Diabetic Foot: Causes, Symptoms, and Prevention

Author :-

Dr.Sreejaya

General Medicine & Diabetology

Understanding Diabetic Foot: An Overview

A skin split with loss of epithelium causes foot ulcers, which can spread to the dermis, bone, and muscle. Amputating a limb means removing a terminal, non-viable part. A diabetic has a 34% lifetime risk of foot ulcers (DFU).

Individual suffering and DFU costs are tremendous. DFUf patients frequently have concomitant diabetic issues, including nephropathy. UK and US research suggests that dialysis patients with foot difficulties have a dismal survival rate. We found that diabetics with amputations and dialysis have a 75% two-year death rate, mostly from cardiovascular causes. Apart from lung and pancreatic diseases, these statistics surpass the mortality rates from most malignant illnesses. Prophylactic measures are necessary to decrease diabetic foot problems.

Why Diabetic Foot Issues are Common in Diabetes

Problems with diagnostic techniques and population selection have plagued diabetes foot disease epidemiological research. Feet problems are prevalent, though. North West Diabetes Foot Care research, a community-based research study of over 15,000 participants, found that 2% of diabetics had foot issues annually, with comparable results in the Netherlands. Diagnosis and geographical variables also affect amputation numbers. Many type 2 diabetics have severe neuropathy; in the UK Prospective Diabetes Study, 13% had neuropathy severe enough to cause foot ulceration.

Importance of Early Detection and Prevention

Diabetics all own:

Neurological foot testing: 10 g monofilament at four places on each foot and one of the following: Assessment of vibration includes 128 Hz tuning fork, pinprick sensation, ankle reflexes, and vibration threshold.

Foot: enlarged metatarsal heads/claw toes, hallux valgus, muscular wasting, Charcot deformity; • Dermatological: callus, erythema, sweating;

Vascular: foot pulses, ankle brachial index, and Doppler waveforms.

A diabetic foot examination can detect peripheral neuropathy and show diminished sensitivity to big and tiny fibre stimuli in the feet and lower limbs. Clinical evaluation helps classify and risk stratify the illness for diabetic foot clinic monitoring.

Causes of Diabetes Foot Problems

How Diabetes Affects Blood Flow and Nerves in the Feet

Neuropathy types have unknown causes. Researchers believe uncontrollable high blood sugar destroys neurons and impairs signaling, causing diabetic neuropathy. Capillaries that feed neurones with oxygen and nutrients diminish with high blood sugar.

Common risk factors leading to diabetic foot complications

The road to ulceration is complicated and multifaceted. No single factor causes ulceration; rather, the interplay and combination of risk factors leads to skin disintegration. According to the prospective research by Reiber et al., neuropathy, deformity, and trauma caused 63% of foot ulcers, with ill-fitting footwear being the primary culprit in Western nations. Neuropathy sufferers have limited sensory input; thus, they cannot feel a shoe's fit until the pressure is strong. Neuropathy sufferers often pick too-small shoes. Before purchasing shoes from the store, individuals with neuropathy should measure their feet.

Ulceration can be caused by a combination of neuropathy, mechanical trauma (such as a neuropathic person with a foreign body in their shoe), thermal trauma (holidays are particularly dangerous), and chemical trauma (such as improper use of over-the-counter chemical corn treatments).

The Role of Poor Glycaemic Control in Foot Health

Lea had a pooled OR of 2.04 (95% CI, 0.91, 4.57) for cohort studies comparing A1C >7.0 to 7.5% vs. lower levels, and 4.80 (95% CI, 2.83, 8.13) for studies comparing A1C ≥ 8% vs. <8%. LEA pooled OR was 1.46 (95% CI, 1.02, 2.09) for cohort studies comparing fasting glucose ≥126 vs. <126 mg/dl. A1C grade did not affect wound healing (OR or HR). As many studies did not account for possible confounders in the link between glycaemic control and DFU outcomes, cohort comparability was heavily biassed.

