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Diabetic Foot Disease can occur due to uncontrolled blood sugar levels in diabetic patients. Initiation of the disease generally starts with minor trauma in the skin (cutaneous).
Risk Factors for Diabetic Foot Disease
- Repetitive minor trauma
- Foot deformities
- Previous foot ulceration
- Neuropathy diagnosis
- Vascular diseases
- Sex, age, and duration of diabetes
- Ethnicity
Repetitive Minor Trauma and Food Deformities
The main causes are high pressure on a neuropathic foot and wrong shoe choice. These may result in deformities in foot shape, such as changes in the bottom, arches, or toes of the foot.
Neuropathy Diagnosis
Continuously high blood glucose levels can damage nerves carrying sensation, resulting in diabetic neuropathy. These patients’ risk is higher due to less sensitivity to pain, so the symptoms can get worse without notice.
Vascular diseases
Persistent high blood glucose levels can damage the vascular system resulting in diminished blood flow to the foot. Also, poor circulation of the skin can lead to foot ulcers formation and impair the healing of wounds. Signs of poor circulation could be cold feet, thin or blue skin, and so on.
Sex, Age, And Duration Of Diabetes
Males have a higher risk of foot ulcers. The risk of ulcers and amputations increases with age and duration of disease.
Ethnicity
Ulceration is more common among Hispanics, Native Americans, and individuals of African-Caribbean descent In the United States.
Diagnosis of Diabetic Foot Disease
Clinical examination of the foot is recommended beginning five years after the diagnosis of type 1 diabetes and at the time of diagnosis of type 2 diabetes. In a foot examination, circulation, abnormalities in the skin, reflexes, sense of pressure, nerve damage will be evaluated by the doctor. X-ray and MRI-Scans can be done to see damage on bones and identify bone mass and inflammation in the foot. Also, a blood test is used to evaluate signs of the infection
- Medical History and Physical Examination of foot
- X-ray and MRI-Scans
- Blood Test
Management Strategies in Diabetic Foot Disease
Knowledge and prevention are key to living a healthier life with the management of diabetic foot disease. The strategies can reduce the risk of developing diabetic foot disease:
- Avoid smoking as it is a major threat to your vascular system and affect the circulation of the foot
- Avoid walking barefoot indoors and outdoors
- Always test the water temperature before getting a bath
- Be careful when trimming toenails; cut according to the shape of the toe and remove sharp edges, but don't cut cuticles
- Wash your feet in lukewarm water and dry, including between toes
- Check your feet daily, examine if there are any changes in the shape of the foot as well as dryness of the skin; if there are any broken skin between toes
- Choose and wear comfortable shoes
- Wear breathable cotton socks that aren’t too snug and change them daily.
Treatments Strategies for Diabetic Foot Diseases
- Blood sugar management
- Debridement
- Pressure offloading
- Wound Dressing
- Growth factors
- Stem cell therapy in peripheral artery disease (PAD)
- Infection Control
- Vacuum-assisted closure
- Amputation
Blood Sugar Management
It is critical to reducing the risk of diabetes-related complications. See your doctor regularly to maintain healthy blood sugar levels with the recommended treatment, get advice on healthy diet habits and make lifestyle changes vital for disease prevention. In doctor visits, your history of foot and leg discomfort would also be questioned, such as if you have burning, tingling sensation, cramping, aching. What is the location and timing of the symptoms etc.? Also, medical examination, tests for protective sensation, and pedal pulses would and should be done.
Debridement
The treatment consists of ulcer cleaning, removing dead skin by the surgeon. In case of infection of the foot, antibiotics are also given. Health care providers clean the ulcer area and apply clean cover twice a day. In these treatments, pressure shouldn't be put on the foot. The area should be checked by a doctor Once a week to track the healing process. Types of debridement consist of surgical, enzymatic, mechanical, and biological debridement.
Pressure Offloading
Offloading pressure on ulcers contributes to the healing process. Methods include short leg walkers, half shoes, total contact casting, and felted foam dressings.
Wound Dressings
Wound dressings aim to keep the environment moist to promote wound healing. It is easy to use and cost-effective.
Growth Factors
Growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (TGF)-β, insulin-like growth factor used to stimulate cell proliferation and angiogenesis.
Stem Cell Therapy for Peripheral Artery Disease (PAD)
Stem cell therapy accelerates angiogenesis and, therefore, increases the rate of ulcer healing.
Infection Control
Extensive Ulcers reaching the deeper layers of the skin to muscle and bone requires treatment in hospital settings. Generally, antibiotics can be given into blood (intravenously) in addition to the debridement treatment. Sometimes even surgery would be needed to remove infected bones.
Vacuum-Assisted Closure
It generates a negative topical pressure aiming to increase blood flow by covering ulcers, speeding up the healing process and reducing edema.
Tips for Diabetic Foot Disease Prevention
- See your doctor regularly to adjust your treatment to maintain your goal blood glucose level
- Eat a healthy diet by incorporating a healthy diet rich in fruits and vegetables
- Adopt a daily foot care routine
- Quit smoking if you're a smoker
References
Amin, N., & Doupis, J. (2016). Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World Journal of Diabetes, 7(7), 153. https://doi.org/10.4239/WJD.V7.I7.153
Boulton, A. J. M., Armstrong, D. G., Kirsner, R. S., Attinger, C. E., Lavery, L. A., Lipsky, B. A., Joseph L. Mills, S., & Steinberg, J. S. (2018). Diagnosis and Management of Diabetic Foot Complications. Diabetes, 2018(2), 1–20. https://doi.org/10.2337/DB20182-1
Diagnosing Diabetic Foot Ulcers | NYU Langone Health. (n.d.). Retrieved October 28, 2021, from https://nyulangone.org/conditions/diabetic-foot-ulcers-in-adults/diagnosis
Schaper, N. C., Netten, J. J. van, Apelqvist, J., Bus, S. A., Hinchliffe, R. J., & Lipsky, B. A. (2020). Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes/Metabolism Research and Reviews, 36(S1), e3266. https://doi.org/10.1002/DMRR.3266
Wexler, D. J. (n.d.-a). Evaluation of the diabetic foot - UpToDate. Retrieved October 26,2021.
Link:https://www.uptodate.com/contents/evaluation-of-the-diabetic-foot?search=diabeticfoot&source=search_result&selectedTitle=2~115&usage_type=defaul&display_rank=2
Wexler, D. J. (n.d.-b). Patient education: Foot care for people with diabetes (BeyondtheBasics)-UpToDate. Retrieved October26,2021 Link:https://www.uptodate.com/contents/foot-care-for-people-with-diabetes-beyond-the-basics?search=diabetic foot&topicRef=1749&source=see_link
