Diabetic foot
"Diabetic foot" is a specific complication of diabetes mellitus in the form of a special foot injury due to disturbances of innervation and blood supply;dystrophic changes in bones, which ultimately leads to the appearance of disorders that impede walking, the development of ulcers and suppurative complications.
Frequent complaints with a "diabetic foot" are: muscle weakness in the leg, numbness, chilliness, a sensation of crawling crawling, pain, cramps in the limbs.
The "diabetic foot" syndrome affects up to 10% of patients with diabetes mellitus, and 40-50% of them can be classified as a risk group. In 10 times the syndrome of the "diabetic foot" develops in people with the second type of diabetes mellitus. Till now all over the world rendering assistance to patients with the syndrome " diabetic foot " is far from perfect. At least 47% of patients start treatment later than possible. The result is amputation of limbs, increasing the death rate of patients in 2 times and increasing the further cost of treatment and rehabilitation by 3 times.
Disease in 85% of cases is represented by ulcers of feet of different severity. It is found in 4-10% of the total number of patients with diabetes mellitus.
Depending on what is affected more strongly, angiopathic( with primary vascular lesions) and neuropathic( with a predominant lesion of nerve endings) are distinguished, as well as a mixed form of lesion of the extremities.
Ischemic form develops as a consequence of atherosclerotic lesions of arteries of the lower extremities, which leads to disruption of the main blood flow. In this case, there may also be neuropathic changes. However, a decrease or a complete absence of pulsation on the arteries of the feet and shins, cold extremities with palpation, pain symptoms, and the characteristic localization of ulcerative defects of the type of acrinal necrosis make it possible to differentiate the neuropathic and mixed( neuro-ischemic) forms of foot damage.
The neuropathic form of the syndrome of diabetic groans occurs in the foot areas experiencing the greatest pressure, which is especially common in interdigital spaces. Prolonged leakage of nerve conduction leads to deformation of the foot, which contributes to the redistribution and excessive increase in pressure on its individual areas, for example, in the projection of the heads of metatarsal bones. In these places there is a thickening of the skin, the formation of hyperkeratoses, which have a rather high density. Constant pressure on these areas leads to inflammatory melting of the underlying soft tissues, the formation of a ulcerative defect. The patient may not notice these changes due to reduced pain sensitivity.
Very often, the formation of ulcerative lesions occurs due to improper selection of shoes. As it was said, the disturbance of the nervous regulation leads to a characteristic deformation of the foot. On the other hand, these same disorders lead to the onset of edema. Thus, the stop changes not only the shape, but also the dimensions. At the same time, shoes are selected by patients based on knowledge of their previous sizes, taking into account one or two measurements. Reduced sensitivity does not allow the patient to detect the inconvenience of new shoes in a timely manner and, as a result, ulcers and scrapes occur. Patients' legs can be exposed to various damaging factors. Because of the increase in the sensitivity threshold, patients may not feel the effects of high temperature, for example, the burn of the rear surface of the foot when taking sun baths or a foot while walking barefoot on hot sand. Of the chemical factors, it should be noted the damaging effect of some ointments that have salicylic acid in their composition, which can lead to the formation of ulcers.
The resulting ulcer is often infected with staphylococci, streptococci and other microorganisms. Anaerobic microflora often takes place. Pathogenic microorganisms produce an enzyme that melts tissues, which leads to the spread of necrotic changes over a large area. In severe cases, there is a thrombosis of small vessels and, as a consequence, the involvement of new large areas of soft tissues in the process. Infected lesion of the foot can be accompanied by the formation of gas in soft tissues, which is detected both by palpation and x-ray. This condition is usually accompanied by hyperthermia, leukocytosis. In such cases, urgent surgical intervention is necessary, consisting in removal of necrotic limb sites with subsequent treatment with antibiotics.
Patients with diabetes mellitus, with violation of all metabolic processes, suffer surgery and postoperative period with more severe painful phenomena. This happens in the event that no measures are taken to normalize the exchange, especially carbohydrate. Using modern methods of treatment with insulin and the necessary diet, it is possible to perform any operation, the outcome of it will depend not only on diabetes mellitus, but on all sorts of conditions on which the outcome of this or that operation, made to a patient with unbroken carbohydrate metabolism, generally depends.
Patients with the diabetic foot syndrome are concerned with:
• thickening and changing the shape of the nails, excessive corns;
• fungal nail and skin damage;
• numbness of the feet, a feeling of "running chills" and a decrease in skin sensitivity in the area of the feet;
• change the shape of the foot.
