Diabetic foot - a problem with the legs, which occur due to high blood sugar. Diabetes, which is poorly controlled, violates the sensitivity of the nerves (neuropathy), and also impairs blood flow in the vessels of the legs. This increases the risk of injury and infection. Diabetic foot syndrome - the patient has ulcers on the legs, joints and even bones. Wounds do not heal well, disease germs multiply in them. In advanced cases, this causes gangrene and amputation. The following describes the causes, symptoms, prevention and treatment of diabetic foot. Learn how to treat leg ulcers at home and in a medical facility. Gangrene, amputation and subsequent disability is a real threat in diabetes. But you can prevent it if you follow the rules of foot care.
Diabetic foot syndrome - a common cause of lower limb amputation
If you have diabetes for several years, and even more so, if you have not been controlling it well all this time, then there is a significant risk of injuring your leg. As you know, any wounds and injuries in patients with diabetes heal poorly. Even small damage can fester, gangrene will develop, and the foot will need to be amputated. This is a common scenario. To avoid it, study and carefully follow the foot care rules below. If you have sore legs due to neuropathy, then read the article “Hurt feet in diabetes - how to get treatment”. The following describes what to do if the sensitivity in the legs on the contrary reduced. This happens more often. The diabetic does not feel pain in the legs, changes in temperature, stress, cuts, blisters, pebbles, shoes, etc. With this problem, you can live carelessly, and then suddenly you will find that the foot has started to rot, and you need to go to the table to the surgeon. Follow the recommendations below to keep the opportunity to walk “on your own two feet”.
The number of people with diabetes who have problems with their feet is constantly increasing, because the incidence of type 2 diabetes is increasing. On the territory of the Russian Federation and the CIS countries in the regional centers more than 200 specialized offices of diabetic foot work. With the help of new modern methods, doctors are increasingly able to prevent amputations.
|Endocrinological Research Center of the Ministry of Health of the Russian Federation, Department of Diabetic Foot||st. Dm Ulyanova, house 11||(495) 500 00 90|
|Endocrinological Dispensary, Department "Diabetic Foot"||st. Prechistenka, 37||(495) 246-6573|
|Moscow Center "Diabetic Foot"||st. Ivana Susanina, 3||(495) 905-1666|
|Clinic of Endocrinology MMA. THEM. Sechenov, office of diabetic foot||st. Pogodinskaya, 5||(495) 248-3866|
|Central Clinical Hospital of the Medical Center of the Office of the President of the Russian Federation, Department of Purulent Surgery with the profile "Diabetic Foot"||st. Marshal Timoshenko, 15||(495) 414-0300|
|Center for the treatment of critical lower limb ischemia||Moscow region, Odintsovo, ul. Marshal Biryuzov, 1||(495) 599-72-41|
The treatment of the diabetic foot syndrome is carried out by a special doctor, who is called a “podiatrist”. Do not confuse it with the pediatrician pediatrician.
|Center for Surgery of the Neuro-Ischemic Diabetic Foot Syndrome and Critical Lower Limb Ischemia||st. Lev Tolstoy, 6-8, building 38 - Faculty Surgery Clinic||(812) 91-7-91-91|
|Hospital for war veterans, the office of diabetic foot||st. Narodnaya 21a||+7-911-225-72-65|
|Vascular Center them. T. Topper on the basis of Clinical Hospital №122||pr. Kultury, 4||+7 (812) 962-92-91|
|The city center for the rescue of extremities on the basis of St. Petersburg GBUZ "City Hospital №14"||st. Kosinova, 19||+7 (812) 786 76 76|
|City Diabetes Center №2||st. Leni Golikova 29-4||(812) 757-30-78|
|City Diabetes Center №3||st. Novocherkasskaya, d. 56, k. 1||(812) 444-14-63|
|City Diabetes Center №4||261 Obukhovskoy Defense Ave.||(812) 368-44-67|
|Territorial Diabetes Center GKDTS № 1||st. Siqueiros, d. 10-D||(812) 296-35-06|
To find specialists who are close to you, type in the search system "center of diabetic foot your city, regional center" or "office of diabetic foot your city, regional center". After that, you will immediately see what kind of state medical institutions and private clinics there are.
