Diabetic foot is a complex of anatomical and functional changes that can occur in patients with diabetes mellitus. In general, pathology is a serious lesion of the skin, arteries and capillaries, bone, muscle tissue and nerve cells. Despite the many factors that provoke the development of the diabetic foot (the photo will only partially get an idea about this problem), its main reason is the toxic effect of blood sugar.
A high concentration of glucose leads to impaired innervation and blood supply to the lower extremities. Against the background of diabetes mellitus and natural stresses on the foot, soft tissues are damaged and their subsequent destruction. The rate of disease progression is largely determined by the duration of the underlying disease and the quality of its treatment. Diabetic foot, in simple words, is one of the most dangerous complications of diabetes.
Why are soft tissues on the legs affected?
Since this syndrome occurs in the late stages of diabetes, its causes are directly associated with the prolonged exposure of sugar, present in destructive concentrations, to small and large vessels. Diabetics suffer from all internal organs, muscles, bones, and cartilage, but when you consider that the lower extremities (especially the feet and ankles) are located remotely from the heart, their blood supply deteriorates due to the disease. In addition, it is known that poorly controlled diabetes mellitus can provoke the development of atherosclerosis and other vascular diseases that interfere with normal blood circulation.
A patient with diabetes develops peripheral neuropathy over time, in which he practically ceases to feel damage to the foot, and since the maximum pressure of the weight when walking falls on the lower limbs, the wounds heal for a long time. Damaged nerves do not allow the patient to fully feel their legs. In the initial stages of the diabetic foot (it is difficult to notice any shocking changes in the photo), patients are not always able to determine the position of the legs and fingers when walking and balancing. A healthy person with normal innervation feels that his shoes are rubbing his skin or that a stone has got into his shoe and prevents him from moving on. A patient with diabetes, on the contrary, can perceive neither a stone, nor scratches, nor callus.
A similar danger poses a fungal infection of the epidermis or nails, therefore, with the first symptoms of damage or bacterial skin lesions, it is urgent to be examined. A person suffering from diabetes for more than a year cannot even ignore such a “trifle” as an ingrown toenail.
Who is at risk
The likelihood of developing diabetic foot ulcers increases several times if the patient:
- Often feels numb, tingling, or burning in the lower extremities.
- Has a history of peripheral vascular pathology that impedes full circulation.
- He wears low-quality, poorly fitting foot shoes. Incorrectly selected shoes are uncomfortable, and if a healthy person feels this, a patient with diabetes may not notice red spots and corns for a long time.
- Suffers from anomalies of the foot (for example, flat feet or hallux valgus).
- He has diabetes for more than 10 years.
- Smokes and abuses alcohol.
If a person falls into a risk group, then, so that the development of a diabetic foot does not begin, he must definitely inform his doctor about potentially dangerous factors.
Syndrome classification
Based on the reasons that cause the development of a diabetic foot, doctors distinguish several main forms of the syndrome:
- neuropathic;
- ischemic;
- combined.
In the first case, damage to nerve cells predominates, with ischemic diabetic foot (in the photo they have no fundamental differences), blood flow is disturbed. For the combined form of the disease, manifestations of a neuropathic and ischemic variety are characteristic.
Signs of illness
At the first symptoms of a diabetic foot, treatment (photos of the appearance of the legs are placed in the review) should be started immediately. Suspecting an ailment, it is urgent to visit a specialist who will draw up further treatment tactics. Signs of a diabetic foot include:
- Wounds, erosion, ulceration, blisters. Even minimal damage to the epidermis is dangerous. At first glance, harmless corns and corns can be a favorable condition for the penetration of a bacterial or fungal pathogen, which will complicate the already difficult course of the disease. The main sign of infection is the flow from the wound of pus.
- Damage to the nails. The fungus and ingrown nails can also cause serious inflammation on the skin of the foot and affect the deeper tissues.
- Hyperemia. Redness of the epidermis may indicate infection, especially if there is a nearby open wound surface, scuffs, calluses on the foot.
