Diabetic Foot - symptoms, description and treatment

The main symptoms are:

• Changes in the perception of temperature, foot pressure.
• Changes in the perception of pain in the feet.
• Excessive cornification of the skin (hyperkeratosis).
• Formation of blisters.
• Formation of ulcers (ulceration) on the toes, soles and heels [1].

If an infection is added, patients may have fever, chills and fluctuating blood sugar levels. [2]. The exact form of diabetic foot symptoms can vary depending on whether the cause is nerve damage or impaired blood flow to the extremities.

•  Problems of neurological origin are most often manifested by ulcers on the ball of the toe or on the heel, i.e. at the point of greatest pressure on the foot. The wounds are usually not painful and the foot is warm and pink.
•  In contrast, problems with blood circulation in the feet lead to ulcers on the toes, between the toes or on the heel. The wounds are painful and the foot is cold and bruised. [3]

• Poorly controlled diabetes (blood sugar levels are not at the right level in the long term),
• being overweight,
• high blood pressure,
• elevated cholesterol levels
• reduced pain perception, where it is easy to miss incipient problems,
• inadequate foot care. ^[7]

The stages show the severity of wounds and damage to the foot. For example, the Wagner classification is used.

Stage 1 – the patient has diabetic ulcers only on the surface of the skin (superficial ulceration).
Stage 2 – deeper ulcers appear but are without serious infection.
Stage 3 – deep ulcers extend to the bone or joint, or the ulcers are not as deep but have severe infection.
Stage 4 – gangrene (tissue death) appears on the toes, heel and other areas of the feet.
Stage 5 – gangrene affects the whole leg ^[8].

• When making a diagnosis, it is important to tell the doctor all the information about diabetes, associated complications and the first signs of skin damage on the feet. You should also mention whether you smoke and if you have any difficulty walking.
• The specialist performs a careful check of the condition of the feet – they listen to the arteries with a phonendoscope, checks the pulse by palpation and watches for swelling, blisters or bone deformities (for example, hammer toes). He will also check footwear, as inappropriate shoes are often the reason why foot wounds occur.
• Patients undergo a neurological and vascular examination of the lower limbs and a wound swab to detect the presence of infection. An X-ray of the foot is performed as needed and the diabetic status is checked with blood tests.^[9]

• Diabetic foot heals in only two-thirds of patients.
• Almost 30% of cases end in amputation of varying degrees.
• Four out of five cases of diabetic foot are caused by external problems, such as improper footwear. ^[10]

It is a serious disease that can have many complications if not treated properly.

• Infections: The diabetic foot is prone to infections.
• Gangrene: Gangrene is a serious form of infection. It causes tissue death. It can lead to amputation of the affected part of the limb.
• Ulcers: It can cause ulcers on the foot. These can become infected and worsen.
• Circulatory disorders: Can lead to swelling, pain and skin discolouration.

Treatment of diabetic foot depends on the severity of the problems and their exact origin. Diabetics often ask if it is treatable. Two-thirds of patients are cured, but up to 40% of patients will have their diabetic foot problems return within the next year. ^[11]

Therapy of diabetic foot syndrome is either through various regimens and supportive measures or through surgery. The aim of the treatment is to keep the leg in such a state that it is functional and the patient does not have to undergo amputation.^[12]

• Systematic cleaning of ulcers, treatment of infection, control of wound secretions and promotion of healing.
• Protection against the development of further wounds is a must.
• The use of modern covering materials for so-called moist healing, which can create good conditions for wound healing. ^[14]

Foot care for people with diabetes is an integral part of life. Not only do healthy feet need regular care, diabetic foot care is much more essential.

• Check the condition of your feet every day. Pay attention to any skin changes, cracks, wounds or blisters.
• Adhere to daily foot hygiene.
• Carefully trim your toenails and don’t underestimate professional pedicures.
• Wear comfortable shoes of the right size, and socks.
• Protect your feet from extreme temperatures – hot and cold. ^[15]

Lubricating foot can have positive effects such as hydration, protection, healing and comfort. The choice of ointment depends on individual needs. Generally moisturising ointments, ointments containing antiseptics, antibiotics or corticosteroids are used.

Prevention is important to maintain a functional limb and can significantly reduce the number of amputations. What exactly should you do to prevent the development of diabetic foot?

• Follow your diabetes treatment and check your blood sugar regularly.
• Have your feet checked regularly by a doctor.
• Learn to recognize the signs of early stage diabetic foot.
• Don’t underestimate the importance of choosing flexible, wide-enough shoes without hard seams.
• Use your feet, not your shoulders, when lifting heavy objects.
• Examine your feet and the area between your toes every day. Remove hard, dry skin gently and lubricate your feet.
• Do not go barefoot and wear cotton socks.
•  Do not smoke.
•  See a doctor as soon as possible for any new wound, pain, swelling or unusual changes in the skin on your feet. ^[17]

As a patient, you may encounter a number of professional terms at the doctor. A glossary of common medical terms will help you understand what your doctor is saying.

• Diabetic neuropathy – nerve involvement in diabetes that manifests as reduced sensitivity in the feet. It is a risk factor for minor leg injuries ^[18]
• Diabetic microangiopathy – damage to small blood vessels that impairs blood flow in the affected part of the body, such as the legs. It is caused by diabetes. ^[19]
• Glycaemia – the level of glucose (sugar) in the blood. ^[20]
• Ulceration – the formation of ulcers. ^[21]
• Debridement – surgical cleaning of a wound in which necrotic (dead) tissue is removed. ^[22]
• Granulation – the phase of wound healing in which new blood vessels and tissue are formed to allow the wound to heal ^[23]
• Podiatry – the specialty concerned with the diagnosis and treatment of foot diseases. It involves doctors, physiotherapists, nurses, chiropodists and specialist shoemakers. ^[24]