Diabetic foot: causes, symptoms, treatment methods
Diabetes mellitus is one of the most dangerous diseases, which is accompanied by a large number of additional complications, and the diabetic foot (aka SDS) is the most formidable among them. According to statistics, such an ailment occurs in 15% of people who have been suffering from high blood sugar levels for 5 years or more.
What is VTS?
Diabetic foot syndrome is formed due to pathological changes in the functioning of the nervous system, arterial and capillary beds. As a result of these processes, ulcerative-necrotic formations arise, subsequently leading to gangrene. The disease is expressed in the form of an ulcer that forms on the surface of the foot, but that’s not all. In advanced stages, the patient’s joints can be seriously affected (purulent arthritis appears) and the complication can have a destructive effect on the state of the bone tissue.
What provokes the disease?
The causes, symptoms and treatments for a diabetic foot is a vast topic that needs careful study. Consider the factors affecting the development of the disease:
- Severe dryness of the skin;
- Deformation of the anatomy of the foot (manifested due to low sensitivity of the limb);
- Impaired blood circulation in arteries and small vessels;
- Ignoring the problems of the state of their own feet, again, due to reduced sensitivity.
Self-diagnosis and constant monitoring of the condition of the feet is an important point in the process of home therapy! A conscientious attitude towards one’s own health allows you to detect an ailment in time and take up its elimination. Modern treatments are effective in combating SDS.
How does the problem affect the body?
Diabetes is characterized by the fact that the hormone insulin, which is responsible for the processing of glucose obtained from food, is in short supply. It is not enough for the normal process of delivery of the substance to the cells of the body, because of which the vessels are clogged, and ischemia (insufficient blood supply) is formed. As a result, nerve fibers become under attack, the sensitivity of the limbs decreases (the fingers first of all suffer, and only then the feet, palms). Wounds also heal more slowly. Even a small wound on the surface of the foot eventually develops into an ulcer. If you run it, the injury will provoke gangrene, and any abrasion or crack on the skin is comparable to a time bomb. Finding a wound is a serious difficulty, since it becomes difficult to notice it under the stratum corneum. Modern treatments for diabetic foot may not work if the problem is discovered too late. Due to impaired sensitivity, the patient may not even notice an open wound, but additional trauma during walking leads to an aggravation of the problem. The result is limb amputation, since the ulcer affects not only the skin, but also the tendons and bone tissue.
In medical practice, there are “diabetic foot rooms”. Statistics show that 70% of amputations in the world are due to diabetes, and with timely treatment, 85% of such cases could be prevented. With the help of qualified pediatricians, the death rate from diabetes mellitus was reduced by 2 times. It is extremely important to monitor your own condition, and periodically examine, palpate the limbs to look for foot injuries.
Danger of reduced sensitivity
As the elevated glucose levels constantly affect the nerves, the tissues gradually atrophy. Pathology is not dangerous in itself, since it does not cause necrotic processes. The threat lies in the following factors:
- There is a slow decrease in pain sensitivity and the rate of wound regeneration;
- The patient does not notice discomfort when wearing the wrong shoes. Burns or frostbite are also difficult to notice;
- The result is a constantly progressive trophic ulcer.
Diabetics need to be careful about the choice of footwear, since 33% of cases of SDS are just dependent on this factor.
Danger of impaired blood flow in arteries and capillaries
Damage to the tissues of the legs often occurs due to atherosclerosis, and the patient’s legs are affected first of all, which leads to a serious deterioration in the quality of life and health. Main risks:
- The pathological process occurs simultaneously on both legs;
- The risk of developing the disease at an early age increases, in contrast to people without problems with blood sugar levels.
The danger of atherosclerosis lies in the fact that this ailment independently provokes necrosis of the skin, and ulcers occur without mechanical damage. If the patient is not aware of the risks, then even with the formation of a small scratch, the area of the trophic ulcer becomes much larger. When the problem is ignored, the most dramatic outcome is shin-deep amputation. If the measure was not taken, then necrotic processes lead to the patient’s imminent death, which again speaks of the need for timely treatment of DFS!
Symptoms of the disease
The symptoms of a diabetic foot include a huge number of factors, each of which needs to be learned by every patient. The main symptom is a decrease in sensitivity. It makes itself felt in several stages:
Severe swelling of the legs, jumps in the temperature of the skin surface are expressed. Its constant change from hot to cold indicates a serious violation of blood circulation or the penetration of a bacterial infection, which is a clear sign of an illness. After the initial stages of development of SDS, the following symptoms appear:
- Legs get tired even when walking slowly;
- Calves ache when resting. Physical activity can make things worse;
- The skin on the feet changes shades (from pale to reddish and bluish);
- Hair falls off the legs;
- Wounds and scratches do not heal in 1-2 weeks, but in 2-3 months (at best);
- Nails change shape and color. In the later stages, black bruises form under the nail plate;
- The final symptom is an open sore on the surface of the skin.
In order to prevent further development of SDS, it is necessary to periodically check your own feet for the listed visual symptoms. In the process, use a mirror to inspect hard-to-reach areas. Pay particular attention to interdigital distances and nails. In the presence of cracks and cuts, you should immediately contact your doctor!
People who suffer from diabetes mellitus visit a doctor at least once a year to conduct a clinical examination of their feet. Only a doctor is able to prescribe treatment, provide guidelines for trauma treatment, and prescribe orthopedic shoes with special insoles to reduce the load on the limbs.
Forms of diabetic foot syndrome
The diabetic foot is formed depending on one or another factor that negatively affects the patient’s health. Therefore, there are 2 main forms:
- Neuropathic ;
- Neuroischemic .
