Diabetic Foot

Diabetic foot is a condition that affects individuals with diabetes, characterised by various foot problems such as neuropathy, infection, and poor blood flow.

Neuropathy, or nerve damage, can cause numbness, tingling, and pain in the feet, making it difficult for a person to detect injuries or cuts. Poor blood flow can make it difficult for wounds to heal and can increase the risk of infection.

Left untreated, these complications can lead to severe infection, amputation, and even death. People with diabetes should take steps to protect their feet, such as regularly inspecting them for cuts or sores and wearing shoes that fit well and provide good support.

They should also work with their healthcare provider to manage their diabetes and blood sugar levels to reduce the risk of complications.

While diabetes is the root cause of a diabetic foot, two primary factors cause diabetes-related foot conditions. These are:

Damage to the nerves: One of the most common complications of diabetes is Diabetic Neuropathy. In this condition, constant high levels of blood sugar damage the nerves. One in every two diabetics faces this condition where nerves in the hands, legs, and feet are affected.

Patients suffering from diabetic neuropathy do not feel pain in the limbs. Hence, they do not realise the presence of any cuts or sores. As a result, they intensify into diabetic foot problems.

Lack of adequate circulation: Many diabetics with higher blood sugar levels also suffer from Peripheral Artery Disease or PAD. In this condition, the arteries get blocked or narrowed. This makes it harder for the blood to flow causing poor circulation in the extremities.

A wound needs proper circulation to heal. With poor circulation, any wound on the feet doesn’t heal faster and causes complications.

Diabetic foot symptoms can include any of the following:

• Numbness or tingling in the feet or toes

• Foot or ankle pain or cramps

• Foot or ankle weakness

• Dry, cracked skin on the feet

• Slow-healing sores or cuts on the feet

• Foot or ankle infection

• Ulcers or sores on the feet that do not heal

• Gangrene (tissue death) in the foot

• Amputation of toes, feet, or legs in severe cases.

It is important for individuals with diabetes to regularly check their feet for any of these symptoms and to seek medical attention if any are present.

Diabetic foot complications can occur due to nerve damage (neuropathy) and poor circulation (vascular disease) associated with diabetes. Some common complications include:**

Ulcers or sores: Diabetic neuropathy can cause loss of sensation in the feet, making it difficult to detect injuries or blisters. This can lead to ulcers or sores that do not heal easily.

Infections: Poor circulation and decreased ability to fight off infection due to neuropathy make people with diabetes more susceptible to foot infections, which can lead to amputation if not treated promptly.

Charcot foot: This is a condition in which the bones in the foot become weakened and begin to shift out of place. It is caused by nerve damage and poor blood flow and can lead to deformities and chronic pain.

Peripheral artery disease (PAD): PAD is a narrowing of the blood vessels that supply blood to the legs and feet, caused by plaque build-up. PAD can lead to poor wound healing, increased risk of infection, and amputation.

Gangrene: This is a serious complication that occurs when the blood supply to a part of the foot is cut off, causing the tissue to die. Gangrene can lead to amputation if not treated immediately.

It is important for people with diabetes to regularly check their feet for any signs of complications and to seek prompt medical attention if they notice any changes. Regular foot care, including proper hygiene and regular visits to a podiatrist, are essential to prevent complications in Diabetic Foot.

Diabetic foot is a progressive condition that can be divided into four Stages:

Stage 1: Early diabetic foot:** At this **Stage, there are no visible signs of wound or infection, but there may be symptoms such as tingling, numbness, or burning in the feet. This is caused by nerve damage (neuropathy) and poor circulation. People with diabetes should be particularly vigilant about checking their feet for any signs of injury or changes in skin colour, temperature, or sensation.

Stage 2: Diabetic foot ulcer:** At this **Stage, a wound or ulcer has developed on the feet. These wounds are often caused by minor injuries or pressure points that are not noticed or treated on time. The wound may be shallow or deep, but it is important to address it immediately to prevent further complications.