Let's take a look at what causes leg problems in diabetes. In diabetics, blood circulation in the vessels that feed the legs is often impaired. Without adequate nutrition, the skin on the legs becomes especially vulnerable to damage, and they heal slowly. Also, frosts adversely affect the skin of a person with diabetes, although healthy people tolerate the winter cold without problems.
Since blisters, burns and abrasions in diabetics are painless, they may not pay attention to their problems with their legs until gangrene begins.
Another manifestation of diabetic neuropathy is that the skin on the legs loses the ability to sweat and remains dry all the time. And dry skin, as is known, often cracks. Cracks of the skin on the heels can turn into ulcers. Since these ulcers do not hurt, the diabetic does not take remedial measures, and the process moves to gangrene. Another form of diabetic neuropathy is one that blocks the work of the muscles in the feet. There is an imbalance of muscles, which leads to deformation of the bones of the foot. This type of deformity includes bent toes or claw-shaped toes, as well as a high arch and a curved foot.
If diabetes has impaired vision, the development of foot problems becomes even more likely. Because a person doesn’t see where he is going when walking. Also, the risk of diabetic foot is increased if the patient's legs become swollen due to kidney problems. Because swelling increases stop volume. The footwear becomes close, squeezes and injures feet when walking.
What to do? The main means is to bring blood sugar back to normal with a low-carbohydrate diet. It is an essential tool to control type 1 and type 2 diabetes. Normalize your sugar - and the manifestations of diabetic neuropathy will pass. You will get rid of them within a few months, in severe cases - in 2-3 years. Learn and follow a type 2 diabetes treatment program (see below) or a type 1 diabetes treatment method.
Constant pain can be a symptom of stretching, deformation of the foot, bruising, overloading, improper footwear or infection.
Redness of the skin is a sign of infection, especially if the skin around the wound reddens. Also, the skin can rub the unsuccessfully selected shoes or socks.
Leg swelling is a sign of inflammation, infection, improper footwear, heart failure, or impaired blood circulation in the vessels.
A rise in temperature on the surface of the skin means an infection or inflammation that the body tries to suppress, but does not cope because the immune system is weakened by diabetes.
Any damage to the skin is serious, because an infection can penetrate it.
Corns mean that the shoes are incorrectly chosen, and when walking, the load on the foot is incorrectly distributed.
Fungal diseases of the nails and skin of the feet, ingrown nails - can lead to severe infections.
Pus flows from the wound - a symptom of infection.
Limping or walking difficulties can mean problems with the joints, a serious infection or that the shoes are incorrectly chosen.
A fever or chills in combination with a wound in the leg is a sign of a serious infection that threatens to death or amputation of the limb
Redness of the skin spreads around the wound - it means that the infection is increasing, the body cannot cope with it, and it needs help.
Numbness in the legs is a sign of a violation of nerve conduction (diabetic neuropathy).
Leg pain is also a symptom of a diabetic foot, but it is treated separately. Read more in the article "Hurting feet in diabetes: how to treat."
Additional symptoms of circulatory disorders (intermittent claudication):
- pain in the legs, which increases with walking and subsides at rest;
- hair stops growing at the ankles and feet;
- The skin on the legs becomes rough, dry.
- ingrown nails;
- plantar warts;
- hammer-like curvature of the fingers;
- dry and cracked skin;
- fungal skin disease of the feet (athlete's foot);
- nail fungus.
Corns occur when some part of the foot is subjected to excessive pressure or something rubs it. As a rule, the reason is unsuccessfully selected shoes. It is officially recommended that the corns be carefully removed with a pumice stone after a bath. Dr. Bernstein objects: Do not remove calluses! Do not do it yourself and do not allow anyone, including a doctor. Because the wound will remain at the site of the callus removal, which with a high probability will turn into an ulcer.
