Diabetic foot : Causes, Symptoms , Treatment
Endocrinology / / August 12, 2017
Diabetic foot, or a syndrome of diabetic foot (hereafter SDS), one of the recent and most serious complications of diabetes, in the form of necrotic processes, ulcers and osteo-articular lesions occurring onbackground changes of peripheral nerves, blood vessels, skin and soft tissues, bones and joints;infection, ulcer and / or destruction of deep tissues associated with neurological disorders, decreased main blood flow in the arteries of the lower limbs of varying severity) is on the feet of people with diabetes mellitus type 1 and 2.Up to 15% of people with diabetes are at risk for foot ulcers.
Diabetic foot ulcers usually occur in the lower part of the foot.
Diabetes (hereinafter DM) - a group of diseases of the endocrine system, developing as a result of an absolute or relative deficiency of the hormone insulin, causing hyperglycemia develops - a persistent increase in blood glucose.The disease is characterized by chronic course and disturbance of all types of metabolism: c
When diabetes is not controlled: damage to organs and immune system disorders.foot problems in people with diabetes usually develop quickly and can be severe.
With the defeat of the nervous system of people with diabetes may not be able to feel your feet properly.At the same time a healthy, normal secretion of sweat and sebum to lubricate the skin of the foot, broken.These factors together can lead to abnormal pressure on the skin, bones and joints of the foot during walking foot and skin breakdown.May develop ulcers, including SDS.
damaged blood vessels and weakened immune systems diabetes difficult treatment of these wounds.May be bacterial infection of the skin, connective tissue, muscles and bones.These infections can develop into gangrene (necrosis of some organs and tissues of a living organism, a black or very dark in color, growing directly or through anatomical channels associated with the external environment on the skin, lungs, intestines, etc. The dark color is due to iron sulfide,formed from hemoglobin and iron sulfide).Because of poor blood flow antibiotics can not easily get to the area of infection.Often the only treatment for gangrene is amputation of the foot or the whole leg.If the infection spreads to the blood, this process can be very dangerous for life.
People with diabetes should be fully aware of how to prevent foot problems before they occur, to detect problems at an early stage and, if they occur, to seek proper treatment.Although the treatment of diabetic foot in the world there is a lot of progress, yet prevention, including strict control of blood sugar levels, it is the best way to prevent diabetic complications.
must learn to analyze their own feet and be able to recognize the early signs and symptoms of diabetic foot, to find out what is reasonable for foot care at home, how to recognize the disease, and when the problem has become serious enough, when you need to call a doctor.
Causes of diabetic foot
- Damage to nerves. People with long-standing or poorly controlled diabetes are at risk for nerve damage to the legs.The medical term for such cases - "peripheral neuropathy."
Because of nerve damage to the legs the patient may not be able to properly feel his legs.Furthermore, it may not be able to determine the position of the feet and toes during walking and balancing.A person with normal nerves usually feels when his shoes rubbing his feet or when, during a walk one of the foot becomes tense.
person with diabetes can not properly feel minor injuries (eg, cuts, scrapes, blisters), signs of abnormal wear of the foot (which turn into blisters and corns).As a rule, ordinary people can feel a stone in his shoe to remove it immediately.A person who suffers from diabetes, can not perceive the stone.
- poor circulation. Diabetes mellitus, especially when it is poorly controlled, can lead to problems with the arteries, or atherosclerosis.When blood flow to the damaged tissue is poor, healing does not come quickly.
- foot injury.Any foot injury may increase the risk of more serious problems in the foot, such as the development of non-healing ulcers.The ulcers are usually caused by:
- repeated trauma or pressure on the foot;
- or puncture wounds on his leg;
- foreign objects in the shoe, which can damage the skin (it may be, for example, a small stone).
- infections. fungal infection of the skin or nails - can cause feet to more serious bacterial infections and should be evaluated as soon as possible.Ingrown toenails should be treated as soon as a specialist.Toenail fungus and foot also needs to be treated quickly.
Risk factors for diabetic foot
The following factors increase the likelihood of developing diabetic foot ulcers:
- Neuropathy (numbness, tingling or burning sensation in the legs).Such feelings indicate violations of blood flow.
