Diabetic With Foot Pain

Diabetes can cause severe foot problems, the most common of which are long-term (chronic) leg ulcers. Their risk increases over the years as additional diabetic diseases begin to appear, especially peripheral nerve disorders, or neuropathy.

Compared to healthy people, a person with diabetes was previously 15 times more likely to have a leg amputation. Of these, 85% were due to difficult-to-treat leg ulcers. The figure is currently clearly lower, as foot ulcers are now actively prevented.

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Ulcers can be very effectively prevented by good treatment of diabetes and taking care of the well-being of the feet. This avoids difficult-to-treat ulcers, thus avoiding extreme treatments such as amputation.

Causes of foot ulcers

In diabetes, various foot-related problems occur more than usual, mainly due to a combination of three causes: peripheral nerve disorder, i.e. neuropathy, impaired arterial circulation, and stiffening of tissues and joints. These predisposing factors alone do not lead to foot disease, but usually, there is always some additional cause, i.e. a triggering factor.

The most common trigger is a foot injury event, which are
Injury caused by a sharp stone, nail, reed stump, etc.
Abrasion, bladder, or another breakage of the skin caused by an unsuitable shoe
Skin damage when cutting nails or treating hardening of the foot with a blade gun or sandpaper

Thermal injury (too hot wash water, keeping the foot too close to an open flame) or frostbite in winter that is not sensed due to neuropathy.

A very common cause of foot infection is as follows: Fracture of the skin is not noticed because it does not cause the same pain as normal due to neuropathy, resulting in a delay in the treatment of the injury. As a result, bacterial inflammation develops at the site of the injury, which the body is unable to fight due to impaired blood circulation. The infection progresses deeper, forming a long-lasting ulcer that is difficult to treat.

Symptoms of foot ulcers

The ulcer associated with peripheral nerve disorder most commonly occurs under the big toe, on the toes, or on the toes in the wrong position (so-called hammertoes). The cause of the ulcer is the hardening of the foot due to incorrect weight distribution in the sole of the foot. If the abrasion is not detected due to the sensory disorder, it can develop into an ulcer. A typical ulcer is round or oval, red at the base, and surrounded by a hard, lighter border (picture ). The ulcer is usually not associated with significant pain due to neuropathy.

Diabetic foot ulcer under the big toe. A typical long-term (chronic) ulcer under the big toe in a patient with diabetic nerve damage (neuropathy). A diabetic foot ulcer is treated by reducing the pressure on the wound, for example with relief insoles.

If the arterial blood flow to the foot is impaired, the associated lack of tissue oxygen exposes the wound. The wound arises from an insignificant bump from the pressure exerted by the shoe on a particular location. In this case, the ulcer is called an ischemic wound. It is often oval, but the shape of the ulcer varies. In the center of the ulcer is a dark covering that is dead skin.

Diabetic foot ulcer in the bony bone. A long-term (chronic) ulcer in the sciatic bone is caused by rubbing a narrow shoe. For more information,

If the arteries of the foot are severely constricted, rest pain may occur in the toes and soles of the feet. In the worst case, the skin color of the toes begins to darken, which is a sign of necrosis.

Self-care

Mild foot problems can be treated by yourself. Small fresh wounds are cleaned and disinfected with chlorhexidine solution (e.g. Chlorhexol ® ) or polyvidone iodine solution (e.g. Betadine ® ). The wound is protected with gauze; the incubating patch is not used. The wound is kept dry. Walk the foot as little as possible until the wound has healed.

An attempt is made to keep the foot blister intact so that the area does not become inflamed. A gauze dressing from a pharmacy is held on top of it, which is fixed with skin tape. The fold is changed daily.

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The healing of a self-treated blister or small wound should be monitored daily. If it does not heal and starts to become inflamed, you should see a doctor immediately.

When to treat

If a self-treated small wound or blister becomes inflamed (the edges are red and the wound or blister is wet), it is advisable to seek medical attention.

If there is a large wound or skin lesion in the foot as a result of the injury, you should go to a health center or other treatment place on the same day. If the ulcer has occurred unnoticed, it is advisable to seek treatment no later than the first working day. As a general rule, if you are unsure whether or not to seek treatment for a foot problem, it is safe to go.

If you notice persistent induration and sore spots on the soles of the feet, on the sides of the toes, or on the toes, it is advisable to go to a health center or a qualified pediatrician within a couple of weeks for treatment.

Treatment of foot ulcers

Treatment is decided by a doctor or a trained pediatrician who is familiar with the foot problems of diabetes. If the foot ulcer is superficial, a shoe relief insole with a thinned area at the wound is often sufficient for treatment. They are made by Podiatrists and Podiatrists. The lightning insole reduces the weight of the ulcer.

Deeper wounds are treated by placing a plaster in the foot with a hole made at the ulcer. Gypsum completely relieves pressure at the wound, and the ulcer can be treated from the opening. Treatment involves removing dead tissue associated with the ulcer. Gypsum is kept for 6-8 weeks. In addition to gypsum, an antibiotic is given to soothe the inflammation.

If the cause of the wound is mainly arterial stenosis, blood circulation is improved, if possible, with medication, balloon dilation, or vascular surgery.

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Prevention of foot ulcers

Foot ulcers can be effectively prevented by the following measures. They are especially important at the latest when the first signs of peripheral nerve disorders, or neuropathy, are detected.

The most important of the measures to prevent foot problems is the choice of suitable shoes. Shoes, including party shoes, should be loose enough. The length of the shoe is suitable if the interior is 1-1½ cm longer than the toe. In a good shoe, the sole is about 2 cm thick but still flexible, and the heel is no more than 1-2 cm.
Socks should be snug, but not tightened and the elastic at the ankle should not be too tight.
The condition of the feet is checked every night when the socks are taken off. In particular, it is ensured that there are no wounds, blisters, or inflammation in the cuticles. If you can't see the soles of your feet otherwise, use a mirror.
The feet are washed in the evenings with lukewarm water without soap or with mild soap. The feet are dried thoroughly, including the toes. If the skin feels dry, grease the feet with a suitable base cream.
The nails of the toes are cut about every two weeks. The nails must not be cut too short, leaving about 1 mm of the white part of the nail. The corners are cut to follow the shape of the toe.
No walking barefoot outdoors.
Hardened and hardened teeth must not be thinned with blade guns or sandpaper.
The feet are not heated by an open fire and in the cold use spacious shoes and warm socks.

Ankle collapse (Charcot's foot, neuroarthropathy)

Charcot’s foot is named after the Frenchman Jean-Martin Charcot, who was the first to describe this disease in the 19th century. It is quite rare and sometimes develops in a diabetic who has already developed neuropathy.

The disease causes swelling and redness in some parts of the foot. They are probably caused by a dysregulation of the blood vessels of the foot associated with involuntary, i.e. autonomic, neuropathy. The activity of bone-breaking cells increases, causing the bones of the ankle and plantar to collapse and fragment. As a result, the shape of the foot changes.

Charcot change in the leg. Charcot change in the leg. When viewed from the side, the longitudinal arch of the foot has collapsed, and the foot resembles the foot of a rocking rocker. The center of the sole of the foot is under great pressure and is easily ulcerated. For more information: see Diabetic foot problems and their prevention.

Despite swelling, redness, and collapse of the foot, the foot is usually painless and the skin can be completely intact. Even if there is no pain, treatment should be sought if strange swelling and redness of the foot occur.

The treatment is plaster, which is kept for 6-9 months. It reduces the load on the foot and allows the bones to ossify in a good position. With plaster treatment, the situation usually calms down considerably. After that, special footwear is needed, because there is easily a postural error in the foot after the illness.