Centres of Excellence -> Endocrinology and Diabetes -> Diabetic foot

Diabetic foot

Diabetic foot refers to the changes that occur as a result of the interaction of diabetic angiopathy (microangiopathy and macroangiopathy) and neuropathy.

As a result of these processes, deformations, sores (ulcers) and gangrene of the foot occur which ends in the loss (amputation) of the leg as the final outcome. Diabetes is the most common cause of non-traumatic leg amputations. Diabetic ulcer (ulcer) is a critical central event of the cascade of diabetic foot syndrome, hence the saying "no ulcer, no amputation. If poor circulation prevails, an ischemic form develops: a skin defect and an ulcer that are painful and tissue death and dry skin can develop gangrene. If nerve damage prevails, a neurotrophic ulcer will appear which is usually not painful and the defect is usually extensive and painless.

Due to neuropathy, even minor trauma caused by, for example, uncomfortable shoes, walking without shoes or an acute injury can favor the development of a chronic ulcer. Loss of sensation, foot deformities and reduced joint mobility can cause inappropriate biomechanical load on the foot. After the usual callus formation, the skin breaks which is preceded by subcutaneous bleeding. As the patient has no sensation, he continues to walk and healing is difficult. Tissue damage favors the development of various microorganisms. In conditions of reduced perfusion when the needs of the inflamed tissue require a multiple increase in blood flow, then this amount of blood cannot be delivered to the inflamed tissue due to weakened circulation and necrotic tissue with local hypoxia and acidosis becomes a good substrate for the growth of anaerobic bacteria.

The spread of infection is also facilitated by the weakened function of leukocytes. Infection develops when microorganisms overcome natural defense mechanisms. The clinical picture of the diabetic foot is dominated by three basic forms of infection complications: ulcers on the lower side of the foot, phlegmon on the upper side of the foot and abscess of deep tissues, bones and/or joints. Diabetic foot is treated by a multidisciplinary team: diabetologist, vascular surgeon, plastic surgery specialist and microbiologist.

In order to prevent diabetic foot, it is important to teach the patient about foot care: maintaining hygiene, proper drying, especially of the space between the toes and applying moisturizing creams, sprinkling powder between the toes, removing deposits of the dead layer of skin with mild abrasives, cutting nails straight and not too short, wearing suitable shoes made of natural materials (rubber only for rain, snow and sports) inspect the inside of the shoes for unevenness and socks made of wool or cotton that must not be tight or have rough seams, never walk barefoot, especially if the feeling in the feet is weakened, avoid getting close to the feet source of heat and putting your feet on a hot radiator, stove or in hot water, check the temperature of the water with your elbow before taking a bath or shower.

The patient should monitor the foot himself daily using a mirror to look at the bottom of the foot (sole) and if this is not possible due to poor vision or poor mobility, then the help of a family member is needed. If you notice any changes on your feet (skin discoloration, corns, calluses, sores, scratches) then you should consult your doctor. To improve circulation it is good to do light exercises with the feet: move the toes forward and backward, make circular movements from the ankle joint. The development of the foot ulcers is mainly a reflection of our care for the patient, that is, the patient's care for himself. That's why Joslin, the famous American diabetologist wrote almost 90 years ago that "diabetic gangrene is not God's punishment, but our failure".

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