- Itching If the skin constantly itches, this symptom is often regarded as a harbinger of a diabetic foot. The initial stage of this ailment in most patients begins with redness, burning and severe itching.
- Constant pain. This symptom can indicate damage to the ligamentous apparatus, bruising, bruising, excessive strain on the legs, tight shoes or infection.
Patients with diabetes have serious difficulty walking. By the way, lameness sometimes indicates the development of Charcot's osteoarthropathy. This pathology is rare, but with inadequate treatment almost inevitably leads to disability. The cause of this complication is considered peripheral neuropathy, frequent mechanical trauma, osteoporosis.
At the initial stage of the diabetic foot, a change in its color is observed. Starting from the ankle to the tips of the fingers, the leg can take on a different shade: from red to bluish green or even black. Along with a change in the color of the skin, puffiness may appear, which is a sign of poor venous circulation.
In the later stages of the diabetic foot, patients also note other symptoms:
- pain in the lower extremities, radiating in the hips and buttocks;
- lameness, increasing with fatigue;
- numbness and periodic tingling in the legs;
- lack of hair on the legs;
- high body temperature;
- the epidermis shines, looks too elastic, stretched.
The main stages of the disease
Depending on the complexity of the lesion of the vascular bed and nerve endings in the lower extremities, a clear staging is attributed to the pathological process. The phased course of the disease was first described in 1997. In accordance with it, the following stages of the diabetic foot are distinguished:
- Initial. In the photo, the lesions of the zero stage are almost not noticeable, but if you examine the patient closely, you can find the first signs of deforming osteoarthritis, thinning of the epidermis, a grayish-bluish or reddish shade of the tissues, and a slight swelling.
- First one. At this stage, shallow surface erosion appears, which exposes subcutaneous fat. Muscles and tissues lying deeper until they are involved in the necrotic process.
- The second one. Muscle tissue, tendons, bones and joints are affected. If the patient seek the help of specialists at this stage, the diabetic foot can be cured without surgical intervention.
- The third. For this stage of the disease, purulent fusion of bone matter is characteristic. Abscesses occur in deep tissues - limited areas of the purulent process, caused most often by anaerobic bacteria. Ulcers on the foot emit a fetid odor.
- Fourth. At this stage, gangrene and tarsus develops. Due to necrotic changes, the tissues of the fingers turn black, while there are no clear boundaries of the affected areas. The patient is completely absent in any part of the foot. At this stage, the treatment consists, as a rule, in the amputation of fingers and dead parts of the limb. In some cases, operations are also carried out to restore blood supply to the foot.
- Fifth. It is hard to imagine what a diabetic foot looks like at this stage. Without proper treatment, gangrene spreads higher and higher, destroying not only the foot, but also the lower leg tissue, affects the thigh. To save the patient's life, the only possible treatment option is a high amputation of the limb.
Diagnostic research
For an accurate definition of the disease, only a patient examination and complaints are not enough. Medical diagnostic evaluation also includes laboratory tests, instrumental screenings and consultations with narrow specialists. For example, you may need qualified help from an angiosurgeon and orthopedic surgeon. Doctors of these specialties are directly involved in the treatment of diabetes mellitus and infections associated with circulatory disorders in the lower extremities.
Clinical tests, which are prescribed for patients with diabetic foot, are a whole complex of studies. These include:
- Detailed blood test. The study will help determine the presence of infection, its severity. In this specialist, the indicators of lymphocytes and leukocytes will help - their increased content indicates that the patient's body is struggling with an infectious disease.
- A blood test for sugar. For patients with diabetes mellitus and diabetic foot, this is a mandatory procedure.
- The doctor prescribes analyzes of kidney function, a study of liver enzymes and other screenings if appropriate, which he determines in each case.
In addition to laboratory diagnostic procedures, a patient with a diabetic foot must be referred for radiography. The study will determine the degree of damage to bone tissue, assess the damage to health from infection, detect foreign bodies in soft tissues and even the early development of gangrene, which will be evidenced by the porous muscles and gaps in the picture.
