Diabetic Foot Symptoms

Diabetic foot is a complication resulting from diabetes and the most common cause of lower leg or foot amputations in Germany. Because minor foot complaints develop more easily in diabetics and often go unnoticed, severe inflammation and ulcers can result. To prevent a diabetic foot, regular care and examinations are important in addition to optimally adjusted blood sugar levels. How a diabetic foot develops, how you can recognize the symptoms and what therapy is possible, you can read here. Detect and treat athlete’s foot

Definition: what is a diabetic foot?

Diabetic foot is also known as diabetic foot syndrome (DFS) in medical terminology. People with diabetes often suffer from poor circulation or nerve damage (diabetic polyneuropathy) in the feet. As a result of poor circulation, the feet are dry and cracked, allowing pathogens to easily penetrate the skin and wounds to heal more poorly. The sensory disturbances mean that pain perception is impaired and injuries are often not noticed until inflammation or ulcers have formed. In addition, the immune system is often weakened as a result of the disease, which also favors infections. According to the definition, one speaks of a diabetic foot when, as a result of the increased blood sugar levels in diabetes mellitus, pathological changes occur in the feet, for example extensive wounds or infections. This is a very diverse clinical picture. The cause can be either nerve damage (neuropathic diabetic foot) or circulatory disorders (ischemic diabetic foot) or a combination of both. Most often, people with type 2 diabetes are affected. The longer the disease has been present and the worse the blood glucose control, the more likely diabetic foot syndrome is to develop.

How does diabetic foot develop?

With a diabetic foot, all it often takes is a small trigger, such as an injury, an ingrown toenail, a pressure sore, or even a fungal infection that gets worse without being noticed. Foot lesions in diabetics often result from unsuitable footwear and improper foot care. Often, those affected also suffer from visual disturbances, so that foot problems such as reddening of the skin and swelling are not immediately recognized. In principle, a distinction must always be made between the two possible causes of diabetic foot – nerve damage or poor circulation. This distinction is important because both the symptoms and the treatment are different. In the case of circulatory disorders, walking and exercise are considered the most important therapy, whereas the neuropathically damaged foot must be immobilized at all costs.

Peripheral polyneuropathy (PNP) as a cause.

In diabetics, damage to the fine nerve endings of the feet can result in impaired perceptual sensation of touch, temperature, and pain. Foot injuries are thus often not noticed in time. Those affected then do not notice, for example, that they are walking – often for days – on a pin, a small stone or a crown cap in their shoe. Blisters caused by shoes that are too tight or ill-fitting, as well as burns caused by hot baths or hot water bottles, are also often recognized too late and cause major problems.

Lack of protective coating due to dry and cracked feet

Due to the so-called autonomic neuropathy, the skin of the diabetic foot has a reduced sebum and sweat production, so it is very dry and cracked. However, dry skin cracks more quickly and provides ideal living conditions for bacteria and fungi – serious infections are imminent.

Incorrect stresses lead to deformation of the foot

Another problem: incorrect loads on the foot due to nerve damage can lead to deformations or deformities of the foot, such as:

  • Hammertoes
  • Claw toes
  • Hallux valgus
  • Charcot foot

Due to the incorrect load, there is also an increased formation of calluses. Infections can spread under these calluses, which can lead to serious complications in a very short time. The danger: A wound may look small on the surface, but a large infection is hidden underneath. It is therefore important to remove the cornea regularly and extremely carefully.

How do I recognize a neuropathic diabetic foot?

Warning signs of a neuropathic diabetic foot include:

  • Very dry skin
  • Calluses and swellings
  • Warm and rosy feet
  • Reduced sensitivity, that is, insensitivity, for example, to temperature differences.
  • Sensory disturbances, for example, numbness, tingling, stinging or burning.
  • Painless injuries, which often go unnoticed and thus worsened
  • Strong callus formation
  • Malpositions of the feet

These symptoms are not only considered possible indications of a diabetic foot in an already diagnosed diabetes. However, they can also help to detect undetected diabetes.

Peripheral arterial disease (pAVK) as a cause.

The second possible cause of diabetic foot is circulatory problems. A lack of blood flow is also known as ischemia. The term diabetic angiopathy is also used in this context; it refers to vascular damage resulting from diabetes. The circulatory disorder in the feet is due to the so-called peripheral arterial occlusive disease, in which the blood flow to the legs is narrowed by deposits in the vessel walls. In many cases, a peripheral circulatory disorder already exists when diabetes is diagnosed. The toes and toe tips usually have the poorest blood supply. In cases of arterial circulatory disorders, blood flow-enhancing measures or even vascular surgery can be used to try to restore blood flow and preserve the limbs.

Symptoms of impaired circulation in the feet

Warning signs of peripheral circulatory disorders include:

  • Affected individuals often have pale, bluish discolored feet.
  • The skin on the feet often feels cool.
  • Sometimes the pulse on the arteries of the foot is not palpable.
  • Injuries are perceived as extremely painful and heal poorly, especially on the toes and heels.
  • Often, even the smallest injuries lead to inflammation or ulceration (ulcer). If the surrounding tissue dies, it becomes pitch black and looks like burned – this is called necrosis or diabetic gangrene.
  • Feet and legs hurt even at low loads, but these go away again at rest.

Because sufferers often stop until the pain has passed, and some make this look like window shopping, the condition is also known as intermittent claudication (Claudicatio intermittens). Diabetic foot with ulcer (ulculus) – iStock.com/Cathy_Britcliffe

Combination of both forms

In about a quarter of all affected individuals, a combination of neuropathy and circulatory problems is the trigger for diabetic foot syndrome. When blood flow is disturbed in addition to nerve function, diabetic foot wounds are very difficult to treat. This is because the typical symptoms of a circulatory disorder occur, but can go unnoticed due to the combination with the neuropathy and the therefore reduced sensation of pain. It is therefore important to look for warning signs of diabetic foot syndrome as soon as diabetes is diagnosed.

