Diabetic foot syndrome
Diabetic foot syndrome is an innervation disorder, as is a violation of the blood supply to the tissues of the lower extremities.
Such a complication develops as a result of diabetes due to an increase in the load on the foot and always leads to its soft tissues traumatically and their further destruction.
The treatment of this disease improves and brings good results.
The whys and wherefores
Diabetes mellitus is characterized by an increased blood sugar level (hyperglycemia). This condition provokes energy-hungry cell energy starvation and dysfunction of metabolic processes. The result is pathological damage to various organs and tissues.
Diabetic Foot Syndrome (DFS) is provoked by the following factors:
Diabetic microangiopathy, represented by the destruction of the thinnest blood vessels (arteries, capillaries, veins). As a result, the tissues lack nutrition;
The target organs in this case are the blood vessels of the brain and lower extremities, the heart.
Diabetic osteoarthropathy is the destruction of bone tissue in the area of increased pressure, traumatic deformation of the joints, the development of pathological fractures.
Diabetic neuropathy is the death of nerve endings because they damage the blood vessels that supply blood vessels. Ultimately, this leads to loss of sensitivity and atrophy of the soft tissues of the lower extremities, which contributes to the occurrence of trophic ulcers.
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symptoms
The symptoms and signs of SDS differ from the characteristics of the three forms of the disease:
In the ischemic form, the lower extremities retain sensitivity with relatively weak pulsation. At the same time, the skin of the feet is cold and pale, and the ulcers formed have uneven edges, heal for a long time, and cause severe pain;
In the neuropathic form of weakness, numbness of the legs is reduced. As a result of changes in the arch of the foot, there is a thickening of the epidermis and calli. Trophic wounds are characterized by flat edges;
The mixed form is characterized by the presence of signs of the two forms of the disease.
Drug treatment
An important step in conservative therapy for the diabetic foot is to correct the cause of its appearance, i.e., replacement of diabetes mellitus. To do this, the endocrinologist must prescribe a specific function of insulin by individual unit selection.
The amount of treatment needed depends entirely on the stage of development of the syndrome and is only determined by an expert!
In the treatment of diabetic feet and the normalization of the general condition, it makes sense to prescribe drugs that have a complex effect:
- Lomoporan;
- Sulodexidia;
- alprostadil;
- Prostavazin;
- Trental 400;
- Delaxin;
- Vulnostimulin;
- Fusicutan;
- Berlition;
- Thiolepta;
- Thiocacid.
Antibacterial therapy and antibiotics
An important role in the treatment of diabetic foot syndrome is played by antibiotic treatment, which is necessary if an infected wound is present or the risk of infection is increased.
Based on the infectious agents and their possible susceptibility to several antibiotics, and based on the localization of the infection, the treating physician will select the best possible drug or a combination thereof:
When the wound is infected with staphylococci - clindamycin, Rifampicin, Gentamicin, and Flucloxacillin;
If the causative agent is streptococcus - erythromycin, amoxicillin, flucloxacillin, and clindamycin;
To relieve enterococcal infection - Amoxicillin;
Anaerobic wound infection - Metronidazole, and Clindamycin;
Coliform bacteria - tazobactam, trimethoprim, Merolenem or Cefadroxil;
Pseudomonas - meropenem, ciprofloxacin, gentamicin, ceftazidime or clavulanate
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Use of creams and ointments in the treatment
In the early stages of treatment for diabetic foot, care is taken for the foot and trophic ulcer.
Before applying the ointment or foot ointment, the wound surface should be treated with an antiseptic solution such as Furacil, Miramistin, or 3% hydrogen peroxide.
The wound should then be treated with healing ointments. In such cases, Iruksol and Solcoseryl are used.
The dressing material is a semipermeable membrane, a foamy sponge. A hydrogel is applied to the dried necrotic wounds to stimulate early healing.
Bandages should be changed once a day, and if there is a lot of secretions, every 8-10 hours.
Diabetic foot, early in the photo:
Operative surgical intervention depends on the form and stage of the SDS.
applicable:
Phlegmon strips, abscesses;
Attachment of the veins of the lower limbs - placement of the prosthesis inside the vein, restoration of the lumen;
Angioplasty - normalization of blood supply by the arterial plastic method;
Bypass surgery - creating a new direction of blood flow;
Endarterectomy - removal of destroyed vessels and redirection of blood flow to adjacent vessels;
Amputation of a limb or part of it is an extreme way to fight for a patient’s life.