A diabetic patient has a corn on his toe removed. There remains a wound that will heal for a long time, and most likely an infection will strike it.
Dr. Bernstein points out that the removal of corns is the main cause of ulcers, which the infection then infects. Next - gangrene and amputation ... Instead of removing calluses, order and wear good orthopedic shoes. After that, the load on the foot when walking will be distributed correctly, and the calluses will gradually pass.
Blisters are bulging skin filled with fluid. A blister is formed due to the fact that shoes all time rub one and the same area on the foot. A blister may also appear if you wear shoes without socks. In order to avoid blisters, shoes should fit well, and do not go without socks. If there is a blister on the leg, the patient with diabetes should definitely see a specialist. The doctor will properly bandage. If an infection develops, the doctor will remove the pus from the blister and prescribe antibiotics.
Fingernails grow in if a person cuts their hair incorrectly or wears too tight shoes. Do not cut nails around the edges. It is advisable not to cut them with scissors, and handle nail file. Patients with diabetes should not leave the ingrown nail without attention, you need to see a doctor. The doctor may decide to remove part of the nail to prevent further ingrowth. It is a lesser evil than an infected wound, gangrene and amputation. If an infection has already appeared in the toe, the doctor will prescribe antibiotics.
Bursitis is a bulge on the outer edge of the big toe. Over time, it can be filled with bone tissue and fluid. Bursitis is formed if the thumb deviates to the other fingers. This may be a hereditary problem. High heels and shoes with pointed toes also increase the risk. To prevent bursitis, the doctor may suggest using soft insoles for shoes. Pain and inflammation relieve medications. If bursitis causes frequent bouts of severe pain, then it is surgically removed. For prevention, wear shoes that fit you well in size.
Bursitis of the big toe, on which the ulcer appeared. It can be seen that the wound is infected.
Plantar warts are small flesh-colored growths. Sometimes they have tiny black dots. Plantar warts cause human papillomavirus. This virus penetrates through small lesions on the skin of the legs. Warts can be painful and interfere with walking. To reduce their spread, wash your hands every time you touch your soles. Feet should be clean and dry. Do not go barefoot in public places. The doctor may suggest removal of plantar warts with a laser, liquid nitrogen or surgically under local anesthesia.
Hammer-like curvature of the fingers arises from the fact that one or two joints of small toes bend unnaturally. This is because the muscles in the foot weaken due to diabetic neuropathy. If there is a problem of curvature of the fingers, the shape of the feet changes. There may be difficulty walking. It is difficult to find the right shoes. The main danger - there may be wounds and ulcers that are prone to infection. Treatment - orthopedic insoles in shoes, as well as medicines for pain and inflammation. In extreme cases, surgery.
Dry and cracked skin is rough and flaky. Skin color changes, it may itch. This problem is caused by various reasons - high blood sugar, nerve damage and deterioration of blood flow to the legs. Cracks in the skin are dangerous because they settle infection. Maintain moisture and elasticity of the skin of your feet. Lubricate it regularly with oil as described below in the “Foot Care: Detailed Instructions” section. If you can not cope and the skin condition worsens - see a doctor. Perhaps you will write a prescription for a potent ointment. Talk to your doctor about whether you should prescribe vitamin A and zinc supplements. Do not accept these funds without permission! Of course, the main thing is to reduce blood sugar and keep it stably normal.
A blister or callus that has passed into an infected ulcer. You can also see a blister on the bottom of the thumb.
Fungal diseases of the skin of the foot are manifested by symptoms - itching, burning, redness, cracks in the skin. The fungus multiplies on the soles and between the toes. To prevent it, keep your feet as dry as possible. Do not wear the same pair of shoes all the time. Have a few pairs of shoes to alternate them. While you are wearing one, the other is drying. During the night the shoes do not have time to dry. In public places do not go barefoot, wear slippers. Socks should be made of natural material - cotton or wool. The pharmacy sells creams and aerosols against fungus on the legs. If necessary, the doctor will write out a prescription for potent drugs.
