed, heel pain is common and could be due to various reasons. But like every problem has a solution, this one is no exception and most individuals respond well to treatment. There are a few practice suggestions that have proven to be beneficial for those suffering from heel pain. Regardless of what is causing you the heel pain, the following recommended tips are likely to help:-Relative rest: A fairly logical pointer! Avoid activities that cause pain or aggravate it.Cryotherapy: Icing the affected painful area helps decrease pain and control inflammation if any.Stretching: Plantar fascia and calf muscle stretching helps address the tight structures that may be one of the causes of pain. This helps in pain- relief and prevents recurrence.                                                           Calf stretchStretching of the plantarfascia4. Shoe modifications: Foot wear that has good support for the arches or has adequate heel cushioning can act like a buffer and reduces stress on the heel and other pressure areas along the foot. Eg: silicone gel heel pad, heel cups.                                                                                                                                                                                        Heel pads/ cups5. Bodyweight: If you are overweight there is more stress on the heels when you walk or run. Shedding off those few extra kilos won’t hurt!

Diabetic Foot, A Frightening Complication Of Diabetes

Dr. Anamay K. Bidwai, General Physician
Diabetic foot, after all it is your foot!Diabetic foot is a very common complication of diabetes, particularly in long standing diabetes or untreated kinds.Amputation of legs due to diabetes related complication is the second most common cause for amputations after traffic accidents.Diabetic foot infections can be limb threatening and/ or life threatening.You can prevent this dreaded complication by taking some simple measures every day.If you are a smoker stop now. If you have high cholesterol control it now.Always maintain good control of blood sugar level and be regular with your medicines and insulin.Walking is a MUST, if you want to prevent diabetic foot complication, please walk, walk, walk, at least 3-5 km in day. Please make sure you wear good quality sports foot wear while going for walk.Never walk bare foot, even inside house wear comfortable sandals, while going out wear shoes. No chappals please.Wear cotton socks, every day a freshly washed pair socks must be used. Wash your feet twice a day with normal soap and water, pay special attention to space between toes, dry feet with towel, and apply any moisturiser, even liquid paraffin or coconut oil is good enough.At bed time gently massage your feet for about 10-15 minute, it helps to improve circulation in the small blood vessels. Take vitamins B complex and omega 3 fatty acid supplements every day, it prevents degeneration of small nerves, a major contributor to diabetic foot.Take care while cutting toe nails, do not try to cut the nails too short or you may end up injuring the skin, sometimes it is better to use a nail file.If you notice an injury, scratch or crack on the foot, sole or any where on foot, immediately see a doctor, no matter how small the injury is.These simple measures can save your limbs from dreaded diabetic foot, you need to do it every day, life long.

Foot & Heel Pain - Plantar Fasciitis

Dr. A Mohan Krishna, Orthopedist
Heel pain is an extremely common complaint, and there are several common causes.Plantar Fasciitis:  It is the most common condition that causes heel pain. Plantar fasciitis is due to irritation and inflammation of the tight tissue that forms the arch of the foot. The most common symptom is pain under the heel after a period of rest, i.e. severe pain and inability to walk in the morning after getting up from sleep. The same might happen after sitting for a long time and then trying to walk. Interestingly the pain gets better after a few steps though it may not go away completely.  Again, the pain may get worse with prolonged walking and standing. X ray may show a bony spur which may develop in long standing cases of heel pain due to plantar fasciitis, but it may not cause the symptoms.Posterior Heel Pain:  Posterior heel pain causes symptoms behind the foot, rather than underneath. Posterior heel pain causes include Achilles tendinitis and retrocalcaneal bursitis. These patients may also develop bony growth behind the heel bone and when they are large may lead to rupture of Achilles tendon. Patients may have difficulty to walk comfortably on the affected side and pain that occurs at night or while resting.Treatment Options:Not all of these treatments are appropriate for every condition, but they may be helpful in your situation.1.Rest - Avoiding the precipitating activity; for example, take a few day off jogging or prolonged standing/walking.  Rest can reduce the severity of pain and will allow the inflammation to begin to cool down.2.Ice Packs - Icing will help to diminish some of the symptoms and control the heel pain. Icing is especially helpful after an acute exacerbation of symptoms.3.Exercises and Stretches - Are designed to relax the tissues that surround the heel bone. Some simple exercises performed in the morning and evening, often help patients feel better quickly.4.Anti-Inflammatory Medications - Help to both control heel pain and decrease inflammation.5.Shoe Inserts - Are often the key to successful treatment of heel pain. The shoe inserts often permit patients to continue their routine activities without heel pain.6.Injection therapy - In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.7.Removable walking cast - May be used to keep your foot immobile for a few weeks to allow it to rest and heal and is used only for severe cases.8.Night splint - Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.9.Weight reduction – It helps to reduce stress on foot and heel and thus help to reduce the severity of pain.If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered.Not being able to take first step out of bed in the morning can be frightening. More over severe pain from the heel may force you to restrict several day time activities. Except for a handful of cases and some uncommon conditions, most cases improve with treatment and time. Even though the time taken for the recovery may vary from person to person there is a natural tendency for these conditions to get better spontaneously.Stretching exercises:1.PLANTAR FASCIA STRETCH:Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold for 10 seconds and repeat 5 to 10 times.2.ACHILLES STRETCH:Stand on forefoot at the edge of stair, reach the step below with your heel, until you feel the stretch in the arch of the foot. Hold this position for 10 seconds and repeat 5 to 10 times.3.HEEL RAISE:Stand behind the chair or any support and raise your body up onto your toes and hold for 5 seconds. Then slowly lower down yourself. Repeat 5 to 10 times.4.TOWEL PICK:Drop a towel on the ground and pick up the towel with your toes. Release and repeat 5 to 10 times.5.FROZEN CAN ROLL:Take a frozen juice can or tin, roll your feet on the can from front to back. Do it for 3 to 5 minutes.6.TOWEL STRETCH:Loop a towel around your toes and pull the foot towards your body keeping your leg straight. Hold this for 10 seconds and relax. Repeat 5 to 10 times.