Usually, in patients with diabetes mellitus, the body's defenses are reduced. Any cut, scratch and even callosity can become a source of serious inflammatory processes on the leg, lead to the formation of ulcers.
To prevent abrasions, scrapes, calluses, it is recommended:
• carefully follow hygiene rules;
• wear soft, comfortable shoes, socks with a tight rubber band;
• In case of injuries, abrasions and cuts should be treated with hydrogen peroxide( 3% solution) or by special means( dioxidin, furacilin) and apply a sterile bandage. Iodine, "manganese", alcohol and "zelenok" should not be used, as these preparations "paint over" and hide the cracks and scrapes of the skin, which can lead to their late diagnosis.
Do not:
• use "magnetic insole"( with protrusions);
• use chemicals or preparations to soften calluses( for example, patch "Salipod"), remove corns with cutting tools( razor, scalpel, etc.).For this purpose, it is better to use pumice and similar special devices.
Only constant attention to the skin of the feet and timely access to a doctor with signs of infection will prevent the occurrence of serious problems of the "diabetic foot".
In case of non-healing wounds and ulcers on the legs;infectious processes: abscesses and phlegmon( suppuration of subcutaneous tissue), osteomyelitis( inflammatory process in the bone), gangrene and other diseases of the extremities should be urgently consulted by a doctor. Treatment of these diseases should be carried out only in a hospital environment, because it often requires surgical intervention.
Risk factors:
• duration of diabetes more than 10 years;
• elderly age;
• atherosclerosis of lower limb arteries;
• deformation of the foot( eg, flat feet);
• frequent corns, hyperkeratosis, bursitis of the thumb;
• tight, uncomfortable shoes;
• badly cut nails, insufficient hygiene of the feet;
• fungal lesions of the feet;
• smoking and other bad habits.
Prevention:
• Prevention of infections;
• Careful foot care;
• examinations and examinations of the orthopedist and angio-surgeon at least once a year.
If a deformity or ulcer is found, the patient is referred to a clinic specializing in a "diabetic foot".
The most important role in the prevention of "diabetic foot" is the training of patients. The program should include information about the care of your feet, about the selection of shoes, prevention of infections and trauma to the foot.
In order to avoid such an unpleasant complication as a "diabetic foot", you need:
1. Stop smoking.
2. To a minimum, reduce the animal fats in the diet, giving preference to vegetable oils and margarines.
3. Constantly include in the diet vegetables and fruits, poor refined carbohydrates, but rich in vitamins C, B, PP, E.
4. In order not to injure the leg, try not to walk barefoot even at home.
5. Carefully select shoes, and with the appearance of the slightest signs of "diabetic foot" wear only individually sewn orthopedic shoes.
6. Every time before you put on your shoes, carefully examine and feel it from the inside, remove all foreign objects that have got inside.
7. Every day, wash your feet with warm water and soap, preferably "child", but not more than 5 minutes. Wipe your feet with a soft towel, gently rubbing the interdigital spaces.
8. Never soar your feet, do not heat them with any sources of heat, focus only on warm socks.
9. Cut nails only at right angles, so that the corners do not cut into the skin, and even better not to cut them, but to file with a special nail file.
10. You can not cut corn, use a corn plaster. You can carefully remove the calluses with pumice stone, or better still do it in the foot specialist.
11. Do not use strong binders, alcohol tinctures, concentrated manganese solution, tinctures of oak bark, etc.
12. Every day, you should thoroughly examine your feet and feet with a mirror and, if the slightest cracks appear, contact your doctor immediately.
13. When you are on the beach, in the pool or in the bath, you should always have a rubber or plastic slippers completely covering your foot. Room slippers and summer shoes should be with a closed toe in order to avoid injury to the fingers in case of impact.
14. Categorically it is impossible to open blisters or calluses independently with needles or pins;you can put on them only a sterile bandage.
15. Do not wear wet socks and stockings, this can lead to abrasions. Socks and stockings should only be cotton or woolen without rough seams, always clean and dry, matching the size. The elastic on the toe should not squeeze the leg and leave a hem.
Such a detailed analysis of the problem of "diabetic foot" is due to the fact that it is extremely difficult to treat its obvious manifestations, it is much easier to prevent them. For experience shows that with a slight rubbing or scratching, an extremely difficult healing complication can begin, up to the gangrene of the leg, which requires its amputation.