Diabetic foot: symptoms and treatment, reasons, photo

Diabetic foot is a complex of pathological changes in the foot tissues, which develops as a late complication of diabetes mellitus.

As a result of prolonged high levels of glucose in the blood, the nerves that go to the feet, large and small caliber vessels that feed the legs suffer.

This leads to disruption of the normal structure and functioning of all tissues( skin, muscles, bones) of the distal parts of the legs, which makes them "easy prey" for infection: ulcers, necrosis, phlegmon develop, and destruction of deep tissues.

Late treatment of diabetic foot can lead to the need for its amputation and subsequent disability of a person.

Causes of diabetic foot

The disease develops only due to diabetes, caused by both genetic predisposition and diseases leading to obesity.

Increased for a long time in the blood glucose( or because of a lack of insulin, or because of its lack of "perception" of cells) converts the walls of large and small vessels.

The foot suffers more, as the arteries that go to it give her blood under less pressure( that is, the tissue gets oxygen less), and it is more difficult for the veins to carry spent metabolites - because of the distance from the heart and work against gravity.

As a result, poor blood supply to the tissues, which leads to:

• for easier traumatization( even a small stone, falling into the shoes, can cause ulcers or phlegmon)
  
• slowed down their "cleaning" and regeneration after infection.

Increased glucose concentration also acts on nerve endings. As a result, pain and temperature sensitivity suffer, and the person does not feel how he burned, rubbed or cut a foot, subjected it to the action of low temperature.


All three factors - disruption of normal blood supply, innervation and immune defense - and lead to the fact that:

1. 1) Pathogenic microorganisms are almost all the time on the "weakened" tissues of the foot;
   
2. 2) Often there is a violation of the integrity of tissues, which, because they are not noticed, are not treated with antiseptics on time;
   
3. 3) Infection quickly enters the formed micro- and macro-cracks;
   
4. 4) Healing takes a very long time, medical assistance is needed for this;
   
5. 5) There is a tendency to spread the purulent-inflammatory and necrotic process along and into the tissues.

The risk of developing a diabetic foot increases with such conditions:

• of leg vessel disease: obliterating endarteritis, angiitis, vasculitis of various etiologies;varicose veins.
  
• "experience" of diabetes for more than 10 years.
  
• bone pathology of the foot: flat feet, varus or valgus deformation, arthritis of the joints of the fingers.
  
• smoking.
  
• inadequately selected shoes, which will lead to traumatization of the foot.

Symptoms of diabetic foot

Diabetic foot, the characteristic symptoms of which will depend on the form of the disease and other factors.

And so, depending on the nature of the disturbances occurring in the foot, three main forms of the development of the disease stand out:

1. 1) Mixed form - when there are signs of both of the above diseases.
   
2. 2) Neuropathic - in this case, the predominant is the defeat of the nervous tissue. This is manifested by the sensation of creeping crawling, burning or tingling, numbness, fever, or chilling. Skin is warm and dry. The pulse on the arteries is determined, but the reflexes and sensitivity are reduced. There is a deformation of the joints. Often ulcers are formed, from which an abundant amount of fluid is released.
   
3. 3) Ischemic form - mainly large or small vessels suffer. This is manifested by pain in the foot, gradually developing muscle weakness, when in the end the stop ceases to move normally, which is manifested by lameness. The skin of the foot becomes pale, cold, on it appear areas in which the skin is colored more strongly. The pulsation of the arteries of the foot is difficult to determine. Wounds do not heal for a long time;corns appear on the ankle, a "bone" on the I and V fingers. The outcome of this form is dry gangrene of the finger( fingers) or the entire foot.

The first signs of

In women and men, the first signs of the disease usually are tingling in the foot, "goose bumps," running around the skin of the legs, and numbness of the feet that a person with diabetes mellitus notes.

Also in the initial stage, one of the following signs can be noticed first:

• does not heal even minor injuries of the skin for a long time, there is the possibility of suppuration;
  
• fungal diseases of the skin of the foot or nails( see how to treat foot fungus);
  
• areas of callosity on the big toe, between the phalanges;
  
• deformation of the joints and toes;
  
• drowsing ulcers;
  
• cracks on the heels.

