What is Diabetic Foot?
One-fifth of diabetic patients develop non-healing wounds, ulcers, or infections at some point in their lives, and this condition can lead to the loss of a foot or leg if not treated well. Diabetic foot wound treatment requires an approach that incorporates much expertise.
Diabetic foot is the development of chronic wounds on the foot due to the long duration of diabetes mellitus or the inability to control blood sugar. Diabetes disease affects the capillaries and causes neuropathy, that is, inflammation in the nerves, or vasculopathy, that is, inflammation in the vessels. Foot ulcers develop in diabetic patients due to both neuropathy and vasculopathy.
A simple shoe hit or ingrown nail that can heal in a short time with appropriate treatment in normal individuals can turn into diabetic foot ulcers in diabetics. If there are signs such as burning in the feet, numbness, loss of sensation, loss of foot sweating and dryness, cracked heel in diabetic patients, neuropathy, and vasculopathy should be suspected and necessary precautions should be taken before a diabetic foot wound develops.
What are the Causes of Diabetic Foot? Diabetic Foot Symptoms
Diabetic foot is a serious disease that develops slowly and over time. Therefore, it does not show any symptoms at first. Irregular and uncontrolled blood sugar for a long time disrupts the structure of the capillaries in the feet. When narrowing and obstructions develop, pain is felt in the legs while walking. This pain intensifies over time, preventing the person from continuing to walk. The patient has to rest.
Diabetes patients are informed about foot care. If the patient does not take the necessary foot care, does not use appropriate shoes, and does not pay attention to the blood sugar regulation protocol, the diabetic foot starts with a small wound on the foot.
How Is Diabetic Foot Care Done?
"What is a diabetic foot?" After answering the question "How is diabetic foot care done?" is the most important issue for diabetics. should be. Diabetic patients' feet tend to be dry. Heel cracks are more common in dry feet. Microbes entering through these developing cracks cause easier and more serious infections in feet with impaired blood flow. Thus, diabetic foot infections begin.
In addition, sweating in the feet creates a predisposition to wound development. For that, the feet should be cleaned daily with warm water and soap and dried thoroughly. Cracks that may develop should be prevented by applying moisturizing creams.
It is necessary to avoid applying moisturizing cream between the toes because if these areas remain moist, the fungal disease may develop and this may cause progressive diabetic foot ulcers. In diabetic care nail care is very important. Nails should not be left long, they should be cut at the level of the meat. In order not to cause ingrown nails, the edges of the nails should be cut straight without leaving the flesh.
For that, the feet should be cleaned daily with warm water and soap and dried thoroughly.
choice of socks and shoes has also to be paid significantly important. Seamless wool or cotton socks should be preferred. Socks should be changed every day and washed with detergents that will not irritate sensitive feet.
Pointed-toed, high-heeled shoes and flip-flops should not be used. Small or large shoes should be avoided. Soft leather or cloth shoes should be preferred, plastic shoes should not be worn. Diabetic patient shoes can be made by taking personal measurements in order to avoid shoe hits.
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Insoles must be put inside the shoes and the insoles must be changed every 6 months. Diabetic peripheral neuropathy, which develops due to sensory damage and loss of sensation, is one of the most important predisposing factors in the development of diabetic foot ulcers. Loss of sensation and insensitivity, especially due to sensory neuropathy, are the most important factors that prevent awareness in traumatic foot wounds.
Diagnosis is made by nerve conduction tests. Neuropathies detected in the early period with EMG (electromyography) to be performed at regular intervals are important in prevention.
How Is Diabetic Foot Treatment Done?
When diabetic foot ulcers and pressure sores are not properly treated, they can turn into gangrene and amputation may be required. Amputation means cutting off the infected limb to prevent the infection from progressing. Approximately 85% of patients who undergo foot or leg amputation due to diabetes have a history of wounds prior to amputation. For this reason, it is of great importance to prevent the opening of foot wounds in diabetics or to repair the wound if it is opened.
The important features that distinguish diabetic wounds from other wounds are that the functions of nerves and blood vessels are impaired and they heal much more difficult than other wounds due to other complications related to diabetes. The first priority in wound care is the removal of dead tissue. This can be done with surgical methods as well as with wound care products developed with new technologies today.
With the dead tissues gone, the next step is to provide an environment where the cells that will heal the wound can proliferate properly. For this, a suitable wound care strategy should be determined, various diabetic foot dressings should be made and the most suitable wound care products should be selected for the patient and used correctly.
The course of the wound should be evaluated by continuous observation. In wounds that do not heal or in wounds that are difficult to close on their own, it is possible to repair by taking tissue from other parts of the body when necessary. Many treatment methods are applied to avoid reaching this stage.
In recent years, gene and stem cell therapies have come to the fore in the treatment of diabetic foot wounds. Especially skin wounds are very suitable for gene therapy due to the ease of direct access. Naked DNA, viral transfection, high-pressure injection methods can be used in gene therapies involving growth factors.
In addition, promising clinical results are reported in the treatment of chronic wounds of mesenchymal stem cells (MSCs), which can be defined as connective tissue cells obtained from tissues such as adipose tissue, umbilical cord, and bone marrow that can be taken from the person or from other living things and grown in culture. MSCs may contribute to wound healing by reducing inflammation, supporting angiogenesis (new vessel formation), and reducing scar tissue.
An effective alternative for wound treatments is the amniotic membrane product, which is applied alone or in combination with MSC.
The amniotic membrane is a tissue obtained from the placenta, of human origin, and contains many growth factors. When used as a wound dressing in acute and/or chronic wounds, it accelerates the healing of the wound and acts as a barrier to protect from infection thanks to the healing molecules it contains. The wound and tissue healing capacity and effect of the amniotic membrane used with MSC increases considerably.
Identifying and determining the level of vascular problems in patients with diabetic foot problems is one of the first procedures to be done. Patients with ischemia, that is, insufficient vascular nutrition, are candidates for the repair of vascular disorders. As imaging methods, Doppler, computed tomography (CT), or magnetic resonance (MR) angiography examinations are performed.
Vascular problems in diabetic patients usually progress with lesions with vascular narrowing or complete occlusions. Vascular reconstruction, that is, the removal of occlusions in the vessels or the methods of opening the completely occluded vessels should be chosen specifically for the patients. Generally, these methods are endovascular (Balloon angioplasty and/or stenting) and open surgery (Endarterectomy or bypass).
Hyperbaric Oxygen Therapy in Diabetic Foot Wound
Hyperbaric (pressurized) oxygen (HBO) therapy is one of the important supportive treatments in the treatment of selected chronic wounds. Providing an increase in oxygen in the blood and tissues, that is, hyperoxygenation constitutes the main mechanism of action of this treatment method.
Sufficient oxygen is provided in the vascularized connective tissue compartment around the wound and reinitiates wound healing remaining in the inflammatory stage. HBO therapy is particularly effective in infected foot wounds and hypoxic/ischemic wounds. Depending on the condition of the wound, an average of 20-30 sessions can be applied. Generally, it is recommended to apply 1 session per day and 5 sessions per week.
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