Non-Alcoholic Fatty Liver Disease (NAFLD)

Dr. Naman Ajudiya, Ayurveda
Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. It's usually seen in people who are overweight or obese. A healthy liver should contain little or no fat. It's estimated that up to one in every three people in the UK has early stages of NAFLD where there are small amounts of fat in their liver. Early-stage NAFLD doesn't usually cause any harm, but it can lead to serious liver damage, including cirrhosis, if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes, heart attacks and strokes.If detected and managed at an early stage, it's possible to stop NAFLD getting worse and reduce the amount of fat in your liver.  NAFLD develops in four main stages. Most people will only ever develop the first stage, usually without realising it. In small number of cases it can progress and eventually lead to liver damage if not detected and managed. The main stages of NAFLD are Simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells that may only be diagnosed during tests carried out for another reason non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD, where the liver has become inflamed this is estimated to affect up to 5% of the UK population   fibrosis – where persistent inflammation causes scar tissue around the liver and nearby blood vessels, but the liver is still able to function normally    cirrhosis – the most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and can lead to liver failure (where your liver stops working properly) and liver cancer It can take years for fibrosis or cirrhosis to develop. It's important to make lifestyle changes to prevent the disease from getting worse.Am I at risk of NAFLD?You're at an increased risk of NAFLD if you are obese or overweight particularly if you have a lot of fat around your waist (an "apple-like" body shape)    have type 2 diabetes    have high blood pressure    have high cholesterol   over the age of 50    smoke However, NAFLD has been diagnosed in people without any of these risk factors, including young children. Although it's very similar to alcohol-related liver disease (ARLD), NAFLD isn't caused by drinking too much alcohol. Symptoms of NAFLD There aren't usually any symptoms of NAFLD in the early stages. You probably won't know you have it unless it's diagnosed during tests carried out for another reason. Occasionally, people with NASH or fibrosis (more advanced stages of the disease) may experience a dull or aching pain in the top right of the tummy (over the lower right side of the ribs)fatigue (extreme tiredness) unexplained weight loss    weakness If cirrhosis (the most advanced stage) developsyou can get more severe symptoms such as yellowing of the skin and the whites of the eyes (jaundice) itchy skin swelling in the legs, ankles, feet or tummy.How NAFLD is diagnosed NAFLD is often diagnosed after a blood test called a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. However, blood tests don't always pick up NAFLD.The condition may also be spotted during an ultrasound scan of your tummy. This is a type of scan where sound waves are used to create an image of the inside of your body. If you're diagnosed with NAFLD, further tests may be needed to determine which stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan). Some people may also need a small sample of liver tissue (biopsy) taken using a needle to have it analysed in a laboratory.Treatment for NAFLDMost people with NAFLD won't develop any serious problems, but if you're diagnosed with the condition it's a good idea to take steps to stop it getting any worse. There's currently no specific medication for NAFLD, but making healthy lifestyle choices can help and treatment may be recommended for associated conditions (high blood pressure, diabetes and cholesterol) or complications.You may be advised to have regular appointments with your doctor to check your liver function and look for signs of any new problems.Healthy diet and lifestyle Adopting a healthy lifestyle is the main way of managing NAFLD. The following can all help  Lose weight – you should aim for a BMI of 18.5-24.9; use the BMI calculator to work out your BMI. Losing more than 10% of your weight can remove some fat from the liver and improve NASH if you have it.    Eat a healthy diet – try to have a balanced diet high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt. Eating smaller portions of food can help too.    Exercise regularly – aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week. All types of exercise can help improve NAFLD, even if you don't lose weight.    Stop smoking – if you smoke, stopping can help reduce your risk of problems such as heart attacks and strokes.NAFLD isn't caused by alcohol, but drinking may make the condition worse. It's therefore advisable to cut down or stop drinking alcohol.MedicationSome Helpful Herbs Bhumyamalaki – Phyllanthus niruriAmalaki – Emblica officinalisSharapunka – Tephrosia purpureaKatuki – Picrorrhiza kurroaPunarnava – Boerhavia diffusaKakamachi – Solanum 

