Diagnosis
The basis for the development of a diabetic foot is a patient’s disease of diabetes mellitus, usually type 2. In order to make the diagnosis, the diabetes itself must be confirmed by laboratory tests and then the long-term blood sugar value, the HbA1c, must be checked at regular intervals. A detailed examination of the feet must be carried out, including examination of the skin, temperature and gross foot malpositions, gait abnormalities and examination of the foot pulses.
Characteristic for the diabetic foot in case of damage to the nerves is a reduced sensation of sensitivity, vibration, temperature and pain. The tuning fork test is a routine examination as part of the regular check-up for diabetic foot syndrome. But it is also used for other clinical pictures that are associated with a reduced sensation in the foot.
The tuning fork test is intended to find out whether and to what extent the vibration sensation and depth sensitivity are still present. The patient lies or sits on the examination couch and the examiner strikes the tuning fork. This is then placed either on the inner ankle or the base joint of the big toe. The patient indicates when he or she can no longer feel anything and at that exact moment the intensity of the vibration is read off a scale.
By which symptoms do I recognize a diabetic foot?
People suffering from diabetes mellitus should definitely take part in preventive examinations at regular and small intervals. It is also important for a patient to know which symptoms to watch out for. In the context of diabetic foot syndrome, for example, there may be a disturbance in the sensation of pain or the perception of temperature.
Affected patients then actually feel less pain and cold or heat on their feet. In contrast, patients may also experience increased sensitivity to pain with nocturnal pain attacks. Damage to the nerves in the foot can also manifest itself in the form of tingling, or the feeling that patients describe as if ants were running over their feet or as if they were being stung by a thousand needles.
Some symptoms of diabetic foot can also be seen on the skin. For example, the skin on the foot is often extremely dry. There are also pressure points with an unusual reddening and the feet sometimes swell.A dreaded complication of the diabetic foot syndrome is the so-called neuropathic ulcer, also called malum perforans.
A neuropathic ulcer is an ulcer that has developed when the nerves are damaged. Due to reduced pain perception and sensitivity, minor injuries can easily turn into a complicated wound. This can also develop into a phlegmon, i.e. a deep, purulent inflammation of the foot tissue. To make matters worse, the blood circulation in the foot is often also reduced, so it is better not to have a surgical wound scraping performed.