- Peripheral vascular disease (poor circulation in the legs);
- Poor fitting legs or incorrectly matched shoes - a common cause of diabetic foot.If the patient has red spots, sore spots, blisters, calluses or prolonged pain associated with wearing of shoes, a new, properly chosen for his shoes as soon as possible should be wearing on his feet.
- Deformation foot.If the patient has a general foot anomalies - such as flat (bone or Hammertoes - deformation that may predispose a person to Morton's Neuroma - a thickening of the fibrous tissue surrounding the one of the sensory nerves in the foot, usually on the basis of the second and third or third and. fourth fingers This benign growth can cause swelling, inflammation, pain, numbness, and even permanent loss of sensation due to nerve damage in the part of the leg and in rare cases neuroma affect both legs at the same time), then it may be necessary shoes or shoe inserts -insoles, etc. prescription.
- Diabetes for more than 10 years. Diabetes can also cause problems with blood flow.Poor blood flow may hamper the healing of the foot.
- Smoking. Smoking of any kind of tobacco accelerates the damage to the small blood vessels in the legs.This damage may disrupt the healing process.Smoking results in poor blood circulation, which is a major risk factor for foot infections and, ultimately, to the foot amputation.The importance of smoking cessation can not be overemphasized.
If you have diabetes or any of these risk factors, it should inform the doctor.
Symptoms and signs of diabetic foot
patient should see a doctor if they have any of these symptoms:
- wounds, sores or blisters on the foot. Any damage to the skin is a serious problem and can be the result of injury or infection.Corns and calluses can be a sign of chronic injury of the foot.During pus from wounds, as a rule - a sign of infection.
- Thickening of the nail. fungus on the nail of the toe - athlete's foot and ingrown toenails can lead to more serious bacterial infections.
- Redness of the skin. Redness may be a sign of infection, especially when there is a surrounding wounds or abnormal friction of the foot and the shoe.
- Itching. Constant itching in the legs (perhaps a sign of a fungal infection or dry skin).
- Pain. Persistent pain can be a symptom of a sprain, strain, bruises, loads of abuse to his feet, picked up the wrong shoes or infection.
- Difficulty in walking. limp or difficulty walking can be a sign of problems with the joints, serious infection or improperly selected footwear.Difficulty in walking can be the result of arthritis, diabetes, or Charcot joints, OR - Charcot osteoarthropathy - is a rare but very serious complication of diabetes, resulting in inadequate treatment with an irreversible disability.This complication is one of the strangest forms of SDS, aspredict the development of the ORs and allocate risk among patients with diabetes is still an extremely difficult task.The origin and development OR the most significant role is played by the peripheral, somatic and autonomic neuropathy, mechanical trauma, osteopenia, osteoporosis, non-enzymatic glycolysis proteins and abnormalities of lung tissue stop;modern definition - "the destruction of bone and joint non-infectious, caused by" diabetic neuropathy »
-.. Change of foot color It can be black, blue or red color red stripes, redness of the wound -. a sign of the gradual development of infection
- Swelling Swelling of legs may be a sign of inflammation or infection, improper shoes, or poor venous circulation Other signs of poor circulation include the following:.
- pain in the legs or buttocks (claudication), increasing with walking, but decreases after the holiday;
- the hair is no longer growing in the lower legs and feet;
- tight shiny skin on legs
- numbness in the feet periodic or permanent numbness in the legs, feeling of "pins and needles", may be a sign of nerve damage from diabetes..that increases the risk of leg and foot problems
-. Increasing temperature. high body temperature or fever in conjunction with a wound on his leg could be a sign of a threatening or life-threatening infections.Localized heat can be a sign of infection or inflammation, possibly from wounds that do not heal or heal slowly.
diagnosis of diabetic foot
Medical diagnostic assessment of the disease should include a careful history and physical examination, and laboratory tests, X-ray studies of circulation in the legs and consultation with experts.
- Medical history and physical examination. First, the doctor will ask the patient questions about his symptoms and will study them.This examination should include vital patient functions (temperature, pulse, blood pressure, respiratory rate), the analysis of sensation in the feet and legs, the circulation of learning in them, a thorough study of any problem areas.For smaller wounds, or ulcers of the extremities examination may include: sensing probe the wound to determine its depth.Small debridement (cleaning or tissue section) may be needed to determine the severity of the wound.
