Diabetic Foot

Overview

Diabetic foot is a condition that occurs in people with diabetes and is characterized by infection, ulceration, or destruction of the tissues in the foot. It is usually associated with neuropathy (nerve damage) and/or peripheral vascular disease (PAD) in the lower extremity.

Diabetic foot is one of the most common and serious complications of diabetes, causing significant pain, disability, and even death. It is estimated that every 20 seconds, a person with diabetes undergoes amputation due to diabetic foot. Managing diabetic foot requires a comprehensive approach to achieve successful outcomes.

Causes and Risk Factors

Diabetic foot is a serious complication of diabetes that can lead to significant health issues. There are several causes and risk factors associated with diabetic foot. Let's explore them in more detail:

Causes of Diabetic Foot:

Peripheral neuropathy: This is a condition where the nerves in the feet are damaged, leading to loss of sensation. It is one of the most important risk factors for foot ulceration in diabetic patients.
Peripheral vascular disease: This refers to the narrowing or blockage of blood vessels in the legs and feet, which can reduce blood flow and impair wound healing.
Foot deformity: Structural abnormalities in the feet, such as bunions or hammertoes, can increase the risk of developing foot ulcers.
Previous foot ulceration: If a person has had a foot ulcer in the past, they are more likely to develop another one.
Amputation of the foot or leg: Individuals who have undergone amputation of the foot or leg are at higher risk for developing diabetic foot complications.
Recurrent chronic abrasions, minor abrasions, bullae (fluid-filled blisters), irritations, verrucas (warts), calluses: These can all contribute to the formation of foot ulcers.
Improper cutting of toenails: Cutting toenails incorrectly can lead to ingrown nails and potential infections.
Fungal infection: Fungal infections can weaken the skin's integrity and increase the risk of developing foot ulcers.
Poor foot hygiene: Neglecting proper foot care, such as not washing and drying feet regularly, can increase the risk of infection and other complications.
Inappropriate footwear use: Wearing ill-fitting shoes or shoes that do not provide adequate support can contribute to foot problems.
Bad metabolic control: Poor control of blood sugar levels can negatively impact wound healing and increase the risk of complications.

Non-modifiable risk factors are factors that cannot be controlled. They include:

Age
Gender
Duration of diabetes
Retinopathy (eye disease)
Nephropathy (kidney disease)

Modifiable risk factors are factors that can be controlled. They include:

Glycemic control: Maintaining good control over blood sugar levels through diet, exercise, and medication can help reduce the risk of diabetic foot complications.
Smoking: Quitting smoking is important as it improves blood circulation and reduces the risk of vascular complications.
Insulin use: Proper administration and management of insulin therapy can help prevent diabetic foot complications.

It is important for individuals with diabetes to be aware of these causes and risk factors. Regular check-ups with healthcare professionals can help identify any potential issues early on and prevent further complications. By taking proactive steps to manage their diabetes and maintain good foot care practices, individuals can reduce their risk of developing diabetic foot problems.

Symptoms

Diabetic foot is a serious complication of diabetes that can lead to foot ulcers, infections, and even amputation if left untreated. The symptoms of diabetic foot can vary depending on the stage, progression, or severity of the condition. Here are the most common early symptoms of diabetic foot:

Loss of feeling: One of the first signs of diabetic foot is a loss of feeling or sensation in the feet. This is known as sensory neuropathy and occurs when diabetes damages the nerves that provide sensation to the feet. As a result, individuals may not be able to feel pain, heat, or cold in their feet.
Numbness or tingling: Another early symptom is numbness or tingling in the feet. This can be described as a pins and needles sensation or a feeling of "falling asleep" in the feet.
Skin changes: Diabetic foot can cause skin discoloration and temperature changes in the feet. The skin may become red, pale, or discolored, and it may feel warmer or cooler to the touch.

As diabetic foot progresses or becomes more severe, additional symptoms may occur:

Wounds and ulcers: Without proper sensation in the feet, individuals with diabetic foot may develop wounds or ulcers without realizing it. These wounds can be painless and may go unnoticed until they become infected.
Infections: Diabetic foot increases the risk of developing infections in the feet. Signs of infection can include redness, swelling, warmth, and drainage from wounds or ulcers. In severe cases, individuals may experience fever, chills, and feel very sick.
Foot deformities: Over time, diabetic foot can lead to changes in the structure of the feet. This can cause deformities such as hammertoes (bent toes), Charcot's foot (collapse of the arch), and claw toes (toes that curl downward).
Poor wound healing: Diabetes can impair the body's ability to heal wounds, so even minor cuts or abrasions on the feet may take a long time to heal.
Gangrene: In advanced cases of diabetic foot, reduced blood flow to the feet can result in tissue death known as gangrene. This is a serious condition that requires immediate medical attention.