Treatment with folk medicines
In addition to drugs, alternative methods of alternative medicine are widely used as ointments:
Cooking blueberries, eucalyptus, burdock roots, and leaves;
Cloves, sea buckthorn oils;
Sour milk;
Linden honey.
Alternative treatment for DFS can only work as an adjunct to treatment and must be agreed with your doctor.
Hirudotherapy
Treatment with flames is allowed in the early stages of treatment for diabetic foot syndrome when there are no ulcers.
The blood circulation in the foot normalizes, which slows down the pathological process.
The duration of the session is usually from 30 minutes to an hour, during which the leech sucks almost 5 ml of blood.
The course consists of 10-12 procedures.
How to improve your feet at home?
To reduce the risk of developing gangrene, complex therapy is allowed at home. This requires the use of orthopedic shoes, a change in diet, with the exception of junk food.
The primary part of the treatment is a careful attitude to health so that there are no bruises and abrasions on the skin of the feet, as well as full compliance with the doctor's recommendations.
The main principle of SDS treatment is to keep blood sugar levels within normal limits and to use orthopedic shoes and insoles for gentle treatment of injured limbs. This approach eliminates the risk of complications and other negative consequences.
Diabetic foot - home remedy and foot care
Diabetic foot is one of the most serious complications in patients with diabetes mellitus.
This is not just a symptom, but a syndrome, abbreviated as SDS, that affects various systems and parts of the body - the peripheral nervous system, the joint and bone tissues of the legs, the blood vessels. The pathology is associated with necrotic ulcerative lesions of the tissues, i.e., the development of gangrene, and this condition already threatens not only the patient’s health but also his or her life. In addition, diabetic foot syndrome is diagnosed in an average of 7% of diabetics.
This means that diabetic patients should be aware of the likelihood of such complications and, even better, how to prevent them from occurring.
Read How to prevent amputation in type 2 diabetes
Relevance
Diabetic foot syndrome is the main cause of limb amputation in diabetes mellitus. About 8-10% of diabetics suffer, and 40-50% of them can be classified as at risk. Ten times more often, diabetic foot syndrome develops in people with type II diabetes. In at least 47% of patients, treatment is started later than possible. The result is limb amputation, which doubles patient mortality and increases the additional cost of patient care and rehabilitation by 3 times. Improving the tactics of diagnosis, clinical examination, and patient care can reduce the frequency of patient amputations by 43-85%.
Diabetic foot syndrome develops in most patients with type 1 diabetes mellitus 7 to 10 years after the onset of the disease, in patients with type 2 diabetes mellitus it may appear from the onset of the disease. In 85% of cases, it is represented by ulcers of the foot of varying severity. Observed in 4-10% of all patients with diabetes mellitus.
Classification
There are several types of diabetic foot depending on the disorders in the patient's body.
1. Ischemic diabetic foot. In the case of an ischemic diabetic foot, the patient's blood circulation is disturbed. Blood does not circulate well through the veins in the legs, causing the foot to swell. The skin color of the feet changes, and when walking, the patient experiences severe pain. Ulcers in such a patient have uneven edges. Usually, the ulcers are located on the toes, they react painfully to contact, but there is no pulsation. Because of circulatory problems, patients have pale skin on their feet and feel cold. Ulcers are not followed by the development of the toes.
2. Neuropathic diabetic foot. This type of foot is characterized by breaking the nerve ends of the patient's feet. The sensitivity of the tactile decreases, the skin begins to crack and shrink. Possible development of flat feet and related orthopedic diseases. Ulcers in such a patient have smooth edges. There are no painful sensations and the heart rate is normal. Most often, these ulcers are located at the base of the feet. In patients, sensitivity decreases, and blood flow increases. The color turns red, the foot is hot but touching.
Risk factors
The risk of developing diabetic foot is higher:
Patients with a history of limb ulcers or amputations. If a patient has a history of ulcers in the foot area, this indicates that he or she already has certain disorders of blood flow or lower respiratory tract respiratory system. With the onset or progression of diabetes mellitus, current pathologies may worsen, accelerating the development of diabetic foot development.
Patients with peripheral polyneuropathy. This term refers to a pathological condition characterized by damage to various peripheral nerves, more often to the nerves of the upper and/or lower limbs. There may be many reasons for the development of this pathology (trauma, intoxication, chronic inflammatory diseases), but they all eventually lead to violations of sensory, motor, and trophic functions in the areas involved. The loss is usually diffuse (widespread) and symmetrical, i.e., if one of the two limbs is affected, the other can be expected to be damaged soon.