Nail fungus - the same preventive measures as for fungal diseases of the skin of the feet. The fungus makes the nails thick, it becomes difficult to cut them. The color of the nail changes. Sometimes the nails affected by the fungus fall off. The doctor can prescribe pills, remove the nail surgically or chemically. Nail fungus is also treated with a laser, but there is still some debate among specialists how well this method helps.
Signs of infection for which you must immediately see a doctor:
- skin redness, temperature increase on its surface.
Diabetes foot problems can be caused by nerve conduction disorders, blockage of blood vessels in the legs, or both. This is called a neuropathic, ischemic, or mixed form of diabetic foot syndrome. The doctor determines the form of the disease and makes a diagnosis in order to prescribe the optimal treatment.
|What the doctor usually does||For what purpose|
|Visually inspects the patient's legs.||Identify what are the signs of diabetic foot (see above)|
|X-ray or magnetic resonance scan of the feet||Find out if there are bone lesions.|
|Checks sensitivity to vibration, temperature, touch, and knee jerks||Determine how severe diabetic neuropathy is in a patient|
|Examines the patient's shoes||Assess how the shoes fit in size and completeness, if there are no foreign bodies in it, whether the sole is not worn out|
|Submits the contents of the wound for bacteriological analysis||Find out which antibiotics can help and which cannot|
- Ultrasound of vessels of the lower extremities;
- Doppler ultrasound in M-mode (USDG);
- measurement of the ankle-brachial index;
- transcutaneous oximetry.
Testing the vibration sensitivity of the foot to assess the severity of diabetic neuropathy
There is also a study - radiopaque angiography. A radioactive contrast agent is injected into the patient’s blood that “glows” through the walls of the vessels. This study is the most informative, but it can cause kidney side effects. Therefore, it is prescribed with caution. However, if surgery is planned to restore blood flow in the vessels, it is mandatory.
|0||There are no ulcers yet, but the risk is high - corns, foot deformity|
|2||Deep ulcers. Tendons may be affected, but not bones.|
|3||Deep ulcers with bone damage|
|4||Gangrene on the toes|
|5||Gangrene involving the entire foot|
The prognosis depends on the experience of diabetes, how well the patient is treated, whether he is motivated to comply with the regime. Associated diseases are also important - atherosclerosis, hypertension, complications of diabetes on the kidneys and eyesight, senile dementia. Therefore, when a diabetic visits a doctor because of problems with his feet, the examination should be comprehensive.
- Diabetes Tests - Detailed List
- Blood Sugar Rates - What to Strive for
Charcot's foot (diabetic osteoarthropathy)
Charcot's foot (diabetic osteoarthropathy) is a complication of diabetes, as a result of which the joints and soft tissues of the foot are destroyed, its shape changes. In the early stage, the joints become stiff and swell. Later, the muscles weaken and no longer cope with the load. Because of this, there are problems with the bones, the foot is deformed. All this usually happens quickly.
Charcot foot (diabetic osteoarthropathy), as well as an ulcer on the sole. Despite significant damage, the person does not feel pain.
The cause of the development of Charcot's foot is diabetic neuropathy. Damaged nerves cannot transmit signals from the leg to the brain. Therefore, a person incorrectly puts his foot while walking. Destruction of joints and bones causes pain, but the diabetic does not feel it. He continues to load the affected foot until the change in the shape of the foot becomes clearly noticeable.
- skin of the foot turns red, the temperature on its surface increases;
- leg swells up;
- pain may be felt, but more often absent due to neuropathy.
Treatment of diabetic osteoarthropathy - the leg is placed in a special dressing of polymeric materials. This gives the opportunity to relieve the affected areas of the foot. Probably, the doctor will prescribe a patient to walk with crutches or even transfer to a wheelchair. Sometimes the curved shape of the bones is normalized by surgery.
Prevention - is the careful implementation of the rules of foot care and daily inspection of the feet. Recommendations for foot care are given below. Now we will discuss how to inspect the feet of a patient with diabetes, what to look for. Foot should be inspected daily, first from the top, and then from the side of the sole. Carefully check the skin between your toes. For this you may need a mirror. It is desirable that someone else participated in the examination of the stop, and not just the diabetic himself.