- Laboratory tests. doctor may decide to appoint a full blood test that can help determine the presence and severity of infection.Very high or very low white blood cell in the body requires a serious infection.The physician can also check the level of sugar in the blood through a conventional blood sampling or by using laboratory tests.Depending on the severity of the problem, the doctor may also order tests of kidney function, blood chemistry (electrolytes), liver enzyme tests, and verify the operation of other systems with the risk of serious infection.
- Roentgen. doctor may order X-rays to check the toe signs of bone damage, arthritis, damage from infection, the presence of foreign bodies in soft tissues.Gas soft tissue gangrene indicates.
- ultrasound. doctor may prescribe ultrasonic Doppler (a technique of ultrasound examination, based on the use of the Doppler effect. From moving objects ultrasonic waves are reflected with an altered frequency. If the motion is directed towards the sensor, the frequency is increased if the sensor is reduced. Doppler ultrasound is used to detect blood flow disorders. in the blood vessels of the head, neck, eyes, upper and lower extremities survey informative for both the venous system and blood circulation; modern ultrasound diagnosis is impossible without Doppler, because it allows you to identify predisposing factors for circulatory disorders) to see blood flowthrough the lower limb arteries and veins.This test is not painful, and involves moving the probe technique on the blood vessels of the lower extremities.
- consultations with specialists. doctor may ask for a vascular surgeon (angiohirurga) and an orthopedic surgeon to examine the patient.These specialists are engaged in diabetes problems in the lower limbs associated with infections or c circulation.
- Angiogram.This method contrast X-ray examination of the blood vessels used in radiography, fluoroscopy, computed tomography.Angiography is studying the functional state of blood vessels, blood flow and the length of the roundabout of the pathological process.If the vascular surgeon determines that the patient has poor circulation in the lower limbs, angiography can be performed in preparation for the operation to improve circulation.The procedure allows the surgeon to see the blockages and plan an operation to bypass them.Angiography is usually performed under local anesthesia.
Treatment of diabetic foot
The sooner treatment is started the diabetic foot, the better the result.We recommend the patient to consult a doctor about the best treatment plan for him.Treatment options include the following:
- wound care. good wound care can help heal ulcers and prevent infection.It is necessary to follow the doctor's instructions for wound care, regularly clean the wound and change dressings frequently to prevent infection;
- Reducing the load on the legs. Constant pressure sores can make them intractable.The patient may prescribe special shoes, which will remove the tension from his legs and let him walk better;
- Control blood sugar. Infectious ulcers can raise blood sugar levels.High blood sugar levels can reduce the body's immunity and its ability to fight infections and keep the wound from healing.Maximum control of blood sugar can help the patient fight against any infections and heal from wounds.Monitoring is often done with adjustments in diet and treatment.Sometimes insulin injections are needed in the short term;
- Healthy Habits. If the patient smokes, he should quit.Smoking can slow down the healing process;
- Shoes. should wear comfortable, proper shoes feet;
- Antibiotics. If the ulcer is infected with an infection, the doctor may prescribe antibiotics.Perhaps the patient will have to take medication for 4-6 weeks.You can not miss a dose.You must all take to the end - on the order of a physician.Your doctor may also recommend a treatment for ulcers.These medications may help speed healing.Typically, the patient needs to see some improvement in the wound for two or three days, and even longer for the first day.When a limb infection, threatening or life-threatening, the patient should be placed in a hospital.Less serious infections can be treated with pills on an outpatient basis.Your doctor may prescribe a dose of antibiotics to the patient;
- Surgery. Dead tissue can accumulate in and around the wound.This tissue can slow down or prevent healing.The patient may need surgery to remove dead tissue and cleanse the wound.This operation is called "debridement."Bypass surgery may be necessary to improve the blood flow to the legs.This operation uses healthy blood vessels capable of delivering blood to the old areas with unhealthy blood vessels.Improved flow can assist in the healing of wounds.Sometimes the infection is too severe and does not respond to treatment.