Symptoms of Diabetes Foot

Recognising early diabetic foot symptoms

Awareness of foot condition symptoms is crucial. Diabetics have an increased risk of significant consequences due to impaired circulation and blood flow. Foot indicators you shouldn't ignore:

Leg/foot swelling
Skin colour alteration
Fire or tingle
Toe or foot numbness
Toe-ingrowth
Heal slowly sores
Toe-cracks
Skin blisters
Hammertoes+Bunions
Grow Corn or Planters Warts
Foot athlete
Hair loss on legs or toes

Diabetic Ulcer Symptoms: What to Look For Signs of Diabetic Foot Infection

Pathophysiology

Ulcers are caused by diabetic peripheral neuropathy and atherosclerosis. Because of capillary basement membrane thickening, loss of elasticity, and lipid deposition, atherosclerosis reduces blood flow in large and medium-sized arteries. Further arteriosclerosis ischemic tiny vessels. Peripheral neuropathy affects motor, sensory, and autonomic nerves. Some of the things that can cause this are endothelial dysfunction, persistent hyperosmolarity, vascular disease blocking the vasa nervorum, and high levels of sorbitol and fructose.

Backstory and Body

Assessing diabetic ulcer patients involves clinical and radiologic screening.

Document the type of diabetes, medication history, comorbidities, peripheral neuropathy symptoms, and vascular insufficiency. Hypoesthesia, hyperaesthesia, paraesthesia, dysesthesia, and radicular pain are neuropathy complaints. More than half of vascular insufficiency patients are asymptomatic. Infrequent cramping, rest discomfort, and ulcers can occur.

Examine the legs and feet in a well-lit, well-exposed environment. Make sure to record the size, depth, appearance, and location of the ulcers. If discolouration, necrosis, or discharge indicate infection, you need to take care. Notice nail discolouration, callus development, and deformities. Neurological injury to foot muscles can cause common abnormalities. The metatarsal-phalangeal joint hyperextends during interphalangeal or distal flexion, causing hammer and claw toe abnormalities. Regular deformities include Charcot arthropathy. Improper footwear can cause foot ulceration. Check for callus or nail irregularities.

Common diabetic foot problems

Overview of Common Complications: Ulcers, Infections, and More

Diseases: Cellulitis, Gangrene, Sepsis
Abscess
Rising lymphangitis
Osteomyelitis. Limb ischaemia.
Amputation

Neuropathy and Its Impact on Foot Health

Peripheral neuropathy can produce blisters and sores. Without sensation in your feet, peripheral neuropathy may prevent you from noticing pressure or injuries that cause blisters and ulcers. Diabetes can impede wound healing and increase infection risk. Sores and infections can cause toe, foot, or limb loss. Early detection and treatment of foot disorders can prevent catastrophic infections.

Diabetes-related nerve damage can affect foot and toe form. Some diabetics develop Charcot's foot, a condition that damages foot bones and tissue.

Falling and losing balance due to peripheral neuropathy might increase your risk of fractures and other injuries. Grief, anxiety, and sadness can result from peripheral neuropathy discomfort.

The progression from minor issues to severe complications

Remote sensorimotor neuropathy. It affects up to 50% of elderly type 2 diabetics. Small-fibre nerve failure causes a loss of pain and temperature sensitivity—the 'gift of pain' that safeguards tissue integrity. Recurring mild injuries may raise the likelihood of Charcot neuroarthropathy, whereas large-fibre dysfunction causes unsteadiness, trips, and falls. Motor neuropathy weakens tiny muscles and may cause foot flexor-extensor imbalance.

Diagnosed autonomic neuropathy. If peripheral sympathetic dysfunction is present, vasoconstriction warms feet and decreases perspiration, increasing the likelihood of callus development. Neuropathic plantar callus increases ulcer risk significantly.

PAD.Page 11 highlights PAD as a key risk factor for diabetic foot lesions. PaD and neuropathy can cause neuroischemic ulceration.

deformity. Foot deformities with additional risk factors enhance ulcer risk. Clowning the toes increases metatarsal head pressures, which might cause breakdown in neuropathic individuals due to recurrent mild stress on an insensate area. Some examples include Charcot deformities and hallux valgus.

Age, gender, and diabetes duration. With age and illness duration, ulcers and amputations double to quadruple. Males have 1.6 times the risk of foot ulcers in Western countries.

Understanding Diabetic Foot Infections

How Infections Develop in Diabetes Feet

Autonomic neuropathy weakens capillary recruitment and blood shunting along capillary beds, making perfusion worse in diabetics. Neuropathy diminishes sensation and inhibits sweat and oil glands, leading to dry, cracked skin and a diminished neuroinflammatory response to irritation. Glycosylation, a process that stiffens and shortens tendons, can lead to the development of claw toes and hammer toes, as well as an increase in forefoot pressure.

Diabetes sufferers must also use proper shoes. Unfit shoes or trauma can immediately reduce blood flow and increase infection risk. Diabetes amplifies peripheral vascular disease.