It is important to note that any person with diabetes who experiences symptoms of an infection on their feet should seek emergency treatment. Prompt medical care is crucial for preventing complications and managing diabetic foot effectively.

Diagnosis

To diagnose diabetic foot, healthcare providers commonly perform the following examinations, tests, and procedures:

Physical Examinations: Healthcare providers conduct physical examinations to assess the presence of neuropathy, retinopathy, and peripheral vascular disease. They examine the skin of your feet for dryness, cracking, calluses, blisters, ulcers, and other damage or abnormal areas. They also check your toenails for cracks and fungal infections.
Podiatric Evaluation: A podiatric evaluation is a subjective test that evaluates diabetic peripheral neuropathy. One common test used in this evaluation is the Semmes Weinstein monofilament test. During this test, you close your eyes while the provider brushes a soft strand of nylon (a monofilament) over your foot and toes. You indicate when you feel the strand touching your foot.
Ankle Brachial Index Test: The ankle brachial index (ABI) test compares blood flow in the arteries of your arm and ankle. It serves as an indicator of vascular disrepair.
Doppler Ultrasound: Doppler ultrasound uses a transducer to emit sound waves that bounce off blood vessels in your feet. This creates images of the state of those vessels and helps evaluate vascular deterioration.

Additional examinations, tests, and procedures are performed to determine the stage or severity of diabetic foot:

Laboratory Tests: Healthcare providers collect laboratory reports to interpret the course and severity of diabetes. These tests include fasting blood sugar (FBS), hemoglobin A1c (HbA1c), random blood sugar (RBS), blood urea nitrogen (BUN), and lipid levels.
Imaging: Imaging techniques such as X-rays or magnetic resonance imaging (MRI) may be used to assess the condition of your foot, including any bone abnormalities or signs of infection.
Clinical Assessment: Healthcare providers conduct a thorough clinical assessment of limb viability to determine whether to save the limb through revascularization therapy or amputation.
Cross-Relation Analysis: In some cases, associations among lab results such as HbA1c, RBS, BUN, total cholesterol (TC), and surgical outcomes are analysed to gain a more detailed understanding of what affects the outcome of diabetic foot.

It is important to note that regular foot exams should be a high priority for individuals with diabetes in primary care settings. Annual comprehensive foot examinations are recommended to identify risk factors predictive of foot abnormalities and ulcerations, which can help decrease the incidence of lower extremity amputations (LEAs) and improve overall outcomes for individuals with diabetic foot.

Treatment Options

The goals of treatment for diabetic foot are to prevent the spread of infection, reduce the need for amputation, improve blood flow to the affected area, promote tissue repair, and prevent complications related to diabetes and cardiovascular diseases. To achieve these goals, various treatment options are recommended:

Medication Types:

Anti-infective drugs: These medications help control and treat any infections in the diabetic foot.
Vasodilators: These drugs help widen blood vessels and improve blood flow to the affected area.
Neurotrophic drugs: These medications promote nerve regeneration and protect against further damage.

Therapeutic Procedures:

Debridement: This procedure involves removing dead or infected tissue from the wound to promote healing.
Decompression: This technique helps relieve pressure on the affected area, allowing better blood flow and reducing the risk of further damage.
Hyperbaric oxygen therapy: This therapy involves breathing pure oxygen in a pressurized chamber to increase oxygen levels in the body and promote wound healing.
Negative pressure wound therapy (NPWT): This technique uses a special dressing that applies controlled suction to the wound, promoting granulation tissue growth and improving healing.

Health Behavior Changes:

Diet control: Following a balanced diet that is low in sugar and carbohydrates can help manage blood glucose levels.
Weight loss (if overweight): Losing excess weight can reduce pressure on the feet and improve overall health.
Self-care: Practicing good foot hygiene, inspecting feet daily for any signs of injury or infection, wearing proper footwear, and avoiding smoking are important self-care measures.

Other Treatments:

Corrective foot surgery: In some cases, surgical intervention may be necessary to address complications such as collapsed bones or severe deformities. The goal of surgery is to restore stability and alignment in the foot.

Always consult with your healthcare professional for personalized advice on treatment options. Medication dosing may be affected by many factors. Check with your healthcare professional about dosing for your individual situation. Other side effects can occur. Check with your healthcare professional or read the information provided with your medication for additional side effect information.