Diabetic foot syndrome is a sometimes severe secondary disease of diabetes mellitus in which either the nerves or blood vessels in the foot are damaged. This can lead to circulatory problems and/or pressure ulcers. In severe cases, the functionality of the foot can be so severely impaired; in some cases, this can even lead to amputations.
What is diabetic foot syndrome?
Poorly healing wounds on the lower leg or feet are usually affected by diabetic foot syndrome. Diabetic foot syndrome not infrequently presents itself in diabetes mellitus patients. It is divided into two different categories. Neuropathic foot syndrome refers to damage to the nerves that causes pressure points, numbness, or even ulcers on the foot. The musculature is weakened and the functionality of the foot is impaired. In the case of the ischemic foot, the blood supply to the foot is disturbed. As a result, entire sections of the affected tissue can die and, in the worst case, must be amputated. The neuropathic foot occurs much more frequently than the ischemic foot; the ratio is about 70% to 30%. The medical treatment required in each case depends on the type of diabetic foot syndrome.
Causes
The causes of diabetic foot syndrome initially lie in an existing underlying disease, diabetes mellitus. Especially patients whose blood glucose level is permanently elevated or repeatedly subject to strong fluctuations suffer from the so-called diabetic foot. The excessively high glucose level in the body disturbs the metabolism, which damages the nerves, arteries and blood vessels in the long term. The risk of diabetic foot syndrome is increased even further in diabetics who smoke, since nicotine impairs blood circulation. The discomfort can be further aggravated by shoes that are too tight, as pressure points or ulcers develop due to a faulty perception of pain, but are not detected early.
Symptoms, complaints and signs
In this syndrome, affected individuals suffer from severe discomfort that significantly limits and reduces the quality of life. First and foremost, there are significant disturbances in blood circulation, which occurs primarily in the legs and feet. This can lead to disturbances in sensitivity or even paralysis in these areas, so that the affected person often also suffers from restricted movement and is dependent on the help of other people in their everyday life. This makes the affected person’s everyday life considerably more difficult. Muscle atrophy can also occur in the feet, so that even walking or standing can result in severe pain in the feet and also in the legs. At night, the pain can also occur, leading to sleep problems and irritability of the affected person. Furthermore, various inflammations and infections occur in the feet, and even ulcers can develop. These are associated with severe pain and redness. The feet of the affected person are often cold, because they are not sufficiently supplied with blood. In severe cases, the foot must even be amputated if direct treatment of the symptoms is not possible.
Diagnosis and course
The risk of suffering from a poorly healing wound is particularly high if there is a concomitant circulatory disorder. Deep skin ulcers (ulcerations) can extend further and further into the foot and also become colonized with MRSA germs, which can prevent normal wound care and healing. Since diabetic foot syndrome is a disease without a uniform clinical picture, it is crucial for the treating physician to first have a discussion with the patient. Subsequently, specific examinations can be performed to check, for example, the sensation of pain or the condition of the arteries. An X-ray of the feet can also be helpful. The course of the disease is determined by the type of diabetic foot syndrome. The neuropathic foot can usually be treated well, provided the ulcers are not too severe. In the ischemic foot, on the other hand, there is a risk that a part of the foot will have to be amputated if there is a prolonged lack of blood flow.
Complications
Diabetic foot syndrome is one of the typical complications of long-standing diabetes mellitus.Due to the permanently increased concentration of sugar, smaller vessels are constricted in the course of the disease, which disturbs the blood flow and leads to a reduced supply of various organs. Nerves in particular are affected by a lack of supply (diabetic neuropathy). This leads to the death of the nerves. Touch and pain stimuli can no longer be perceived properly. This leads to complications, especially on the foot, because wounds there are not properly perceived, which can always increase in size in the course and irreversibly destroy the tissue. In the worst case, the foot can die, which must be amputated (diabetic foot syndrome). In addition, the wound may become infected. The resulting inflammation can spread systemically and lead to sepsis. This can degenerate into life-threatening shock, resulting in multiple organ failure. The retina can also be affected by diabetes (diabetic retinopathy). This leads to visual disturbances in the affected person, which can even result in blindness. Diabetes also typically affects the kidneys (diabetic nephropathy). In the course of the disease, the kidney can fail and the quality of life is impaired. In some cases, dialysis or even transplantation must be performed.
When should you see a doctor?
Diabetic foot syndrome is one of the most serious complications that can accompany diabetes mellitus. Excessive sugar concentration in the blood causes smaller vessels to constrict, resulting in inadequate supply to the nerves and tissues in the foot. Affected individuals should consult a physician at the first signs of diabetic foot. If the disorder is not treated adequately in a timely manner, the risk of ultimately having to have the foot amputated increases significantly. In the early stages, diabetic foot becomes noticeable through the following symptoms: Circulatory problems associated with tingling and numbness, constantly cold feet, increased formation of calluses, small ulcers or other inflammations that spread to the foot or toes. These symptoms, most of which are completely harmless for healthy people, must definitely be presented to a doctor in diabetics. Because of the poor blood circulation in the feet, even small injuries or corns do not heal on their own. Instead, the wounds often become heavily colonized with bacteria and the inflammation progresses permanently. Even minor injuries to the foot must therefore be disinfected and professionally treated in diabetics. A patient should do this under the guidance and supervision of a physician, especially since antibiotics often have to be prescribed as well. The physician will also educate the patient about any other necessary precautions.