Diabetic foot: examination by the physician

Every diabetic should look at his or her feet daily and palpate them for pressure points and injuries. Those who cannot perform this inspection of the feet themselves should ask other people for help or seek professional foot care. The doctor should examine the feet of type 1 diabetics after a longer period of illness or of type 2 diabetics at least once a quarter, at least once a year he should check the vibration sensation as a measure of neuropathy. In addition, the physician examines the feet for:

  • Texture of the skin (dry, cracked).
  • Skin lesions
  • Pressure points
  • Calluses
  • Fungal infections (athlete’s foot, nail fungus)
  • Injuries
  • Changes in foot aesthetics and motor function

Furthermore, he will palpate the foot pulses to check the blood circulation. If the foot pulses cannot be palpated, a so-called Doppler pressure measurement should be performed.

Neurologic examination of the diabetic foot.

The neurological examination at the doctor’s office is not very complex, but very effective:

  • The most important instrument available is the Semmes-Weinstein 10-g monofilament.A nylon thread is pressed onto the examination point. At a contact weight of exactly 10 g, it bends. If the patient does not feel this pressure, it can be assumed that his foot is at risk from neuropathy. First, the patient should be demonstrated on the forearm what he should feel.
  • Checking thermosensitivity with the Tip-Therm. This device has a metal end and a plastic end. There is a temperature difference between the two ends. The difference is felt by the patient when he has a normal temperature sensation.
  • Rydell-Seiffer tuning fork: At least once a year, the doctor should check the vibration sensation as a measure of neuropathy. With the tuning fork damped to 64 Hz, the vibration sensation is tested at various points.

For the three tests mentioned, it is useful that the affected person closes his eyes to be able to concentrate completely on the sensation at the foot. By the way, the reflex hammer is also an important tool for assessing neuropathy, because the Achilles tendon reflex may be extinguished at a very early stage.

Diabetic foot syndrome: stages.

If diabetic foot syndrome is diagnosed, the physician will determine the stage. This is done according to the Wagner-Armstrong classification:
According to Armstrong, stages A to D are distinguished, which include infections and circulatory disorders:

  • A: No lesion is present
  • B: Lesion with infection
  • C: Lesion with ischemia (deficiency of blood supply).
  • D: Lesion with infection and ischemia.

In addition, the depth of the wound that occurred as a result of diabetic foot is divided into different grades according to Wagner:

  • 0: There is no injury, only a pressure point or malposition.
  • 1: There is a superficial wound
  • 2: The wound extends to the tendon or joint capsule.
  • 3: There is damage to the bones and / or joints.
  • 4: There is partially dead tissue (necrosis) in the forefoot or heel area.
  • 5: There is necrosis on the entire foot.

Therapy in diabetic foot syndrome

Treatment for diabetic foot should always be carried out by specialists. Which therapy is required, is based on the degree of the wound in the classification according to Wagner:

  • Grade 0 – initial stage: there should be regular control.
  • Grade 1 and 2 – Wound care: The treatment of the wound and the relief of pressure are the main focus. This should normalize the blood supply to the affected area to support healing. If necessary, tissue is removed for wound care or negative pressure is used to treat the wound (vacuum therapy).
  • Grade 3 – Antibiosis: In addition, therapy with antibiotics should be given.
  • Grade 4 and 5 – Amputation: the rise of inflammation can often only be prevented by amputation.

In the treatment of diabetic foot syndrome, amputation is sometimes the last resort when all other therapeutic options have been exhausted. Nevertheless, the goal is to avoid major amputation, as this can shorten life expectancy. For example, depending on the progress of necrosis, it may be sufficient to amputate the toe, but sometimes the entire foot or portions of the lower leg must be removed.

Correct causes

In addition to therapy for the acute wound, measures may be needed to address the causes, such as surgically correcting foot deformities. In any case, blood glucose levels should be properly adjusted to prevent progression. Cholesterol and blood pressure levels should also be lowered with appropriate therapy, if necessary. Existing nerve damage cannot be cured, but circulatory disorders can often be treated. Medications such as blood thinners are used for this purpose. Through appropriate training, diabetics can learn to prevent diabetic foot syndrome.

Diabetic foot: here’s how to prevent it

Because diabetic foot is often difficult or impossible to treat at an advanced stage, prevention is key. To do so, consider the following tips:

  1. Thoroughly check your feet every day for changes and signs of circulatory or nerve problems, and make regular preventive appointments with your doctor.
  2. Pay attention to even the smallest injuries or changes in the foot and treat them immediately.
  3. The best possible blood glucose control helps to eliminate the causes of diabetic foot syndrome.
  4. When caring for the feet, such as applying cream, caring for the nails and removing calluses, there are a few things to consider. Here you get detailed tips on the proper care of the feet.
  5. Reduce your body weight to relieve the feet. This is especially helped by a healthy diet.
  6. Refrain from smoking, as this impairs blood circulation.
  7. Put your feet up regularly.
  8. Targeted foot exercises can improve blood circulation in your feet.
  9. Buy breathable comfortable shoes that do not pinch or chafe and are neither too wide nor too tight.
  10. When choosing your stockings, make sure they fit comfortably. The socks should not cut or have chafing seams. In addition, they should be made of wool or cotton and changed daily.

With these tips, you can succeed in preventing the development of diabetic foot from the outset. What is your risk of diabetes?