The term «diabetic foot» describes pathological alterations of the feet of patients with diabetes mellitus, such as skin changes, pressure marks, open wounds or malposition of the bones.
The causes of the diabetic foot are well known. A deficient metabolic state can damage nerves and hence lead to a reduced perception of sensations such as pain, positioning and temperature. The skin usually becomes dry and prone to injury, which is caused by a reduced functionality of the perspiratory glands. Many diabetics have experienced increased callus formation, pressure marks without pain and skin cracks. Furthermore, calcification of the arteries accelerates, reducing circulation of the foot and its skin. This is encouraged by high blood sugar over long periods of time.
Recognise the signs
The risk of developing a diabetic foot can be significantly recuced by a close and early cooperation of the patients and the attending doctor. Maintaining a healthy level of blood sugar prevents nervous dysfunction (so-called neuropathy). It also protects the blood vessels, which are also highly affected by cholesterol and blood pressure, both of which should be kept in healthy boundaries as well. Diabetic patients should show their feet to a physician at least once a year to make sure that symptoms are detected early on.
The start of a neuropathy can be diagnosed at an early stage by measuring vibration sensation using a tuning fork. The shape of the foot is evaluated and the typical symptoms are checked. A medicinal therapy is often necessary to improve the quality of life.
An experienced doctor can detect reduced blood flow in the foot almost instantaneously. The pulses within the foot are checked, and the blood pressure at the ankle is measured. If these examinations show an inadequate blood supply, an angiologist is consulted.
All diabetics can take measures to prevent these consequences. A diabetic therapy should be started as early as possible. Moreover, the right care of the feet is very important. The knowledge needed is offered in diabetes training. Well-informed patients will seek medical assistance much faster, recognising the symptoms. Furthermore, a periodic assessment of the condition of the feet as well as the footwear by a doctor is highly recommended.
If injuries or non-healing wounds have appeared regardless of preventive measures, the causes have to be determined carefully to guarantee an optimal treatment. This is possible only in cooperation with numerous specialists, such as cardiologists, vascular surgeons, angiologists, radiologists and orthopaedists and should always involve the primary care physician. The following therapy is interdisciplinary as well, the overall goal being the preservation of the whole foot and a fast healing of the wounds.
Each wound is cleaned, bandaged and depressurised. An MRI can show to which degree the bones are involved, and hence for how long the foot should not be exposed to pressure. An antibiotic therapy is started in cases with infections and the blood sugar level is monitored to speed up recovery. Heavily calcified or closed vessels are opened by widening or avoided with bypass surgery. In some cases, it is necessary to perform surgery on the bones as well or even remove some of them, always trying to preserve the functionality of the foot.
In very large or heavily infected wounds, therapy is done in the hospital. Smaller wounds or those healing fast can be treated on an ambulatory basis. In those cases, doctors work closely with specially trained diabetes-wound assistants or spitex workers. Cooperation with orthopaedic shoe-makers and podiatrists is imperative as well, since the healing of a wound should always be combined with preventive measures to avoid others.
The closer the cooperation of all disciplines, the better the result of the therapy. However, the role of the diabetic patient him- or herself is the most important one. To guarantee long-term therapeutic success, patients need good knowledge of their condition and have to be able to detect signs of pathological alterations.