A subspecies of X-ray examination is angiography, a method for diagnosing blood vessels, which involves the use of a contrast medium (most often gadolinium). Using an angiographic image, one can adequately assess the functionality of blood vessels, determine the degree of elasticity and thickness of their walls, and the extent of the pathological process. Surgical intervention to restore blood circulation must be preceded by angiography, which is performed under local anesthesia.
Is it possible to cure the foot with pills
When treating a diabetic foot (photos once again confirm that diabetes is a dangerous, life-threatening disease), the use of medicines can partially neutralize high blood glucose levels and start the process of regeneration of affected tissues. As the basic means, drugs of the following pharmacological groups are used:
- insulin substitutes;
- antibacterial;
- antifungal;
- anti-inflammatory;
- painkillers;
- local antiseptics.
Systemic drugs and antibiotics
Strengthening the immune system with immunomodulators is of great importance for the effective treatment of diabetic foot. Neurotropic drugs are also prescribed (for example, Milgamm, Compligam), which contain B vitamins, support the work of the heart, kidneys, and prevent thrombosis. To improve the general well-being of the patient, anti-inflammatory non-steroid drugs and tricyclic antidepressants are used to reduce pain.
Antibacterial agents are prescribed without fail with the progression of the necrotic process and the deepening of ulcerations. Usually, doctors, not waiting for the results of bacteriological culture, which is carried out to determine the sensitivity of pathogenic microflora, prescribe broad-spectrum antibiotics from the group of cephalosporins and fluoroquinolones:
- Zeftera.
- "Tsifran ST".
- Avelox.
- "Tsiprolet A".
- Heinemox.
- "Invasion."
Depending on the severity of the symptoms of the diabetic foot, combinations of antibiotics may be used. For example, a pair of “Clindamycin” - “Ciprofloxacin” shows good performance even with ischemic ulcers at an advanced stage.
In addition to antibiotics, patients are prescribed complex-acting drugs. These include a class of heparinoids, which have a powerful antithrombotic effect. Most of these drugs are available in capsules (Sulodexide, Lomoporan), but in some cases parenteral infusion solutions are also used. For complex ischemic ulcers caused by the destruction of blood vessels, “Prostavazin”, “Alprostadil” are prescribed. These agents dilate blood vessels, minimize blood viscosity, and prevent platelet adhesion. “Trental 400” shows an excellent result - this medicine is most often used to treat diabetic foot, as it quickly establishes microcirculation in the affected tissues. Its analogues have the same properties:
- "Vulnostimulin."
- "Delaskin."
- "Fusicutan."
To restore the sensitivity of the foot, the loss of which occurred due to damage to nerve fibers, use drugs with thioctic acid in the composition. These include “Tieolept”, “Thioctacid”, “Berlition”.
How to flush ulcers
The undoubted reason for contacting a doctor is the absence of pain in diabetic foot syndrome. Conservative therapy of awesome leg ulcers requires thorough care and proper use of local medicines.
The success of treatment to a greater extent depends on how responsibly the patient approaches the implementation of medical prescriptions. Extremely important:
- always keep the wound clean;
- not to allow it to get wet;
- change dressings regularly with recommended medications;
- wear socks and slippers at home;
- minimize physical activity and walking.
Particular attention must be paid to the quality of cleaning and rinsing of the wound with antiseptic solutions, followed by sterile dressings. Doctors believe that the best way to cleanse a wound is through the surgical method. Using a scalpel from a deep ulcer, you can remove dead tissue particles, purulent masses. The method of mechanical cleaning allows you to leave only healthy tissue in the wound.
The patient will be able to wash the ulcer at home independently. Compared to surgical cleaning, this method is safer. For washing the wounds using saline. Sodium chloride has no toxic side effects. In the absence of this product at home, you can prepare a solution of 0.9% concentration of sodium chloride. It is also recommended to clean the ulcer with a “standard” 3% solution of hydrogen peroxide - this disinfectant removes pus and destroys anaerobic bacteria. If you need frequent washing of the wound, the peroxide solution is diluted with saline. Both components are taken in equal proportions.