Each is expressed in a unique list of symptoms that require detailed consideration. The importance of this information lies in the specificity of the treatment of each form, since there are no universal methods.
The visual characteristics of the foot are normal at the initial stages. It has a pink color, is warm to the touch, the vessels can be easily palpated . The ulcer is localized in places of increased mechanical stress. The ulcer is wet, painful sensations in the lesion does not occur. The skin around the injury is dry and thick. This form is found among people with alcohol abuse, type 1 diabetes and young patients.
This form has other external features. The color of the foot changes to reddish or bluish, rubeosis is characteristic . If the limb is not infected, the temperature will be cold. A dry ulcer forms in places with the worst blood supply. Diabetics feel pain when physically exposed to an open area. More often, the neuroischemic form occurs in the elderly, heavy smokers, people with high blood cholesterol.
Who is at risk?
People are at risk of developing diabetic foot syndrome:
- People with diabetes for more than 10 years;
- Severely obese;
- With unstable blood glucose levels;
- Addicted to smoking and alcohol;
- Have had a stroke or heart attack;
- Prone to blood clots.
Persons in risk groups must undergo diagnostics in a clinic. Reckless attempts at self-medication lead to the most sad consequences!
To begin with, the patient should consult a therapist, surgeon or endocrinologist. Also, help is provided by doctors working in specialized offices for diabetic feet, but these are not available in every city. The diagnosis is made on the basis of the collected analyzes. First, basic body studies are performed:
- Blood biochemistry, as well as its general analysis;
- General urine analysis, coupled with checking the stability of the kidneys;
- Ultrasound of the heart, x-ray of the chest and its organs;
- Assessment of the degree of blood clotting.
After that, the work of the patient’s nervous system is examined:
- Checking the safety of reflexes;
- Assessment of tactile / pain sensitivity.
Further, the quality of blood flow to the lower extremities is examined:
- Measurement of blood pressure in the vessels of the feet;
- Dopplerometry ;
If there is a formed ulcer:
- A sample of the microflora of the wound is taken to assess its sensitivity to antibiotic drugs;
- Examination of an open lesion under a microscope.
The final stage is radiography of the lower extremities. Despite the duration of the diagnostic stages, an effective treatment plan cannot be built without them.
The methods of treating diabetic foot are complex, that is, they contain several procedures at once that have a beneficial effect on the injury and on the general condition of the patient. Doctors divide the methods of treatment into several types, each of which universally adapts to the problem of the diabetic. The first option is to treat SDS with stable blood flow to the affected limb:
- Complete rejection of addictions;
- Physical relief of the injured foot;
- Suppression of the development of infections by antibacterial treatment;
- Tracking the course of the underlying disease;
- Treatment of possible concomitant ailments caused by SDS.
The second option is relevant in case of impaired blood flow to the injured foot:
- Identical therapy described above;
- Restoration of the quality and stability of blood supply to tissues.
The third type of treatment is the most difficult because it concerns the forms of ulcers with necrosis:
- Surgical intervention;
- If there is no effect, amputation.
Treatment carried out under the close supervision of a physician is not the only required attribute on the path to healing. A huge role is played by the patient’s personal attitude, as well as his responsible attitude to the subsequent care of his own health.
Diabetes mellitus is a chronic disease, so patients need to pay attention to the condition of their own legs daily. The most important problem that is ignored by diabetics is the correct selection of shoes for daily wear:
- It should be made of genuine, high-quality leather and have no seams inside, which can be easily checked by hand;
- You cannot buy tight shoes, the thing should sit freely on the foot, not rub it or pinch it;
- The nose is wide so that the fingers are not in constant tightness;
- The maximum permissible heel size is 4 cm;
- It is advisable to select models according to the cardboard blank of the outlined leg;
- To find the optimal pair, it is better to visit the store in the evening and try things on a swollen tired leg. Be sure to wear cotton socks to reduce friction on your skin. They need to be changed 1-2 times a day. It will also require regular changes of shoes to provide general physical relief from joints, bones and muscles.
The next tip concerns hygiene care. You need to wash your feet daily, with special care. After each shower, the skin is thoroughly dried with a towel. Any scratch you see should be shown to your doctor to prevent SDS in time. Before each going outside, it is necessary to check the shoes for foreign bodies inside, so as not to injure the leg again. It is also not recommended to walk barefoot on sandy beaches, as well as on the grass outside the city. Even micro-trauma to the skin can lead to the formation of minor wounds that can develop into gaping ulcers.
Treatment of wounds
An independent method of treating a diabetic foot includes antibacterial treatment of an open lesion. Rehabilitation therapy does not work without home care. There are several basic guidelines on this topic:
- “Aggressive” antiseptics like brilliant green, alcohol, potassium permanganate, Vishnevsky’s ointment cannot be used. The skin will become oak and begin to crack even more, only aggravating the situation;
- Clean abrasions are treated with furacilin solution. If dirt and foreign bodies are visible, use classic hydrogen peroxide. Chlorhexidine or Miramistin are ideal options for wound treatment;
- Sterile gauze dressings should always be in the medicine cabinet of a diabetic with SDS. After each treatment, they are applied to the injured surface. It is not necessary to press the material strongly to avoid additional trauma and pain. Do not use softening and ordinary plasters, as they almost do not allow oxygen to pass through, and bacteria can actively multiply in the formed favorable environment;
- An additional effect will be provided by Actovegin and Iruksol ointments . The best option for healing is Solcoseryl gel ;
- You can not use the methods of traditional medicine. Most of the recipes have no effect, some can completely harm the patient’s condition. Give up compresses, herbal ointments, buying obscure medicines on the Internet.