Diabetic Foot Syndrome
Diabetes mellitus causes blood glucose level to become high that over time may cause damage of nerves in feet and peripheral blood vessels. Due to this some people may lose sensation in feet, while others may develop ulcers, sores and infections. This condition is called diabetic foot syndrome and it is one of the consequences of diabetes mellitus. Diabetic foot symptoms are numbness, skin discoloration, etc. Diabetic foot syndrome treatment varies depending on the severity of symptoms and overall condition of the patient. More detailed information about this condition, its symptoms, diagnostics services and diabetic foot syndrome treatment options is presented below.
A foot that exhibits any pathology that results directly from diabetes mellitus or any long-term or chronic complication of diabetes mellitus. Several characteristics including infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome.
Patients have a reduced ability to feel pain due to the peripheral nerve dysfunction associated with diabetes (diabetic neuropathy). Minor injuries may remain undiscovered for a long while. Diabetic people are also at risk of developing a diabetic foot ulcer. Research estimates that the lifetime incidence of foot ulcers in the diabetic community is around 15% and may grow as high as 25%.
Peripheral nerve dysfunction can be combined with peripheral artery disease in diabetic people causing poor blood circulation to the extremities (diabetic angiopathy). About half of patients with a diabetic foot ulcer also have co-existing PAD.
Infection may set in and lower limb amputation may be necessary as wounds take a long time to heal. Foot infection is the most common cause of non-traumatic amputation.
The 3 components to diabetic foot:
- Ischemia: Blood vessels are blocked and hardened; this reduces blood flow to the feet or leg
- Neuropathy: Damaged nerves reduce sensation in the leg or foot
- Infection: Tissues rich in glucose are ideal for bacterial growth
DIABETIC FOOT SYMPTOMS
Signs and symptoms of a diabetic foot may include:
- Reduced sensation in the foot or leg
- Presence of ulcers or gangrene areas
- Infection or inflamed areas in the foot or leg
- Symptoms of peripheral vascular disease
DIABETIC FOOT SYNDROME TREATMENT OPTIONS
Treatment can be challenging and prolonged. It may include orthopaedic appliances, antimicrobial drugs and topical dressings.
Most diabetic foot infections require treatment with systemic antibiotics. The choice of the initial antibiotic treatment will depend on several factors such as:
- The severity of the infection
- Whether the patient has received another antibiotic treatment
- Whether the infection has been caused by a micro-organism that’s known to be resistant to usual antibiotics (e.g. MRSA).
The objective is to stop the infection and ensure it does not spread. It is still unclear whether or not any particular antibiotic is better for curing infection or avoiding amputation. It is also unclear whether different antibiotics are associated with more or fewer adverse effects.
- Control of blood pressure, cholesterol and stop smoking: Improve overall health and decrease the risks of any complications.
- Antiplatelet therapy: Prevent intravascular development of clots and help to avoid any blockages in the lower limb vessels.
- Other medications: Improve circulation and blood flow into the lower limbs promoting recovery.
- Proper wound/ulcer care: Essential as it helps to prevent infections, spread of inflammation and development of gangrene.
Revascularization procedures tailored for individual patient based on anatomy, particularly the inflow and outflow as defined by the preoperative angiography. Patients with multilevel disease may require multilevel reconstruction at the aortoiliac and infrainguinal levels.
Infrainguinal bypass procedures need to arise from a patent and uncompromised inflow artery. The quality of the outflow artery is an equally important determinant of patency and a distal vessel of the best quality should be used for distal target. Conduit is also important with the vein having better long-term patency than prosthetic for infrainguinal revascularization.
Polytetrafluoroethylene has delivered nearly equivalent results in the above knee position in the short-term even though, below knee or infrapopliteal bypass, long-term patency of synthetic conduit remains dismal.
Patients with ischemic tissue loss and superimposed infection who have a salvageable foot should have the infection controlled before revascularization.
Broad-spectrum antibiotics in concert with debridement and may require partial foot amputation. Bypass may be performed once cellulitis, lymphangitis, and edema have improved. Surgery includes:
- Percutaneous transluminal angioplast: Achieve a straight line flow from the aorta down to either a patent dorsalis pedis or plantar arch. The aim of treatment is limb salvage. This procedure is the first choice revascularization procedure in many cases as it is feasible, safe and cost effective for limb salvage in a high percentage of diabetic patients
- Bypass surgery: The goal is to preserve limb function and to prevent more serious complications. This might be an option for patients who are not candidates for angioplasty or stenting. Surgery can help to restore the flow of blood to vital regions of the body.
- Amputation/debridement surgery: An amputation may be the only option when the condition results in a severe loss of tissue or a life-threatening infection.
The damaged tissue is removed and preserve as much healthy tissue as possible. You’ll be monitored in the hospital for up to 2 weeks after surgery. It may take 4 to 8 weeks for your wound to completely heal.
It’s important to follow your diabetes treatment plan even after amputation as amputees have a higher risk of having another. To help prevent additional diabetes complications, you should eating healthy foods, exercising regularly, controlling your blood sugar level and avoiding tobacco.
Prevention of complications development
Following the proper diabetic foot care routine will help to prevent the development of complications.
DIAGNOSING DIABETIC FOOT
- History taking and physical exam: You will be asked about the symptoms you have. Your overall health and medical history will be checked, as well as your family history. A careful examination of your feet to discover the problems will be performed.
- Blood test: A blood test may be ordered to check for any infections in the body.
- Doppler Ultrasound: Measure the direction and velocity of blood-flow through the vessels.
- X-ray: To seek for any signs of arthritis or bone damage in your feet.