What is Diabetic Foot?
In patients with unstable chronic diabetes, which is characterised by sudden rises and falls in blood sugar, many complications arise over time. First, numbness in the feet and weakness in vascular blood flow begin. Due to sensory defects in the legs, small wounds on the feet cannot be easily recognised. Therefore, in these diabetic patients whose treatment is delayed, the wounds grow and rapidly become infected. This complication process, which leads to amputation of the foot, progresses very rapidly. Unfortunately, in order to prevent the spread of the infection, the toe, the whole foot or even part of the leg may have to be amputated.
In whom are foot disorders due to diabetes most common?
1. Patients with nerve damage in their feet and generally weakened leg blood flow,
2. Diabetic individuals with diabetes for a long time
3. Overweight patients (BMI level higher than 25)
4. Diabetic patients with high blood pressure and high cholesterol levels
5. Patients who cannot maintain normal blood glucose levels due to sudden episodes of hyperglycaemia
How common are diabetes-related foot conditions?
The chance of developing foot disorders in a person with diabetes is about 15 per cent. However, this is much higher in patients with unstable (labile) diabetes
Causes and Symptoms of Diabetic Foot
Long-term high blood sugar can cause a type of nerve damage called diabetes-related neuropathy. Diabetes-related neuropathy can occur not only in the feet but also elsewhere in the body. However, it is most commonly seen in the legs and feet. If neuropathic patients have numbness in their feet due to decreased sensory perception ability, it becomes difficult for them to notice injuries such as blisters and cuts that may occur even with very simple strains. These simple irritations quickly turn into wounds. Simple wounds that go unnoticed and untreated can quickly become infected.
Diabetes can affect blood flow to the feet over time. As a result, peripheral artery disease (PAD) occurs in people with diabetes. This causes narrowing and even blockages in the arteries. As a result of decreased blood flow in the feet, progressively deeper wounds occur. It can become infected in a short time and recovery becomes increasingly difficult.
What are the symptoms of diabetic neuropathy?
Symptoms of diabetes-related neuropathy may include: In the affected area; There is a decrease in the ability to perceive hot or cold. Due to poor circulation, the color of the skin gradually darkens. Hair falls out in the area and the skin tissue’s ability to detect objects touching it gradually weakens. Irritation pains that feel like tingling are typical. Since vascular circulation is weakened in diabetic neuropathies, the ability of problematic tissues to repair themselves is weakened. Tissue deterioration that begins with scratches, blisters and calluses quickly turns into deep wounds on the foot. Skin problems are often accompanied by toenail problems.
Symptoms of diabetic foot
- Serum leakage or pus discharge at the wound site
- Bad smell
- Pain skin discoloration
- Local or general swelling in the foot
How Are Diabetes-Related Foot Disorders Diagnosed?
It is necessary to pay attention to some tips to diagnose diabetes-related foot problems early. In the questionings to be made to the patient, especially the following should be paid attention to.
A. It should be learnt how many years ago diabetes was diagnosed,
B. How patients manage their blood glucose levels during this process should be questioned
C. Patients should be asked to check the skin of their own legs, feet and fingers at regular intervals. Even the slightest redness should be carefully searched for and monitored before the wound is opened. If necessary, a mirror should be used or someone else should be asked for help. This is because redness, swelling, warmth, discolouration or discharge may be a sign of a rapidly developing serious infection.
D. The toes, the lower part of the leg should be touched with a sharp object and the patients themselves should be monitored whether there is a sensory defect in the foot.
Definitive Diagnosis in Diabetic Foot Disease
For the definitive diagnosis of diabetic foot disease, imaging of the area (ultrasonography, direct X-ray, CT and MRI) is required. Visualisation of the flow in the arteries feeding the foot (vascular doppler examinations) must be performed. In addition, photographs of the foot from the same angle should be taken once a week to monitor the progression of the disease. To confirm the presence or type of infection, swab or discharge samples should be taken from running or open wounds of the foot and examined (wound culture and antibiogram).
Peripheral angiography is used to determine whether the blood vessels in the leg are functioning actively enough. Vascular surgeons or interventional radiology specialists detect narrowed or blocked leg veins millimetrically and use special applications to open the veins and restart circulation.
Apart from this, foot wound care (wound dressings-vacuum systems etc.) should be performed at regular intervals and infection should be kept under control. Supportive therapies (ozone- alpha lipoic acid-glutation) and hyperbaric oxygen treatments in special centres are among the applications that will always be used.
How to Reduce the Risk of "DIABETIC FOOT"?
- To reduce the risk of diabetic foot, patients should carefully monitor their blood sugar levels.
- In addition, the external appearance of the feet should be carefully checked every day. Of course, in order to avoid diabetes-related wounds and neuropathy, these follow-ups should be continued from time to time in a health institution.
