Diabetic foot (or neuropathic foot) is one of the most widespread and fearsome complications of diabetes. It is an extremely disabling pathology, which causes anatomical-functional alterations of the foot and ankle.
It manifests itself with the onset of lesions and ulcers in the feet which, in the most serious cases, can even lead to the amputation of the limb. The diabetic foot is determined by the malfunctioning of the nervous system (neuropathy) and the cardiovascular system (arterial disease). Both of these conditions result from diabetes.
Timely diagnosis and early and appropriate treatment are of paramount importance to avoid serious consequences such as limb amputation.
What is Diabetic Foot?
The World Health Organization describes the diabetic foot as “the condition of infection, ulceration and/or destruction of deep tissue, associated with neurological abnormalities and varying degrees of peripheral vascular disease of the lower limbs”.
In other words, diabetic foot is that set of foot lesions caused on the one hand by diabetic neuropathy (malfunctioning of the nervous system), and on the other hand by diabetic arterial disease (malfunctioning of the cardiovascular system).
Both of these late complications of diabetes cause poor sensation in the lower limbs, which gives rise to two different pathologies:
- Neuropathic foot. Diabetic foot is defined as neuropathic when the damage is neurological, i.e. diabetes has damaged the nerve, sensory and motor fibers of the limb.
- Ischemic foot. Diabetic foot is defined as ischemic when the damage is due to arterial vascular deficit, for which the person is subject to a reduction in blood flow to the lower limbs.
People with diabetic foot may have a loss of sensation in their legs and feet, making it difficult to detect sores, cuts, or ulcers. Additionally, diabetes can cause decreased blood flow to the feet, which can slow wound healing and increase the risk of infection.
Foot injuries can then progress rapidly and lead to serious complications such as foot ulcers, infections and even, in the most serious cases, amputations.
In summary, the diabetic foot is also characterized by osteoarticular deformations of the feet, which can appear as a result of damage to the nerves, muscles and tendons. These alterations cause, in fact, a reduction of strength in some muscles of the leg and foot and stiffening of the tendons for which the toes tend to bend (hammer toes), altering the support of the foot on the ground, which undergoes abnormal and exaggerated workloads.
Furthermore, the skin of the foot, made fragile by diabetes, tears easily or calluses and blisters appear which, if not treated in time, can degenerate into ulcers.
If you want to know more, read our in-depth study on diabetes mellitus.
Diabetic foot symptoms
Diabetic foot is a complication that does not occur in all people with diabetes. Its development is always preceded by a long period (years) of poorly treated or neglected diabetes with constantly elevated blood sugar. In other cases, however, it occurs in people who did not know they were diabetic. In practice it becomes the clinical manifestation with which you discover a diabetes that you did not know you already had for some time.
In fact, an inadequately controlled disease over the years underlies the development of chronic complications of diabetes, such as peripheral neuropathy or arterial disease. These are risk factors at the base of the diabetic foot and identifying them allows you to counteract the risk of getting foot ulceration as much as possible.
Thanks to specific tests it is possible to define exactly the risk of ulcerative processes. It therefore becomes possible to adopt preventive measures appropriate to the level of risk.
As already indicated, in order for the diabetic foot to develop, there must be at least one chronic complication between neuropathy and peripheral vascular disease.
Neuropathy leads to reduced sensitivity of the foot, while peripheral vascular disease makes the feet more vulnerable due to insufficient blood supply to all structures of the foot, especially the skin, due to the reduced oxygen supply.
The skin gradually becomes more fragile and can undergo ulcerations that are difficult to heal due to an insufficient blood supply.
Every diabetic person should be aware of the ulcerative risk, in order to take all the necessary measures and avoid ulcers.
Loss of sensation can be quite risky. In fact, lacking thermal and pain sensitivity, subjects are unable to perceive dangerous situations, such as contact with excessive temperatures or heat sources.