Anaerobes, including staphylococcus, streptococci, pseudomonas, and others, cause diabetic foot infections. Other gas-producing gram-negative microbes are frequent in diabetic foot infections.

Warning Signs of Infection in Diabetic Ulcers

Swelling blood or drainage in shoes or socks
Large calluses or heel cracks
Blisters Redness
Sores
Scrapes and splinters
Pus, odour, pain

Consequences of Untreated Infections and Gangrene Risk

Chronically high blood sugar: The sugar levels damage foot nerves and blood vessels, increasing the likelihood of foot problems.

Diabetes can compromise circulation by reducing blood flow to the foot and slowing wound healing.

High blood sugar: Elevated blood sugar levels can damage the nerves in the feet, making it difficult to feel pain.

Smoking: Smoking exacerbates the effects of diabetes on blood vessels, leading to a reduction in blood flow to the feet.

Diabetes increases foot infections, which can cause gangrene.

Diabetic Foot Ulcers

What Causes Diabetes Ulcers?

Nervous, neuroischemic, and ischaemic diabetic foot ulcers exist. Most ulcers are caused by sensory neuropathy, which is caused by small injuries that patients may not notice and may not treat before a standard assessment. Myocardial infarction is a major occurrence in peripheral arterial disease and ischaemic risk. Ischaemia, which can lead to diabetic ulcers, is a chronic condition that is challenging to treat due to restricted blood flow, resulting in increased suffering and healthcare expenses.

Stages of Diabetes Foot Ulcers

Stage 1: Normal foot without risk factors
Stage 2: High-risk foot
Stage 3: Ulcerated Foot
Stage 4: Cellulitis foot
Stage 5: Necrotic foot
Stage 6: Unsalvageable foot.

Treatment Options for Diabetic Foot

Wound Care and Infection Management: Diabetic Ulcer Management Multimodal

Foot care and blood sugar management should be taught early. Social workers and diabetes educators can assist in this.

Blood-Sugar Control: A primary care physician, podiatrist, and vascular specialist team manages this based on disease severity and patient motivation to take medication, notably insulin.

Crutches, wheelchairs, and casts help mitigate pressure and avoid additional injuries. Total contact casting and irremovable cast walkers have been shown to promote better ulcer healing.

Insufficiency requires a surgical bypass, but antiplatelet medications are the first line of treatment.

Control Infection: Antibiotics and surgical debridement prevent and control infection.

Topical wound treatment involves dressing and debridement. Obstructive and semi-occlusive bandages treat shallow ulcers. For full-thickness ulcers, we need hyaluronic acid, collagen, and surgical debridement.

Medications and antibiotics for diabetic foot infections

Combining carbapenems with anti-psychotic medicines decreased adverse effects compared to penicillins.

Daptomycin has shown fewer side effects than vancomycin or other semi-synthetic penicillins.

Linezolid caused more damage than ampicillin-sulbactam.

tigecycline had higher side effects than ertapenem or vancomycin.

Advanced Treatments: Hyperbaric Oxygen Therapy, Skin Grafts, etc.

Early instruction in foot care and blood sugar management is necessary. Social workers and diabetes educators can assist in this.

Blood-Sugar Control: A primary care physician, podiatrist, and vascular specialist team manages this based on disease severity and patient motivation to take medication, notably insulin.

Reduced pressure, no new trauma: crutches, wheelchairs, and casting distribute pressure. Total contact casting and irremovable cast walkers were found to promote better ulcer healing.

Surgical bypass is needed for insufficiency; however, antiplatelet medications are the first treatment.

Control Infection: Antibiotics and surgical debridement prevent and control infection.

Preventive Strategies for Diabetic Foot

Daily Foot Care Tips for Diabetics

Keep blood sugar levels normal. High blood sugar can induce neuropathy and vascular disease, which can cause foot difficulties. You may prevent these consequences by controlling your blood sugar with food, exercise, and medication.

Daily foot inspection: Look for cuts, blisters, redness, oedema, and other ailments. Get help or a mirror to view your feet.Quick diagnosis and treatment stop foot problems from getting worse..

Wear comfy shoes. Tight or rubbing shoes can create blisters or calluses, which can cause infection. Wear shoes with a padded sole to absorb shock. Forget heels, flip-flops, and barefoot shoes.

Avoid going barefoot: Going barefoot outdoors or on warm surfaces like sand or tarmac increases the risk of injury. Inside, wear slippers; outdoors, wear sturdy shoes.

