The following symptoms and complaints may indicate diabetic foot:
In diabetic neuropathy (nerve damage) – diabetic polyneuropathy – blood flow to the foot is intact. However, due to paralysis of the foot muscles, there is an incorrect load on the foot. This is manifested in the progressive sinking of the metatarsalia (metatarsal bones) in the area of the forefoot. The first signs of this incorrect loading are circumscribed hyperkeratoses (excessive keratinization of the skin), which in the further course lead to tears in the skin. The tears are often not noticed by the patient due to the reduced sensitivity.
Leading symptoms of diabetic foot in diabetic neuropathy (nerve damage) (= neuropathic foot).
- Burning/stabbing pain, especially at rest.
- Altered perception of pain
- Paresthesias (insensations)
- Temperature sensation disorders
- Sleep disturbances
In diabetic angiopathy (vascular damage), due to atherosclerosis (arteriosclerosis; hardening of the arteries) of the leg vessels, ischemia (reduced supply) of the foot occurs and, as a result, necrosis (death of tissue) and ulceration (ulceration) (= ischemic foot).
Leading symptoms of diabetic foot in diabetic angiopathy (vascular damage) (= ischemic foot).
Often there is a combination of neuropathy and angiopathy, so that not all symptoms are present (= neuropathic-ischemic foot).
Caution. Note, unlike peripheral arterial occlusive disease (pAVD; most important differential diagnosis), in the presence of neuropathy, the foot is warm, has palpable foot pulses (of the tibial and dorsalis pedis arteries, bilaterally), and a rosy skin coloration.
