Diabetic Foot

Diabetic foot is unfortunately a relatively common complication of long-lasting diabetes. Many cases of diabetic foot eventually lead to an extensive amputation. This is often unnecessary because the risk of complications can be quite easily reduced by the patient himself.

Causes

The condition is primarily cause by hyperglycemia, i.e. the elevated level of blood glucose. High blood sugar damages both big and small blood vessels and accelerates the process of atherosclerosis and causing narrowing of the arteries. The arteries of the lower extremities are usually affected; sometimes we speak about peripheral artery disease (PAD). The supply of oxygen and nutrients to leg tissues is logically inadequate. Chronic hyperglycemia also causes damage to nerves (diabetic polyneuropathy) leading to tingling sensations and sensitivity disorders in the lower extremities. Sensitivity disorders cause a more easy injury that is underestimated because of inadequately mild pain or no pain at all. If an injury occurs in soles or toes, the diabetic does not have to notice it. Glucose is an important nutrient for the bacteria and diabetics tend to have slower wound healing and weakened immunity causing an easy infection of any wound.

 

When the above mentioned factors combine, the diabetic foot can occur. The patient injures his foot, underestimates the wound, the wound does not heal, it gets infected by bacteria and the infection further prevents the wound from healing. The infection can spread and cause a sepsis or gangrene.

Symptoms

Diabetic foot manifests as a chronic defect occurring anywhere in the leg. However, the most common locations are soles under the fingers, on the thumb and on the heel.

 

Diabetic_foot

 

Scheme -Areas of the most common formation of defects on the sole in diabetic foot (filled)

Prevention

Prevention is very important as once formed defects are difficult to treat. The diabetes should be cautiously treated and the patient regularly monitored including the check his or her feet.

 

 

It is necessary to minimize the risk of injury of the extremities by wearing special socks and high-quality shoes. Adequate hygiene and skin care must be maintained including very cautious nail trimming (it is better to use a nailfile than sharp scissors). If a wound occurs, it is important to visit a doctor and treat it properly (sterile covers, local therapy, antibiotics in infection). If such wound occurs in a patient with suspected peripheral artery disease, it is important to perform angiography to diagnose the artery narrowing and treat it by an endovascular intervention or by surgical creation of an arterial bypass (see text about PAD).

Treatment

The therapy consists of hygiene, coverings and regular changing of the dressing. If there is an infectious complication, we administer antibiotics. When the situation in unsolvable conservatively, it is necessary to treat surgically. Surgeons remove the dead tissue and clean the wound. When this does not help, a local amputation must be performed. The problem is that one amputation may not be enough as the stub in a diabetic also heals inadequately and it can get infected as well leading to a more extensive amputation. Even a small infection of a finger can end in amputation below the knee or even higher.