Diagnosis

Both therapy and diagnosis are performed by such physicians:

• a diabetologist( endocrinologist);
  
• surgeons: general and vascular;
  
• neurologist;
  
• the doctor-podog.

Diagnosis of the disease consists in the following points:

1. 1) Patient survey: the doctor specifies whether the person has diabetes, what type, how many years he is ill, than he is treated, "habitual" blood glucose levels.
   
2. 2) Examination of the feet, determination of the pulse on them, probing of the wound( ulcer) in order to determine its depth. If a purulent discharge is defined, necrosis or wound edges are of a changed nature, treatment is performed. This is performed by a vascular surgeon, a general surgeon.
   
3. 3) The blood glucose level is determined.
   
4. 4) A general blood test is used to assess the severity of the inflammation.
   
5. 5) Also conducted is a study of glycated hemoglobin, cholesterol and fat fractions. In the urine, ketone bodies, glucose and protein are determined.
   
6. 6) If the suspicion of involvement in the pathological process of the bone is performed, the radiograph of the foot is performed.
   
7. 7) To assess the state of blood vessels supplying a foot with blood, dopplerography of vessels, CT angiography or radiopaque angiography is performed.
   
8. 8) Sowing of wound detachable on nutrient media is conducted, in order to determine the microbe and its sensitivity to antibacterial agents.

Treatment of diabetic foot

First of all, for the proper treatment of diabetic foot try to follow the following recommendations to avoid complications.

1. 1) Normalization and further monitoring of blood glucose levels. At type 2 of the patient is transferred to the insulin intake, at type 1 - its dosage is revised.
   
2. 2) With the neuropathic form of the disease, the foot should be kept at rest. When ischemic - the orthopedist prescribes a prescription for the manufacture of special footwear, the purpose of which is to unload the foot.
   
3. 3) The surgical treatment of the wound is performed, if necessary, its drainage. The second stage of surgical treatment for ischemic form of the disease are operations aimed at restoring the patency of the vessel. So, stenting, endovascular dilatation, shunting, arterial veins, removal of thrombi and emboli are performed. After healing of a wound defect, its plastic can be carried out by a patch of its own skin.
   
4. 4) Antibacterial therapy is prescribed: first, a wide range of preparations is used, then, after receiving the results of bacteriological research, their purpose is reviewed.
   
5. 5) Medical normalization of blood pressure is performed.
   
6. 6) Hyperbaric oxygenation is performed: saturation of tissues with oxygen fed under increased pressure.
   
7. 7) Drugs are prescribed to normalize blood lipids and cholesterol( statins, fibrates).

Drugs are also prescribed:

• preparations of lipoic acid( "Berlition", "Dialipon");
  
• antispasmodics( "No-shpa", "Papaverin") for the purpose of vasodilation;
  
• drugs that reduce the risk of deposition of blood clots on the walls of blood vessels( "Kurantil", "Trental");
  
• preparations that improve microcirculation in ischemic tissues( "Actovegin");
  
• B-group vitamins( "Neurorubin", "Milgamma").

If there is purulent melting of bones, or the level of blood supply of tissues is reduced to critical numbers, or gangrene is diagnosed, one must resort to amputation of the limb above the level of necrosis / osteomyelitis.

Prognosis and prophylaxis

Prevention of the disease consists in observing the following rules:

• monitoring of glucose and glycated hemoglobin in the blood;
  
• visit to the "School of Diabetics" or "Diabetic Foot";
  
• wearing comfortable shoes, not narrow, not rubbery and not open, with a heel no more than 4 cm;
  
• refusal to use traumatic items for foot care;
  
• adherence to hygiene measures;
  
• performing pedicure only at home, cutting off nails without rounding corners;
  
• daily perform massage, gymnastics for feet;
  
• treat dry skin with stop creams matched by a doctor;
  
• treatment of neuro- and angiopathy courses;
  
• treatment of fungal lesions of the foot.

Especially serious prognosis in the development of diabetic foot in the elderly, in persons suffering from diseases of the vessels of the lower extremities, with the long-term existence of the underlying disease.

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