Simple Breathing Exercises for Chronic Obstructive Pulmonary Diseases

Dr. Radhika Bharath, Physiotherapist
What is COPD?Chronic Obstructive Pulmonary Disease (COPD) is characterized by breathlessness (short of breath) or getting tired while breathing. COPD is an umbrella term for conditions such as chronic bronchitis, emphysema or a combination of both.Exercises of COPD• Deep breathing exercise:1) Diaphragmatic Breathing:- Sit Upright with back support- Look straight with chin neutral.- Place both your hands (palms one over the other) on your stomach (mid- abdomen)- Now take a deep breath in through your nose and feel your stomach move out (like an air filled balloon)- Make sure your chest does not move while breathing.- Once you have breathed in maximum, slowly breath out only through your mouth (as you blow a whistle) and feel your abdomen going inside.- Repeat this 10 time x 3 times a day2) Collateral Breathing: - Sit upright with back support - Look straight- Place your hands on the side of your chest wall (one hand on either sides)- Now take a deep breath in through your nose and feel the walls of your chest (rib cage) moving outwards as your chest expands.- No upper chest movement to be performed.- Now blow out the air through your mouth (as you blow a whistle) and feel the chest wall coming inside.- Repeat it 10 times x 3 times a day3) Apical Breathing:- Sit upright with a back support- Look straight, chin up- Place your palm across your upper chest (as the tips of your finger touch the collar bone).- Breath in through nose and feel the upper chest moving up.- Now once you have completely breathed in, slowly blow out through your mouth (as you blow a whistle) and feel your chest coming down to normal.- Repeat it 10 times x 3 times a day• Chest Expansion Techniques:1) Sit straight on a chair with back support (can also be done in lying).- Keep both the arms stretched out in front of the chest.- Now take your arms to the side and breath in through nose.- Slowly bring back the arms back in front of the chest and breath out through mouth.- Repeat 10 times 3 times a day.2) Sit on a chair with back support.- Keep both the arms stretched over head.- Bring both the arms to your shoulder level and breath in through nose.- Now gently take the hand back over head and breath out through mouth.- Repeat 10 times x 3 times a day.STAY HEATH WITH REGULAR EXERCISE!! GOOD LUCK!!

Most Common Foot Problems In Adults In India

Dr. Sanjay Sharma, General Surgeon
Ingrown toenails occur when a piece of the nail breaks the skin - which can happen if you don't cut your nails properly. Ingrown toenails are very common in the large toes. A doctor can remove the part of the nail that is cutting into the skin. This allows the area to heal. Ingrown toenails can often be avoided by cutting the toenail straight across and level with the top of the toe.Hammertoe is caused by a shortening of the tendons that controls toe movements. The toe knuckle is usually enlarged, drawing the toe back. Over time, the joint enlarges and stiffens as it rubs against shoes. Your balance may be affected. Wearing shoes and stockings with plenty of toe room is a treatment for hammertoe. In very serious cases, surgery may be needed.Corns and calluses are caused by friction and pressure when the bony parts of your feet rub against your shoes. If you have corns or calluses, see your doctor. Sometimes wearing shoes that fit better or using special pads solves the problem. Treating corns and calluses yourself may be harmful, especially if you have diabetes or poor circulation. Over-the-counter medicines contain acids that destroy the tissue but do not treat the cause. Sometimes these medicines reduce the need for surgery, but check with your doctor before using them.Dry skin can cause itching and burning feet. Use mild soap in small amounts and a moisturizing cream or lotion on your legs and feet every day. Be careful about adding oils to bath water since they can make your feet and bathtub very slippery.

