Definition

Diabetes is a metabolic disorder characterized by excessively elevated blood sugar levels. The consumption of food results in the production of sugar or glucose. Glucose is an essential energy source for cellular processes. Insulin, a hormone, facilitates glucose entry into cells.

Diabetes is classified into two categories, type 1 and type 2, based on its underlying cause. Type 1 diabetes is characterized by the inability of the body to produce insulin, whereas type 2 diabetes is characterized by the impaired ability of the body to utilize insulin effectively. Inadequate insulin levels and impaired insulin activity result in the inability of glucose to penetrate the body's cells, leading to the circulation of sugar in the blood.

Elevated levels of glucose in the bloodstream may lead to several physiological complications. Diabetic foot is a prevalent complication among individuals with diabetes. This is because, over time, elevated blood sugar levels may cause nerve and blood vessel injuries in the lower extremities. Diabetic neuropathy is the medical term for this nerve injury, which manifests as tingling and numbness in the feet. Injuries to the foot may remain unrecognized and lead to infection if pain is not perceived. Infected wounds are typically delayed in healing due to vascular damage and a compromised immune response.

Causes

Although it may appear in numerous parts of the body, diabetic neuropathy, also known as nerve damage from diabetes mellitus, frequently occurs in the lower extremities. Peripheral neuropathy in the plantar region of your feet results in sensory loss in your feet. If you experience sensitivity in your feet, you may lack the ability to perceive cuts, scratches, rips, or discomfort. In the absence of rapid detection and treatment, there is a potential for infection and complications, such as tissue necrosis or damage.

Risk Factor

Elevated blood glucose levels increase the risk of diabetic foot. It may lead to neuropathy and vascular injuries, resulting in compromised blood circulation to the lower extremities. This, in turn, triggers a cascade of more tissue damage. Inadequate circulation to the foot can result in a reduced presence of infection-fighting blood cells, resulting in delayed healing. Additional lesions that develop in that region progressively enlarge, causing necrosis. Despite excessive blood sugar, other risk factors include:

• Poor glycemic index control
• Peripheral artery disease refers to the development of plaque in the blood vessels of the limbs, causing a blockage in blood flow, particularly to the extremities.
• Lifestyle factors: smoking, obesity, high blood pressure, excessive alcohol consumption

Symptoms

Common manifestations of diabetic neuropathy include:

• Hyperpigmentation in the affected areas
• Impaired thermoreception, resulting in an inability to differentiate between cold and hot temperatures
• Alopecia in the area
• Paresthesia
• Painful

If diabetic neuropathy results in foot ulcers, it is crucial to remain careful for signs such as:

• Lesions on the skin or under the fingernails
• Discharge of fluid or pus
• Bad odour
• Differences in color, including erythema or pallor

Diagnosis

The doctor will recommend a comprehensive physical examination and specific diagnostic tests to identify abnormalities associated with diabetic feet. During the examination, the doctor will inquire about your medical background, including your medical records and current medical conditions. They will also inquire about recent injuries. Additionally, they will thoroughly inspect the skin, specifically focusing on feet, toes, and soles, in order to identify the indications of diabetic foot complications.

The doctor might plan to use a range of instruments to determine the presence of diminished sensory nerves. The doctor may also inquire about the symptoms and methods to regulate your blood glucose levels.

If there are diabetes-related wounds, the doctor will perform additional tests to determine whether there is an infection, which is visible as redness, swelling, warmth, and color changes. Additional examinations are conducted to diagnose the condition further, including:

• Hematological analyses to assess the presence of infection
• Bacterial culture analysis is conducted to determine the presence of bacteria and identify suitable antibiotics for treating the infection
• Diagnostic imaging techniques, such as CT scans or MRIs, are used to verify the diagnosis and assess the extent of tissue necrosis
• Assessment to evaluate blood flow in the affected region

Management

Possible treatments for diabetic foot issues include:

• Wound care
• Extracting exudate or purulent material from the wound
• Performing debridement (removal or cutting of necrotic tissue)
• Administering a specific ointment or bandage to absorb excess fluid, protect the wound, and support the healing process
• Recommend the use a wheelchair or crutches to reduce the burden on the injured leg (offloading)
• Administer oral or intravenous antibiotics to control and eradicate the potential for infection

Depending on the severity of the infection, the doctor may advise surgical intervention if deemed necessary. In certain cases, amputation may be required to prevent the dissemination of the infection.

Tissue lifting
The doctor might conduct a cleansing procedure. A surgical procedure is required to eliminate the injured tissue. To repair gangrene-related damage, the doctor might also suggest skin grafting. The procedure involves transferring healthy skin from another part of the body to the injured location. Laboratory-developed larvae may eliminate the damaged tissue. After applying maggots to the laceration, the doctor will bandage the affected area. Maggots can consume deceased tissue without causing damage to living tissue. This procedure requires multiple days. In severe cases, the physician may advise the amputation or removal of the infected foot, finger, thumb, or affected area.

Infection control
Antibiotics are required for the treatment of gangrene-causing infections. The doctor will determine the suitable dosage for a specific condition.

Improving vascularization
The doctor may perform angioplasty and bypass surgery (during which the doctor will create a new pathway for blood to flow properly and inflate tiny balloons within your blood vessels to dilate them and facilitate better blood flow) as surgical interventions to improve blood flow.

Complications

Inadequate treatment and care for diabetic feet may lead to the development of gangrene, which can progress into a severe infection known as sepsis. Sepsis may contribute to further complications, including:

• Changes in mental status and unconsciousness
• Life-threatening hypotension
• Organ failure

Prevention

By controlling blood sugar levels, you may avoid developing diabetic foot complications. There are numerous ways to prevent diabetic feet and enhance blood flow. If you have risk factors such as diabetes or peripheral artery disease, you may:

• Exercise regularly while protecting your feet
• Control blood sugar levels
• Healthy eating includes low-fat and low-sugar foods
• Stop smoking and drinking excessively
• Check your feet for wounds regularly
• Prevent barefooting, especially outdoors
• Regularly clean and moisturize your feet
• Wear fit-size socks and shoes

Decrease the risk of diabetic foot complications by:

• Check your feet daily. Remember to check between your fingers by using a mirror or asking for help
• Trim your nails regularly
• Maintains foot blood flow. Example: elevating or moving your legs. Be active, but choose foot-friendly activities like walking or swimming.
• Wear sandals or socks all day. Make sure your socks and shoes fit properly
• Daily, wash and dry your feet, especially between the toes. Lotion from head to toe, but not between toes, to avoid saturated conditions

When to See a Doctor?

Perform regular checkups, especially for high-risk individuals. If you have diabetes and feel pain, tingling, numbness, or changes in foot shape, skin, or color, see your doctor immediately. If you experience a fever or have pain in the wound due to infection, it is necessary that you immediately contact the hospital. Consideration of the following sepsis symptoms is necessary because they might be life-threatening:

• Tachycardia and weakened pulse
• Confusion
• Pale and frigid skin
• Dyspnea
• Vomiting or diarrhea

Looking for information about other diseases? Click here!