- Toenails should be cut properly and ingrown toenails should be prevented. Calluses should be cared for.
- In order to increase blood flow to the feet, the toes should be moved frequently and the feet should always be kept slightly elevated. Of course, you should always stay active, but movements should be slow and careful to avoid injuries to the feet.
- Diabetic patients should look after their feet as if they were their eyes,
- Therapeutic shoes or splints should be worn to prevent wounds.
- Powder should be placed between the toes to prevent dampness. Body hygiene should also be observed and feet should be washed in warm water. But then dry them thoroughly between the toes.
Things Diabetes Patients Should Definitely Not Do?
Diabetic patients should never smoke. Feet should not be left wet and bare feet should not be walked around in any way. Tight socks and shoes should be avoided.
When should I seek medical help for foot pain due to diabetes?
- Loss of sensation in the toes, feet or legs
- Wounds, redness, warmth or an atypical odour on the foot
- Thickening, yellowing and darkening of toenails
- Hair loss on the feet or legs
- The appearance of pain, tingling, burning or cramps in the feet
Classification of Diabetic Foot Risk
For this purpose, a careful foot examination of the patient should include
- Checking the pulse in the arteries in the foot
- Testing the foot sensation using a thin and sharp object or vibration
- The feet should be checked for any wounds or deformities. The shoes of the diabetic should also be examined. Deformities in the shoe, the shape of the worn or pressed side should be examined.
As a result, the risk of diabetic foot;
Low
Centre
Classified as high.
Negative Pressure Wound Therapy
Negative pressure wound therapy is an increasingly common method of treating diabetic foot ulcers. The aim is to remove the wound fluid from the wound through a closed vacuum. This will stimulate increased blood flow in the deeper tissues and the formation of granulation tissue on the ground. Growth factors and skin substitutes stimulation of wound healing by bio-physiological methods give very useful results. Studies have shown that various growth factors such as platelet-derived and epidermal growth factor make important contributions to the healing of diabetic wounds.
Fighting Infection in Diabetic Wounds
In case of infection, it is necessary to identify the source of infection under the management of infectious disease specialists and to administer the correct antibiotics, which are defined as pinpoint antibiotics, for adequate periods of time.
In the meantime, the wounds should be checked frequently and the dead tissues should be removed (debridement). This procedure can be performed at the patient’s bedside or in the operating theatre to protect muscles and tendons in larger wounds.
DIABETIC FOOT WOUND TREATMENTS
Negative Pressure Assisted Wound Treatment (VAC)
It is a method of applying controlled and localised negative pressure to the wound area to accelerate healing in acute and chronic wounds. Thanks to its prophylactic negative drainage effect, it provides drainage of chronic wound fluid in the wound area, leaving the wound surface clean and reducing the number of bacteria. With the effect of pressure, it dissolves the oedema in the cells, increases blood supply and provides cell nutrition, which accelerates wound healing.
Wound Treatment with Intermittent Positive Pressure
It is especially preferred in venous ulcers and lymphatic obstructions. They are tools whose pressure and duration can be adjusted, used to reduce oedema and to provide nutrition to the wound by regulating blood circulation. It can be used in all kinds of wounds where the negative effect of oedema is seen.
Wound Treatment with Stem Cell
The fats taken from the navel area by liposuction method under local anaesthesia in the amount of 20-50 cc are processed in special laboratories, separated into stem cells and reproduced. They are sent to the clinics ready to be injected into the wound with 2-5 cc injectors. The application is carried out by injecting the liquid containing stem cells into the entire wound surface. Stem cells heal the wound by switching to the damaged cell position required by the wound.
Wound Treatment with Growth Factor
Heberprot-P, used especially in diabetic foot ulcers, is a human growth factor applied intra-lesionally directly to the wound. (FCHrec.) Heberprot-P has been a unique treatment modality for stubborn chronic wounds and has played an effective role in the amputation rate by increasing the healing rate and reducing recurrence.
Hyperbaric Oxygen Therapy
It is a treatment method based on 100% oxygen inhalation of the patient who is completely pressurised in a pressure chamber. It can be applied for different durations depending on the patient and the disease. Single, multi-person, single compartment, multi-compartment pressure chambers can be used for treatment purposes. Dissolved oxygen has antihypoxic, antioedema, antitoxic, antibacterial, and helpful properties in the correction of impaired wound healing.
Ozone Therapy
In ozone therapy, wound healing is accelerated due to the increase in oxygen level in tissues. In ozone therapy, the anti-microbial effect of ozone can be used directly, as well as indirectly with its stimulating effect on the immune system.
Modern Wound Care Dressings
In chronic wound treatment, many different modern wound care dressings are used according to the wound surface, age and general condition of the patient in order to perform wound treatment by keeping the wound surface clean, maintaining the heat and moisture of the wound area, and controlling the infection.