Treatment and therapy
Once the attending physician has determined what type of diabetic foot syndrome the individual case is, he or she can initiate appropriate therapy. The primary treatment for neuropathic foot is to disinfect and dress the wounds that have occurred. No pressure should be exerted on the ulcers. Supportive antibiotics are usually prescribed. Once the wounds have healed, the skin of the foot must be constantly well cared for and creamed. A cream containing urea is particularly suitable for this purpose. This counteracts drying of the skin so that no new ulcers form. Furthermore, wide and breathable shoes should always be worn. Special orthopedic shoes may be necessary. An ischemic foot is treated with medications that promote blood flow. In some circumstances, a bypass may also be placed. If the damage to the tissue is already far advanced, amputation of the affected parts may be necessary. Often the toes are affected; in the worst case, however, the entire lower leg can be removed. In principle, however, care should be taken in advance to ensure that the blood glucose level is not permanently elevated. At the latest when diabetic foot syndrome occurs, it is imperative to regulate the blood glucose level so that there is no aggravation of the disease.
Outlook and prognosis
The healing prospect of diabetic foot syndrome depends on the severity of the existing symptoms. The more pronounced the symptoms are, the less favorable is the further course.If the patient additionally suffers from a disturbance of the blood circulation, it worsens the prognosis by another. In severe cases, an amputation is necessary. A distinction is made here between removal of the toes, parts of the foot or lower and upper leg amputations. The patient himself can contribute to the improvement of existing complaints by wearing suitable footwear or proper foot care. Massages of the feet for diabetic patients specifically stimulate and promote blood circulation. Injuries to the feet occur more frequently with tight-fitting shoes or foreign bodies in the shoes. These have a bad influence on the prognosis. Healing of pressure sores is more difficult in diabetics because of increased circulatory problems. The prognosis is particularly unfavorable in patients suffering from neuropathic as well as vascular symptoms. In most cases, the leg has to be amputated in these patients. In about half of all cases, amputation of the first leg is followed by amputation of the second leg after four years. This has a strong impact on the quality of life and promotes the onset of mental illness.
Prevention
Diabetic foot syndrome can be prevented especially by abstaining from cigarettes and maintaining a stable blood glucose level. In addition, the skin of the foot should always be well creamed and cared for, even if there are no symptoms. Wide and comfortable shoes and stockings should also be worn. Supportive mobility exercises with the feet can be performed regularly to prevent the development of diabetic foot syndrome in time.
Aftercare
Follow-up care for diabetic foot syndrome differs depending on the severity and treatment method. In any case, it is important to see a podiatrist as well as a diabetologist regularly to prevent further complications. If it is a superficial wound, it is usually sufficient to relieve the foot until it is completely healed. Pressure-reducing shoes can help with this. In addition, prescribed wound creams and ointments should be used as directed by the physician. If the wound becomes infected, prescribed antibiotics must always be taken as directed by the physician. This applies even if symptoms of infection are no longer apparent. A physician must be consulted before discontinuing antibiotics. If parts of the foot have been amputated, special aftercare is necessary here. In the first days after the operation, the corresponding area must not be loaded. After that, a rehabilitation phase is necessary. The length of this period depends on how much of the foot is still intact after the amputation. In addition, a physiotherapist will train the perception and mobility of the residual limb. This serves to improve the handling of a later prosthesis. The surgical wound itself must be cared for according to the doctor’s instructions. Antibiotics may also need to be taken.
What you can do yourself
Adjustment of behavior in everyday life and self-help measures should begin even before a person develops diabetic foot syndrome, because in most cases the disease is caused by a poorly adjusted blood glucose concentration in diabetes mellitus. A permanently too high and a strongly fluctuating blood sugar concentration lead to damage of the vessel walls of the arteries and the veins as well as to damage of the nerves, so that neuropathies can also develop on the feet. If diabetes has already been diagnosed, strict control and management of blood glucose concentration is very effective as a self-help measure to prevent diabetic foot syndrome as much as possible. The preventive measures are independent of whether the diabetes diagnosed is the acquired type 2 or the genetically determined and much rarer type 1. Another preventive measure concerns smokers and lovers of alcoholic beverages. Smoking and excessive consumption of alcoholic beverages increase the negative effects of a fluctuating and generally too high blood sugar concentration. It is therefore advisable to keep smoking and alcohol consumption to a minimum or to abstain from nicotine consumption altogether. A well-coordinated skin care regimen also has a preventive effect, making it more difficult for pathogenic germs to penetrate the skin and cause infections or fungal infections.For self-monitoring and early detection of diabetic foot syndrome, it is helpful to check the feet daily for swelling, as it is considered an early indicator and symptom of the onset of the disease.