What is the best treatment for diabetic foot?
As we all know, diabetes has a slow evolution, which affects most organs and systems of the human body, the diabetic foot being just one of the complications that can occur in the evolution of the disease.
What is a diabetic foot?
The term diabetic foot refers to all manifestations and symptoms secondary to vascular and neurological damage to the lower limbs in diabetes. The condition is more common in patients with uncontrolled diabetes and can be prevented by taking a set of simple and easy-to-apply measures.
What are the determinants of diabetic foot?
The neurological component is of three types that can be described as follows:
- Sensitive neuropathy is a decrease in nociceptive and thermal sensitivity (the patient does not feel pain or cold/hot), the mechanisms of interruption of nerve impulse transmission being multiple;
- Peripheral motor neuropathy refers to the state of unilateral or bilateral "muscle weakness" of the lower limbs;
- Vegetative neuropathy is affected by impaired microcirculation (we notice a delay in the healing process in case of lesions) and sweating dysfunction with anhydrosis in the lower half of the body with an increased risk of skin cracks in the legs.
Vascular damage to the lower limbs is also called peripheral diabetic arteriopathy and is due to vascular obstruction with the appearance of ischemia (stopping blood flow) secondary to narrowing of the vascular caliber due to the presence of atheroma plaques. This context of slowing down or stagnation of blood circulation favors the appearance of skin trophic changes and peripheral ulcerations with the risk of bacterial superinfection.
How we recognize the diabetic foot
Careful monitoring of any foot changes that occur during diabetes is essential and can be a lifesaver for the affected limb. We must not neglect the appearance of signs that indicate the presence of the diabetic foot:
- Hyperesthesia - increased skin sensitivity, hypoaesthesia - decreased sensitivity threshold, paresthesia - the presence of tingling;
- Anhydrosis - skin dryness that may be accompanied by spontaneous cracks;
- Fragile calluses (thickening of the skin) that flake off and can easily break at low pressures with the appearance of skin continuity solutions (cracks) that present a risk of infection;
- Ulcers - "wet" wounds that do not heal at the points of support (heel, distal metatarsal, thighs especially toes).
What are the complications of the disease
The risk of infection of the skin lesions is the most common complication in the diabetic foot and can occur:
- At the superficial level in the form of skin-limited cellulite or lymphangitis with the involvement of lymphatic vessels - infection given by group A hemolytic beta streptococcus;
- At the level of soft tissues - it is due to the deep propagation of germs from the superficial skin level and they appear especially inguinal being due to anaerobic bacteria;
- Deep in the form of acute or chronic osteomyelitis (bone infections), that can progress asymptomatic in the presence of diabetic neuropathy.
How we care for the diabetic foot
Prevention is the most effective method of treatment we can adopt and includes all skin and nail care measures by: keeping the foot clean and dry (we remove gentle corns with a pile, we use white cotton socks with weaker elastic on top, choose appropriate footwear that does not cause us discomfort when walking), moisturize the skin with an emollient cream, carefully cut the toenails without causing damage, avoid the position "foot over foot" or at the edge of the bed with "hanging feet".
Effective control of diabetes by maintaining blood sugar and blood pressure in optimal parameters through hygienic-dietary and medicinal measures, adopting a healthy lifestyle that includes daily exercise and quitting smoking are also preventive measures used successfully in this case.
The actual treatment of the disease aims to prevent the occurrence of infections and could be the surgical removal of unviable, necrotic tissue by debridement and local wound care (in mild cases) or partial/total limb amputation in imminent life-threatening situations as septic shock.