For irrigation of wounds it is convenient to use the Miramistin antiseptic. By the way, this remedy has several advantages in comparison with solutions of manganese, iodine, and brilliant green - Miramistin does not inhibit the healing process and stops the death of tissues. Moreover, its analogue “Chlohexidine” is used mainly in the first stages of the diabetic foot. The thing is that this tool loses its disinfectant properties in a purulent environment.
It is recommended to dilute all of the above wound cleansers with too frequent use, alternate with each other, do not constantly use the same drug.
Means for local treatment
Treatment of a diabetic foot by external medicine alone will not produce any result. To stop the destructive pathological process, it is necessary to use antiseptics in combination with the method of surgical cleaning of the wound. Before applying a bandage to the medicine, Iruxol, Dioxicain-P ointment is placed in the wound - these products contain collagenase and protease enzymes. It is necessary to use these drugs with extreme caution in case of bacterial wound damage, as they can have a toxic effect not only on pathogenic microbiota, but also on healthy tissues.
Ulcers on the extremities, accompanied by purulent discharge and swelling, are treated with creams and ointments, which include iodine and polyethylene oxide. These include:
- "Yodopiron."
- Brownol.
- Lavasept.
- "Dioxidine."
The use of local medicines implies regular examination of the wound due to the risk of drying its surface during the regeneration process. To treat deep erosion with a significant amount of necrotic tissue, Purilon gel is used - a drug that stimulates regenerative processes and natural cleansing of a wound filled with purulent masses.
Surgical intervention
The radical method of treatment of the diabetic foot of the ischemic type is used more often than conservative therapy. This form of pathology is difficult to give to other therapeutic methods. The dynamics of ulcer healing improves dramatically after surgical reconstruction of the arteries by shunting or endovascular intervention. Such operations are aimed at restoring blood flow in the arteries of the lower leg and popliteal blood vessels. Manipulation is carried out under local anesthesia. During the operation, a catheter is inserted through the external incision into the femoral artery, through which tiny balloons are placed - they expand the lumen of blood vessels and improve blood flow.
In case of severe infection and failure of treatment, a decision is made on amputation of the limb. Only the removal of the affected part of the body will help stop the spread of infection and save a person's life.
Prevention and recommendations
The success of the treatment of pathology depends largely on the observance of a sparing regimen, minimizing physical activity on the foot. The best discharge for the lower extremities is bed rest. If its observance is impossible for any reason, the patient should wear only orthopedic shoes with special insoles made to order. Crutches can also be used to reduce the weight load on the leg when moving.
If a person suffering from diabetes is at risk of developing ulcers on the foot, he should take care of himself and purchase a fixing bandage made of polymer materials. It does not interfere with moderate physical activity and does not irritate the wound surface.
Another measure for the prevention of diabetic foot is the correct choice and application of wound dressing. The chronic course of the pathology necessitates covering the ulcer, but at the same time providing a sufficient level of permeability for gas exchange. For this purpose, hydrogel and collagen dressings are most often used.
Disease prognosis
Of the ten patients with diabetic foot, seven are diagnosed with a neuropathic form associated with nerve damage. A positive result of conservative treatment is achieved in almost 90% of cases. Less optimistic is the prognosis of ischemic and combined forms of the disease. In case of damage to blood vessels, conservative therapy helps prevent amputation in only a third of cases of ulcerative lesions. In addition, the treatment of diabetic foot syndrome is often complicated by the risk of secondary infection of an open wound, mechanical damage that can enhance necrotic processes, lead to tissue breakdown and gangrene, in which it will be impossible to avoid limb removal.
At the first symptoms, treatment should be started immediately. Do not risk your own health and life, choosing at random pharmacy drugs and folk remedies. An incorrect approach to treatment increases the risk of developing gangrene, which means that the probability of remaining disabled for the rest of the days automatically increases.