Diabetic foot syndrome is one of the main complications of diabetes. The term includes foot injuries in diabetes patients regardless of the diabetes type and nature of the injury. Nerve damage and blood circulation disorders in the extremities that can appear as a result of permanently elevated blood sugar levels are the most common causes of diabetic foot syndrome. As diabetes patients only feel a limited amount of pain or no pain at all due to impairment of their nerves, and the blood circulation in their feet is inadequate, the injuries do not heal properly. At worst, if there is no treatment in time, diabetic foot syndrome may result in the amputation of the affected foot or leg.
Even minor incidents such as
- The wrong type of shoes which are too tight*
- Pressure marks
- Entering of foreign objects
- Ingrown toenails
- Burns from foot baths that are too hot
cause injuries to the feet that become infected quickly and damage tissue.
* The most common cause of foot injuries are shoes that are too tight. Shoes that exert local pressure on the foot should be avoided. Shoes with hard cork insoles, straps or hard insoles are unsuitable.
These types of infected wounds heal badly in diabetics as patients experience less pain due to diabetic nerve damage and the legs are often not adequately supplied with blood. The infection spreads to deeper tissue layers so that the extremity may have to be amputated completely if not treated correctly.
When treating diabetic foot syndrome the principal goal is to prevent amputation.
What prophylactic action can prevent the occurrence of diabetic foot syndrome?
It is very important for diabetic patients to have their feet examined every three months by their treating physician. Patients who are at risk should also be given all the information they need.
Further preventive measures are:
- Daily washing with lukewarm water
- Massaging the feet with moisturising cream
- Proper care of the nails (not letting them become too sharp)
- Removing corns and calluses
- Supply with proper footwear
- Long-term, severe course of diabetes
- Very elevated blood suger levels, poorly controlled metabolism
- Nerve damage
- Arterial occlusion
- Advanced age
- Grade 2 obesity (grade 2 means that the body mass index [BMI] is greater than or equal to 35. BMI is calculated by dividing weight [kg] by height in metres squared [m²])
- Joint disorders (e.g. in the hips/knees) or joint replacement with function impairment
- Walking barefoot
- Limited joint mobility, e.g. foot deformations
- (Seriously) reduced visual acuity
- Suppressed immune system through medicinal products including glucocorticoids
- Lack of/wrong type of foot care
- Impaired motor function/paralysis of one or both legs
- Psycho-social factors
- Visual impairment
- Addictions (e.g. smoking, alcohol abuse)
- Unsuitable shoes
It is very important to have regular check-ups, at least every three months, where physicians examine diabetics’ feet, and to provide training and information for risk patients.
Further preventative measures include:
- Cleaning feet daily with lukewarm water
- Applying moisturising lotions
- Professional pedicure
- Removal of calluses
- Suitable shoes
First clues to the presence of diabetic foot syndrome are found when inspecting diabetics’ feet. During the examination attention is paid to skin structure, bone deformations, loss of movement, signs of nerve damage and circulation disorders, infections and injuries.
Symptoms of diabetic foot syndrome include:
- Burning, tingling sensations in the toes and feet
- Pain in the feet when resting, particularly at nighttime
- Sensation of numbness
- Swelling of the dorsum (top) of the foot
- Claw toes
- Gait disorders
Sensitivity of the nerves is tested with a tuning fork to check for signs of nerve damage.
Circulation disorders are diagnosed by palpating foot pulses and x-ray or ultrasound.
When diabetics have foot injuries, professional diagnosis and treatment should be initiated immediately in an outpatient foot department for diabetes patients. Once the causes of the foot injury have been determined, the necessary treatment is initiated.
Treatment of diabetic foot syndrome in case of nerve damage
The necrotic, infected tissue that is healing poorly is removed. Antibiotics are used to fight any bacterial infections.
It is very important to relieve the pressure on the affected foot through special shoes, bedrest, walking aids or a wheel chair. This will allow the injuries to heal and prevent the development of further pressure points. In the vast majority of cases the injury will heal completely with the help of these treatment measures.
Treatment of diabetic foot syndrome in case of circulation disorders
If a circulation disorder is present, arterial circulation must be improved without delay. The wounds can only heal if the tissue is adequately supplied with oxygen, which in turn can only be safeguarded by good circulation.
The following methods are available for the treatment of circulation disorders:
- Widening of a constricted or occluded vessel with a balloon catheter
- Creation of a bypass
- Increasing circulation with the help of medicinal products
- A healthy lifestyle and diet, and more exercise will help with the treatment of diabetic foot syndrome. Risk factors such as smoking and obesity should be avoided. It is also important to control blood sugar and blood lipid levels, and blood pressure as well as possible.