The task of inspection is not to miss if new calluses appear, swelling, bruises, painful areas, skin damage, any other changes. The shape, color and temperature of the foot may change. Sensitivity to touch - weaken or, on the contrary, increase. If you notice that the changes are proceeding for the worse - see the doctor the next morning, do not pull. There may be minor fractures and bone fractures, due to which the foot swells, its shape changes. This requires urgent attention from the doctor.
Damage to the feet, which should be wary of diabetes:
- accidental cuts and abrasions;
- blisters after burns (including in too hot a bath);
- fungal skin diseases, especially between the toes;
- nail fungal diseases;
- ingrown nails into the skin;
- corns on the feet and toes (“natoptysh”);
- bruises, bruises.
Even minor damage can turn into a trophic ulcer that will be long and difficult to heal. In the case of bacterial infection of the wound - gangrene will develop, and it may turn out that only amputation will save the diabetic from death.
If the skin of the feet darkens or brightens on the contrary, the hair disappears on it - this means that the blood supply to the legs is deteriorating. The worse the supply of oxygen and nutrition to the cells, the longer the skin lesions heal. Check whether the skin's sensitivity to touch is worsening. For this you can use, for example, feathers. Make sure that a person with diabetes can feel the difference between warm and cold water when he puts his foot in water. Before taking a bath, you need to check the water temperature by hand. In any case, a bathroom thermometer is necessary to have and use.
Diabetic foot syndrome usually develops due to the fact that the patient's leg is injured, but he does not feel this. The purpose of the daily inspection is to identify negative changes that the diabetic did not notice at the time when they occurred. Doctors now have effective modern dressings and ointments. These are tools that help heal wounds in the legs, prevent infection, gangrene and amputation. But still you need to consult a doctor on time. When gangrene has already begun - there is no other means besides amputation.
Diabetic foot bothering you? Contact your doctor immediately, do not pull!
Follow the rules of foot care, inspect the feet daily and contact your doctor as soon as something seems suspicious to you. The main way to prevent and treat diabetic foot is to lower the blood sugar to normal, and then to maintain it stably normal, like in healthy people. This can be achieved with type 1 and type 2 diabetes with a low-carb diet. Control your metabolism - and most of the symptoms of diabetic neuropathy will eventually pass. In particular, the sensitivity of the legs will be restored. Damage to the skin of the legs will also heal. But, unfortunately, if the blood vessels are clogged, then their patency simply does not recover. Also, if you have had fractures or dislocations of the bones of the foot, then it is incurable.
Foot care: detailed instructions
The following are the rules for foot care for type 1 and type 2 diabetes. If the sensitivity of the feet to temperature, pain, and pressure is largely lost, then they must be carried out especially carefully. This is the only way to not get to the operating table to the surgeon who is engaged in amputations.
At the same time, if you carry out a type 1 diabetes treatment program or a type 2 diabetes treatment program and keep your blood sugar stable and normal, then the nerve sensitivity is restored over time. After that, the risk of fatal leg problems in diabetes is reduced to zero. Recovery of nervous sensitivity takes at least several months, and usually 1-2 years.
Stop smoking! Smoking impairs blood circulation in the legs and, consequently, increases the chances that sooner or later an amputation will have to be done.
The danger of burning the legs is high because the sensitivity of the feet to temperature is weakened. Keep your feet as far away from heat as possible. This means no fireplaces, heaters, hot water bottles or electric blankets. In the bath or shower, the water should be cool, not even warm.
In cold weather, wear thick warm socks and shoes of sufficient width so that it does not press on the legs in the socks. Whether the blood circulation in the leg vessels is disturbed can be checked at the doctor’s office with the help of a painless study called “transcutaneous oximetry”. If it turns out that it is broken - do not stay in the cold for more than 20 minutes in a row. Never walk barefoot, not on the street, not even indoors.