Quit smoking: Smoking damages blood vessels and reduces foot circulation, delaying healing and increasing infection risk. For better blood flow and fewer foot issues, quit smoking.

Exercise: Exercise improves circulation and lowers foot risk.

Importance of Regular Foot Examinations

Diabetics need regular foot inspections to prevent catastrophic problems and promote health. Diabetes-induced nerve damage diminishes the sensation in the feet. This syndrome makes cuts, blisters, and ulcers difficult to spot, which can quickly lead to infections.

Suppose your foot is sliced. It may seem small, but diabetes might raise concerns. Without adequate care, a wound might become an ulcer and require amputation.

A foot callus is another possibility. Without proper treatment, calluses can progress to ulcers in diabetics. Foot doctors can safely remove calluses and teach you to avoid them.

See a podiatrist for diabetic foot care if you have non-healing cuts, blisters, or sores, as well as swelling, redness, or unusual sensations such as tingling or numbness. Even in the absence of symptoms, routine checkups every two to three months can detect problems early. Warmth, drainage, or discomfort indicate infection; seek medical assistance.

Lifestyle and Dietary Changes for Prevention

Managing Blood Sugar Levels to Prevent Complications: Nutritional Tips for Diabetics to Support Foot Health: Physical Activity and Its Benefits for Circulation

Reducing weight
Daily exercise
Cardio exercise
No tobacco
No alcohol
Quitting smoking
Be proactive daily.
Dietary modification
Calorie intake measurements
Protein intake measurements
Have a thorough knowledge of self-health and growing issues.

When to Seek Medical Help

Recognising Red Flags in Diabetic Foot Health: When to Consult a Specialist

Loss of feeling in your feet can be a significant concern and a symptom of nerve damage. Ignoring small sores or wounds can aggravate them and make them harder to cure due to poor blood flow. Reach out to a foot expert if touching, heating, or cooling your feet seems dull or nonexistent.

For diabetics, thicker, yellow toenails may appear. Your body breaks down sugar, which affects nail collagen. Yellowing is harmless, although it can make walking difficult and hide fungal infections. Your doctor can treat diabetes-related nail issues.

If you observe that one foot is changing shape or your two feet no longer seem alike, see a professional. Untreated diabetes can cause falling arches, hammertoes, and bunions, which can be uncomfortable.

Besides letting infection in, dry, cracked skin might indicate nerve damage. Nerve injury can cause dry, cracked feet. While lotions and creams can moisturize your feet, a foot specialist can help with nerve damage.

Foot ulcers and sores can emerge from persistent pressure on a foot that doesn't get enough circulation. Because of circulation issues, these sores commonly worsen unless you consult a doctor. Even if an ulcer or foot sore isn't painful, diabetics should never overlook them since they can lead to foot infections and amputation.

Conclusion

If you notice any symptoms or irritation in your diabetic foot, promptly contact the nearest expert or visit Ovum Hospital. The hospital has ample physicians who have expertise on such issues.

FAQs

1 Who Gets Diabetic Foot Ulcers?

Anyone with diabetes can have a foot ulcer. Ulcers are more common in Native Americans, African Americans, Hispanics, and elderly men. Insulin users and diabetics with kidney, eye, and heart problems are more likely to develop foot ulcers. Overweight, alcohol, and tobacco use also cause foot ulcers.

2: How valuable is treating a diabetic foot ulcer?

Seek podiatric therapy soon after discovering an ulcer. Diabetes foot ulcers should be addressed for numerous reasons:

To lower infection and amputation risk
To boost life quality and function
To cut healthcare expenses

3 Diabetic Foot Ulcer Treatment: How?

The main objective of foot ulcer therapy is speedy recovery. Infections are less likely with rapid wound healing.

Diabetic foot ulcer therapy involves various factors:

Infection prevention
Pressure removal, or “off-loading”
Dead skin and tissue removal (debridement)
Applying ulcer medicines or dressings
Controlling diabetes and other health issues

4 Foot Ulcer Prevention: How?

Prevention is the best treatment for diabetic foot ulcers. Regular podiatrist visits are advised. He or she can identify high-risk foot ulcers and prevent them.

High risk if:

Be neuropathic
Have weak circulation
A bunion or hammer toe?
Inappropriate footwear
Uncontrolled glucose

5: Which way to manage blood glucose?

Diabetic foot ulcer therapy requires strict blood glucose control. Working with a doctor or endocrinologist will speed recovery and decrease problems.