What is diabetic foot?
Diabetic foot is a complication of peripheral arterial disease (PAD) and/or compromised leg nerves due to diabetes. Diabetic foot syndrome is when several pathological characteristics are present, such as infection, ulcers in the toes and feet, and damage to foot bones.
Patient's feet have a reduced ability to feel pain due to deficient functioning of peripheral nerves related to diabetes (diabetic neuropathy). Thus, minor injuries go undetected for a long while, allowing time for them to ulcerate. Research shows that the occurrence of foot ulcers in diabetic patients is 15-25%.
Peripheral nerve dysfunction may be combined with PAD that causes poor blood flow in the extremities (diabetic angiopathy). Approximately half of the patients with diabetic foot ulcer also have PAD.
When wound healing takes a long time, infection may set in, spreading to bones and joints, and could lead to lower limb amputation. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.
What are the symptoms of diabetic foot?
- Sensory loss
- Tingling or pricking
- Blisters or other wounds with no pain
- Skin discoloration or temperature changes
- Red lines
- Secreting or non-secreting wounds
- Stained socks
What are the preventative treatments for diabetic foot?
- Examine your feet every day
- Wash your feet every day
- Wear suitable shoes with socks
- Increase blood flow to the legs
- Cut toenails carefully – preferably by a trained medical pedicurist
- Protect your feet from extreme temperatures
- Routine doctors' examinations of the foot
- Control blood sugar levels
- Do not smoke
What are the treatment options for diabetic foot?
- Using suitable footwear
- Wash daily with water or wet pads to ensure a damp environment for wounds
- Clean wounds
- Refrain from pressure on the wound area
- Remove skin and affected tissue from the wound
- Antibiotic treatment if infection sets in
- Maximum control of blood sugar levels
- Evaluation and repair of arterial dysfunction
What are the intervention options in leg blood vessels?
The indications for surgical or endovascular intervention when leg arteries are compromised include pain at rest or at night, ulcers in toes and feet, and foot gangrene.
Vascular surgery is performed under general anesthesia. A vascular surgeon makes a bypass around the afflicted part of the artery in the leg. The bypass may be a graft from the patient's vein or a synthetic tube that is inserted to the artery before and after the obstruction. This surgery takes several hours and requires several days of subsequent hospitalization.
Endovascular treatment (catheterization) is performed under local anesthesia to the groin area, through which the radiologist performs a small incision and inserts a thin tube (catheter) to the artery and maneuvers it to the treatment site. A small amount of contrast agent is injected for the doctor to properly view the diseased arteries. Then, the arteries are opened up with the assistance of small balloons or placement of stents (just like in cardiac catheterization). The obstruction or narrowing is opened and blood flow to the foot is therefore increased. The tiny incision on the skin is covered by a dressing. This procedure is usually completed within 2 hours.
Endovascular treatment is critical for accelerating ulcer healing and preventing amputation. If blood flow to the foot is restored, chances of wound healing are higher.