If you lubricate your feet with some kind of medication, then do it only as directed by your doctor. Many common remedies that are sold over the counter without a prescription are dangerous for the skin of a person with diabetes. For example, iodine, hydrogen peroxide and salicylic acid. Do not use iodine or hydrogen peroxide to disinfect leg wounds, even if advised by a doctor. Buy in a pharmacy special iodine, which does not burn the skin, and keep it close at hand.
If you have dry skin on your feet, then ask a cardiologist or a general practitioner so that you do not prescribe beta-blockers for hypertension or heart problems. Because taking drugs from the group of beta-blockers will further complicate hydration of the skin of your feet. How to treat cardiovascular diseases without harmful “chemical” pills, read here - this is a site for the treatment of hypertension, akin to Diabet-Med.Com.
If corns appeared on your legs, do not try to remove them! Do not use for this nails or scalpel, or other objects. Do not remove the corns yourself and do not allow anyone to do this, including a podiatrist. Rough skin on calluses - is the protection of the soles of the feet from damage due to unsuccessfully selected shoes. If you remove the corns, then this protection disappears.
Removal of corns in diabetics is the most common cause of ulcers, which then lead to amputation of the foot. In the case of callus on the legs, you need to go to comfortable orthopedic shoes. If the shoes are picked up correctly, then there will be no excessive load on the soles of the feet, and with time the calluses will disappear themselves.
Fungus on the nails. On the big toe of his right foot, he has already caused nail peeling.
If a patient with diabetes has thinner nails, then you need to find out if the fungus is the cause. If it turns out that this is really a fungal infection, the doctor will prescribe a remedy that needs to be applied to the affected nails twice a day. Unfortunately, the fungus usually has to be treated for 12 months or even longer. Not only local remedies may be needed, but also pills against fungus.
It is advisable to print out the rules for foot care that are given above, as well as the section "How to maintain foot hygiene". Periodically re-read this material and familiarize yourself with family members of a diabetic patient. If you diligently carry out a type 1 diabetes treatment program or a type 2 diabetes treatment program, then you will be able to keep your blood sugar stably normal. After a few months, the sensitivity of the nerves in the legs begins to gradually recover. Not later than in 2-3 years, it will recover completely. The risk of diabetic foot syndrome or gangrene will decrease to almost zero.
How to buy shoes
Buy or order all shoes not in the morning and not in the afternoon, but in the evening, because in the evening the foot size is maximum. Shoes should be comfortable immediately, as soon as you try it on for the first time. It should not be necessary to wear new shoes. Do not wear shoes with pointed toes. You need shoes with a wide and deep space for the toes. Orthopedic shoes are a good choice. It does not look very aesthetically pleasing, but it is comfortable and increases the likelihood that you will be able to maintain your legs without damage.
Never wear sandals with a strap between your toes. Because the strap can rub the skin. Blisters appear, which then go into an ulcer. Do not wear the same shoes for several days in a row. Have a few pairs of comfortable shoes to alternate them every other day. Each time, before putting on a shoe, inspect it from the inside. There should not be any third-party items - pebbles, etc.
Do not wear stockings or socks with tight elastic bands that squeeze the legs and impair blood circulation in the vessels. Do not wear socks with holes or darted. Do not wear socks that are too sore or have thick seams. Problematic socks can damage the skin of the legs, cause first a blister, then an ulcer and further down to gangrene and amputation. Saving on linen can turn into irreparable losses due to disability.
Every day you need to inspect the feet of a patient with diabetes, whether new injuries or signs that shoes are uncomfortable have appeared. Make sure that there are no blisters, calluses, cracks, traces of fungus or other skin damage to the feet. Also check the skin between the toes. Inspect the soles with a mirror. If a person with diabetes cannot do it himself, then he needs the help of another person. If you find any injuries on your legs, contact your doctor immediately.
Do not check the temperature of the water in the bathroom with your foot, but only with your hand, even better - buy and use a bath thermometer. The temperature of the water in the bathroom should not exceed 33 degrees Celsius. Because even water temperature of 34 degrees Celsius can cause a burn if blood circulation in the vessels is disturbed.