The term diabetic foot is used to describe a foot that presents with a pathological condition (diabetic ulcer, infection, neuropathic osteoarthritis) associated with diabetes. Diabetic foot manifests after several years of unregulated diabetes, more often in type I diabetic patients (namely, people with insulin requirements).
What predisposes patients with diabetes to the development of diabetic ulcers?
There are two main complications that patients with diabetes have and are responsible for the development of diabetic ulcers:
- Peripheral neuropathy
Nerves receive messages related to pain or other stimuli (such as touch, temperature) . Even a small increase in blood glucose levels over the years can lead to the destruction of some foot nerves. This complication is called peripheral neuropathy and results in a decrease in the sensitivity of the feet and a reduced ability of the person to understand if their foot has been damaged. This means that small cuts or bruises can go unnoticed and slowly get worse and develop into ulcers.
- Peripheral arterial disease
People with diabetes have an increased risk of developing narrowing of the arteries. The arteries inside are smooth, but due to the deposition of calcium, cells and fibrous tissue, their walls may become thicker. These deposits are the atherosclerotic plaque. This accumulation causes arteries to narrow or block, resulting in reduced blood flow to various parts of the body. The arteries of the legs are very often affected resulting in poor leg blood circulation. Thus, due to insufficient perspiration the skin cannot heal quickly and a small cut that remains open can develop into an ulcer.
Diabetic foot – Clinical picture
Patients with diabetic foot may notice that:
- their foot is swollen
- the skin breaks or there is a wound
- the foot is warmer
- its shape has changed or its color has changed
- the foot has a stronger odor
- there is a bubble or callus
When a diabetic patient notices any of the above symptoms it is advisable to visit their doctor. Early treatment is extremely important.
When is a patient at risk of developing diabetic ulcer?
If diabetes remains unregulated for many years the chances of complications are increased, while poor leg blood circulation is an aggravating factor. Patients should pay attention to the hygiene of their feet and visit their doctor periodically for the necessary check-up.
Diabetic foot: Treatment
Diabetic foot can be prevented with proper care. Research has shown that diabetic patients who take care of their feet and protect them from injury significantly reduce the chance of developing a diabetic ulcer. Foot care includes:
- Thorough examination of the feet daily (and on the toes) for any bruises, redness, cuts, etc. When the person himself is having difficulty, a familiar person can do it.
- Daily cleaning of the feet and careful wiping.
- Use of moisturizer to maintain skin elasticity and avoid cracks.
- Careful cutting of the nails.
- Choosing the right shoes (low heel, enough space in the front, proper fastening).
- Walking with shoes and not barefοοt.
- Stop smoking to reduce heart and vascular problems that may affect blood circulation in the legs.
How is diabetic foot treated?
The treatment of diabetic ulcers depends on their severity and extent. The doctor will assess the condition and proceed with the appropriate treatment. The goal is the immediate healing of the ulcer. With the clinical examination and the ultrasound of the arteries of the lower limbs, the doctor will check the blood flow and the presence or absence of peripheral arterial disease.
When peripheral arterial disease is ruled out, treatment includes taking antibiotics. In the case of superficial ulcers, the lesion is surgically cleaned or special patches are used. After cleansing, the patient with diabetic foot should be especially careful not to put any pressure on the area while the doctor monitors the patient’s progress once a week.
When the ulcer is not infected, silver pads are used which help in faster healing and prevent any infections.
In cases where the ulcers reach deeper parts of the foot, after surgical cleansing, antibiotics are given intravenously and the patient remains in the hospital for follow-up and further examinations.
When there is a problem of arterial disease, it is very important to restore blood circulation in the diabetic foot because the patient is faced with the risk of amputation. Depending on the level of damage, reconstruction can be obtained by:
- surgical bypasses (using a synthetic or venous implant): in this operation an implant is placed at the points before and after the blocked part and in this way a bypass is created through which the blood passes.
- endovascular techniques (balloon, stent): during the operation, the blocked arteries are opened to restore blood circulation to the diabetic foot. The fact that it is a minimally invasive technique is very important if we consider that the viability of the diabetic foot is directly affected by the wounds.