Among the most common symptoms:
- Loss of sensation and possible tingling, numbness or a “pins and needles” or electric shock sensation in the lower extremities.
- Changes such as dry and flaky skin, which may become more prone to cracking, fissures or ulcers.
- Ulcers or wounds due to reduced sensitivity and impaired blood circulation with difficult healing.
- Cuts and skin lesions that fail to heal.
- Changes in toenails which may change to become thick, brittle or show signs of infection.
- Changes in the temperature of the feet, i.e. they may feel colder or warmer to the touch than the rest of the body due to blood circulation problems.
- Foot deformity, as diabetic foot can lead to deformities, such as flat feet or hallux valgus, due to weakening of the muscles and ligaments in the feet.
- Increased exposure to bacterial infections.
Causes of diabetic foot and risk factors
As already specified, this pathology is a chronic complication of diabetes mellitus.
There are several complications that can arise due to diabetes: we are talking about cardiological pathologies, renal failure, problems relating to the nervous system and even blindness.
Yet the diabetic foot, due to the ulcerative lesions it causes on the lower limbs, involves one of the greatest risks to the health of those suffering from diabetes. Furthermore, it is also one of the most common complications: the WHO estimates that approximately 15% of diabetic patients will have to deal with foot injuries that require specific medical treatments.
Diabetic foot is the consequence of lack of or inadequate control of blood sugar (blood glucose levels) and other risk factors such as high blood pressure, high cholesterol, smoking, excessive body weight, sedentary lifestyle, long duration of the diabetic disease, etc. .
In fact, if diabetes is not kept under control, metabolic alterations can cause damage to the arteries (diabetic arterial disease) or nerves (diabetic neuropathy) of the lower limbs, compromising the function and/or structure of the foot.
Diabetic foot can be present in both type 1 and type 2 diabetes, consequently affecting both young and elderly people.
Diabetic foot: diagnosis and instrumental tests
Since 60% of non-traumatic amputations of the lower limbs occur in diabetic subjects and about 80% of amputations are preceded by a foot ulcer, early diagnosis and timely treatment of this complication is essential.
For this reason, a clinical evaluation of the person with diabetes cannot be disregarded, which also includes a diagnostic phase that is structured on different levels:
- Medical history and physical examination. It is necessary for the doctor to review the medical history and perform the physical examination. In this way he can realize the seriousness of the condition. With the physical examination the vital signs of the subject are evaluated (body temperature, pulse, blood pressure and respiratory rate) followed by the sensitivity test of the hands and feet (often altered in diabetics) and the analysis of the circulation of the lower limbs.
- Blood analysis. They are used to determine a possible infection in progress or the presence of other pathologies. However, the doctor can prescribe more in-depth and specialized tests, such as liver enzyme tests and tests for kidney function.
- Diagnostic tests (radiography, Doppler echo, angiogram, etc.).
A screening of peripheral neuropathy, vascular disease and morphological alterations of the foot is then performed and a podiatric risk score is assigned. The screening consists in the execution of the physical examination, the ankle-brachial index (Winsor Index), in the detection of the vibratory sensitivity (with Biothesiometer) and the protective tactile sensitivity.
Screening positive subjects will have to perform 2nd level instrumental tests: arterial Doppler ultrasound and transcutaneous oximetry.
Treatment of pre-ulcerative lesions is also provided for in subjects at high podiatric risk: tylomas, hielomas, hematomas, nail dystrophies, plantar hyperkeratosis, etc.
For the treatment of the ulcerated diabetic foot, on the other hand, surgical toilets and dressings are performed.
Diabetic foot: cures and treatments
At the basis of an effective treatment, there is a correct and early diagnosis: analyzing the foot with regularity and timeliness allows in fact to avoid the worsening of the pathology.
To reduce the risk of more serious damage, such as amputations, constant therapy is also essential, to be carried out together with periodic blood sugar checks and all the other tests prescribed by your doctor.
Pharmacological therapy must be combined with a series of fundamental measures to limit the…