Foot Arches and Its Types

Dr. Yogesh Kumar, Ayurveda
All right we all have done this growing up, remember after coming out of water we used to see the footprints that were made by water and wonder why my footprint is somewhat different from others. The difference is in the arches of the foot. Arch of the foot differ in individuals according to the positioning of foot bones (Tarsal and Metatarsal), tendons, ligaments and the amount of pressure being exerted on the feet over the period of time. The arch of foot plays a pivotal role in the health of feet on a long term. Ancient Indians used to take the footprints to determine the foot arches before making the footwear.The arch of a foot is the curve like shape best seen on footprints.Classification of arch (types of arch): The arch of foot is basically of three types. The Normal arch, Flat arch, and High arch. These three terms are generally used and are more known by normal public.The normal arch: It is the most found type of arch in human feet and is thought to be the best in all the types of foot arches as it is less likely to induce any foot problems because the weight of the whole body gets easily spread in this type of foot arch. People having normal foot arch are more likely to get away with foot injuries.The Flat arch: It is not found commonly, in this type the arch of the foot  do not bend over enough to absorb the pressure exerted by the body and hence is likely to cause injuries to the foot and cause pain and other problems. It is also called the low arch as the arch stays very low to the surface level.The High arch: In this type the arch of the foot is quite high than normal and the pressure do not gets evenly spread, rather most of the shock is diverted to toe and heel portion of the foot and hence this type of foot arch are more likely to cause problems of toe and heel.Anatomically the arches are of two types, longitudinal and transverse arch.Longitudinal arch: longitudinal arch is the one which is length wise, from top to bottom of the foot.The longitudinal arch is subdivided into three more arches namely, the medial arch, the lateral arch and the third one known as fundamental longitudinal arch.Transverse arch: This arch is in transverse direction which is breadth wise involving three ligaments (plantar,dorsal and introsseous )and two muscles (Adductor hallucis and Peronaeus  longus). Knowing your arch of foot is very important, when you know your foot arch type you can easily find out whether you are using the right footwear or not and hence can eliminate most of your foot problems.  A very popular and simple test in which your foot prints are taken by stepping your wet feet on paper to find out what is your arch type is and your physician will advice you the right foot wea

Diabetic Kidney Disease - Your Awareness Guide

Dr. Ashwinikumar Khandekar, Nephrologist
India is the capital of kidney diseases in the world. Commonest cause of kidney disease in India is diabetes mellitus (DM).There are two types of diabetes. Type 1 is Insulin Dependent Diabetes Mellitus (IDDM), which manifests in childhood and depends only on insulin administration for sugar control.Type 2 where an adult, usually over 30 years of age is found to have diabetes and can be treated with oral medications (Non Insulin Dependent Diabetes Mellitus [NIDDM]).We will discuss common kidney problems in diabetes and their early detection and treatment.Anatomy and PhysiologyBefore we discuss how diabetes affects the kidney, the reader is suggested to review the pertinent anatomy. Click here for a brief overview.. What is Diabetic Kidney Disease ?When blood sugar levels are abnormally high for a long period of time, they cause changes in the small blood vessels including those that supply the kidneys.These changes significantly affect the blood vessels of the glomerulus altering its functional abilities.The affected filter leaks protein in the urine. If untreated, damage to the filter continues, kidneys begin to fail and when the function falls below 10% of normal, artificial means to purify blood (dialysis) are needed.However, if sugar control is achieved early and consistently, this damage can definitely be delayed by a long period of time.Can we detect it early?Even before protein loss is evident in urine, microscopic changes are already present in the kidney, especially in the glomerulus (the ‘filter’).The protein loss is in very small amounts and is detected by special tests. This stage is called the ‘Microalbuminuria’ stage and precedes the more advanced involvement of kidneys and therefore better amenable to interventions.If filtration capacity is measured at this early stage, it would be found to be paradoxically higher than normal.If intervened at this stage, severe damage can be prevented.How does the disease progress?This stage then evolves into varying degrees of protein losses in the urine, over the subsequent 5 to 10 years, before reaching the final stage where all the glomeruli undergo irreversible damage and manifest itself as advanced kidney failure.If not intervened at this stage, there is usually a steady downhill course hereafter and therein lies the importance of screening patients with diabetes for kidney involvement. In type 1 diabetes, approximately 10 – 20 % patients reach this stage by after 5 to 15 years of diagnosis.Type 2 diabetes patients are usually found to have complications of diabetes at diagnosis and rarely kidney failure may bring diabetes to notice.One symptom that is peculiar to kidney involvement is that, when kidneys begin to fail, sugar control improves. This is because insulin, the hormone that reduces blood sugar level & is normally destroyed by the kidney, is no longer destroyed in failing kidneys. Sometimes the sugar levels go abnormally low, occasionally needing hospitalization.So, when a long standing diabetic patient has an ‘improved’ sugar control or sugar levels fall ‘low’ too frequently, kidney involvement should be suspected.What is the relation with the eyes?Just as small blood vessels of kidney are affected by diabetes, so are the small blood vessels of the retina in eyes. This is detected by an ophthalmologist by a simple eye check done in the out patient department (OPD).Involvement of the eyes and kidney go hand in hand. If eye involvement is noted, evidence for kidney involvement must be actively sought and vice-versa.Conversely, if a diabetic has significant protein loss in urine, but blood vessels of the retina are normal, the involvement is less likely to be because of diabetes and other causes should be searched for.