Patients with high blood pressure (chronic high blood pressure). Chronic increases in blood pressure contribute to faster vascular damage through atherosclerotic plaques, which underlying diabetes mellitus may accelerate the development of angiopathy.
Patients with high blood cholesterol. An increase in blood "bad" cholesterol is one of the most important factors that determine vascular damage in the context of diabetes.
Patients who abuse tobacco. It has been scientifically proven that nicotine (in cigarettes) increases the risk of atherosclerosis by increasing the level of "bad" cholesterol in the blood. At the same time, nicotine directly damages the inner layer of the vascular wall, exacerbating the course of atherosclerosis and diabetes mellitus.
Patients aged 45 to 64 years. Numerous studies have concluded that it is in this age group that diabetic feet are most common. This is due to the fact that at a younger age, compensation mechanisms prevent the development of such a huge complication.
Diabetic foot symptoms
If the following symptoms of the diabetic foot occur in the early stages, the patient should consult a specialist:
- Formation of wounds, blisters on the feet. In diabetics, violation of skin integrity can turn into a serious pathology. The presence of domes or ears indicates chronic damage to the foot, a wound with purulent bleeding indicates infection;
- Reddening and swelling of the skin. Hyperemia and edema are symptoms of the diabetic foot that suggest infection;
- Thickening of the nail plate. Fungal pen infection (mycoses) indicates a decrease in immunity, may cause an increase in secondary infection;
- Itching and burning. These mycosis-related symptoms indicate dry skin;
- Difficulty walking. The condition develops in arthritis, severe infectious leg lesions, diabetic arthritis, Charcot's osteoarthropathy;
- Leg numbness. The appearance of "goosebumps" indicates damage to nerve fibers;
- Pain. Pain syndrome can occur when wearing uncomfortable shoes, increased leg strain, sprains, infection, or bruising;
- Foot color. The skin may turn blue, red, or black. The latter speaks of a necrotic lesion and requires amputation of the limb;
- Swelling. Swelling of the foot is a sign of an inflammatory or infectious process, a violation of venous blood flow;
- Temperature rise. If the symptom is associated with a wound in the foot, it may indicate a serious infection. The condition can be life-threatening. If the temperature rises locally in the wound area, it indicates inflammation that heals slowly.
Symptoms of neuropathic diabetic foot
This form of the disease occurs in more than 60% of cases and is characterized by trophic changes in the lower extremities that occur underlying damage to the nervous system of the foot. In this case, the blood supply to the tissues remains relatively normal, but due to difficulty breathing, the muscles, skin, bones, and joints are damaged, leading to the development of clinical symptoms of the disease.
The neuropathic nature of the disease can be demonstrated:
Normal skin color and temperature. In this form of the disease, the blood supply to the foot tissue is not impaired (or slightly impaired), resulting in skin color and temperature remaining normal.
Dry skin. As a result of autonomic (autonomic) nervous system damage, the function of the sweat glands is impaired, resulting in dryness of the skin.
Diabetic osteoarthropathy. Specific deformations of bones and joints occur mainly in the neuropathic form of the diabetic foot due to disruption of the internal respiration of these structures.
Painless ulcers. Wound formation in the neuropathic form of the disease occurs as a result of damage and destruction of the nerves that provide skin tropism. As a result of the development of the pathological process, painful nerve endings also suffer, as a result of which neuropathic ulcers are painless even palpation (probes).
Sensory impairment. In the early stages of the disease, patients may complain of leg and/or foot paresthesia (creeping sensation, mild tingling), which is explained by functional damage to nerve fibers. As the disease progresses, numbness, drop in temperature, pain, and tenderness may occur (the patient does not feel any contact with the skin).
Symptoms of ischemic diabetic foot
The ischemic form of the disease occurs in only 5-10% of patients. In this case, the main cause of foot tissue damage is a violation of their blood supply due to damage to large and small blood vessels. The most important specific feature of an ischemic diabetic foot is severe pain in the lower part of the leg. The pain comes or gets worse when walking and heals at rest. The mechanism of pain, in this case, is explained by the development of tissue ischemia, i.e., the inadequate blood supply to the tissues. In addition, when the microcirculation is disrupted, metabolic byproducts accumulate in the tissues, which also contributes to the development of pain syndrome.
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