Stage 3: Diabetic foot infection:** At this **Stage, the wound or ulcer has become infected. The infection can spread to the bones, tendons, and surrounding tissue. Treatment at this **Stage may include antibiotics, wound care, and/or surgery to remove the infected tissue.

Stage 4: Diabetic foot amputation:** At this **Stage, amputation may be necessary to prevent the spread of infection and save the person's life. This can be a traumatic and life-changing experience, and people with diabetes need to be aware of the risks and take steps to prevent the progression of diabetic foot.

Diabetic foot diagnosis typically begins with a physical examination of the feet and legs. The healthcare provider will look for signs of neuropathy (nerve damage) and poor circulation, which are common in people with diabetes. They may also check for sores, ulcers, or other injuries on the feet.

Additional tests that may be performed to help diagnose diabetic foot include:

• Monofilament test to check for loss of sensation in the feet

• Vibration perception threshold test to check for nerve damage

• Ankle-brachial index (ABI) to check for poor circulation

• X-rays or other imaging tests to check for bone or joint problems

• Culture or wound biopsy to check for infection

It is important to be aware of the symptoms of Diabetic Foot and to have regular foot exams to detect any problems early on. Foot care is especially important for people with diabetes, including regular foot inspections, proper foot hygiene, and comfortable, properly fitting shoes.

Diabetic foot can lead to serious complications, including amputation, if not treated properly. Early diagnosis and proper management are essential for preventing these complications.

Treatment for diabetic foot depends on the specific condition and its severity. The main goal of treatment is to prevent infection and promote healing.

In the case of minor injuries, such as cuts or blisters, the wound is cleaned and covered with a sterile bandage. If an infection is present, antibiotics may be prescribed.

If a person has an open sore or a diabetic foot ulcer, the wound is cleaned and dressed regularly to prevent infection. Off-loading, which takes the weight off the affected foot by using crutches, a wheelchair, or a special shoe, is also important for diabetic foot ulcer treatment.

In more severe cases, surgery may be necessary to remove dead tissue and promote healing. In some cases, amputation may be necessary to prevent the spread of infection.

In addition to the specific treatment for the wound, people with diabetic foot should also take steps to control their blood sugar levels and to improve circulation in their feet and legs. This may include taking medications, such as insulin or blood sugar-lowering drugs, and making lifestyle changes, such as following a healthy diet and exercising regularly.

Regular follow-up care is also essential for people with Diabetic Foot to monitor the healing process, check for signs of infection, and make any necessary adjustments to the treatment plan.

Preventing diabetic foot is an important aspect of managing diabetes. The following are some key steps that can be taken to prevent diabetic foot:**

Control blood sugar levels: High blood sugar levels can damage nerves and blood vessels, leading to diabetic foot. Keeping blood sugar levels within a target range, as recommended by a healthcare provider, is essential for preventing diabetic foot.

Regular foot exams: People with diabetes should have regular foot exams to check for any problems, such as sores, calluses, or ingrown toenails. These should be performed by a healthcare provider or a podiatrist (foot doctor) trained to detect and manage a diabetic foot condition.

Proper foot hygiene: Keeping the feet clean and dry is important for preventing infections. This includes washing the feet daily with soap and water, and drying them thoroughly, especially between the toes.

Wearing appropriate footwear: People with diabetes should wear shoes that fit well and provide foot support and protection. Shoes should be comfortable, have a non-slip sole, and be wide enough to accommodate any foot deformities resulting from diabetic neuropathy.

Smoking cessation: Smoking can cause peripheral artery disease, increasing the risk of foot complications.

Exercise: Regular exercise can help improve circulation, which is important for preventing diabetic foot.

Control blood pressure: High blood pressure can also damage blood vessels and nerves, leading to diabetic foot. Keeping blood pressure within a target range, as recommended by a healthcare provider, is important for preventing diabetic foot.

Regular check-ups: Regular check-ups with a healthcare provider are important for monitoring diabetes and preventing diabetic foot complications.

By following these preventive measures, people with diabetes can reduce their risk of developing diabetic foot and other complications associated with diabetes.

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