Diabetic foot refers to various wounds and tissue damage on the foot of a diabetic. People with diabetes mellitus can live well with their condition if they are well controlled with insulin. Poor control, on the other hand, damages the blood vessels and nerves. Small injuries to the foot can lead to wounds and other damage to the tissue.
Here you will find further information and doctors who treat diabetic feet.
There are currently around 8 million diabetics living in Germany. A third of them have legs with poor circulation. Approximately one million diabetics have a high risk of open wounds or already suffer from open foot injuries.
The problem of "diabetic foot" is widespread. This shows that diabetics do not always follow the guidelines for their condition.
The diabetic foot mainly occurs when diabetes has been poorly controlled for many years . The constantly high blood sugar level damages nerves and blood vessels in the feet. It can also trigger neuropathic pain.
Thefirst signs of an impending diabetic foot are usually circulatory and sensory disorders. The immune system is also weakened. This means that even the smallest injury can lead to major inflammation.
There is actually no typical picture of the diabetic foot. Diabetics can therefore often hardly recognize whether they are at risk or not. The clinical picture is extremely varied and ranges from athlete's foot to large ulcers. Around a quarter of all diabetics are already suffering from a diabetic foot when they are diagnosed by their doctor.
Poorly healing wounds on the foot should always serve as a warning signal. If a diabetic foot is treated too late, there is often a risk of amputation of the foot or at least some of the toes.
Diabetics must therefore pay particular attention to their foot care .
Important risk factors for diabetic foot, in addition to poorly adjusted insulin levels, include
Patients with diabetic foot syndrome often already have limited sensitivity in the affected leg.
There are two basic forms of diabetic foot syndrome. The subsequent treatment depends on the type of diabetic foot.
Neuropathic-infected foot: This form occurs due to a deficient supply of nerves and damage to them. This type occurs in around 70% of all cases of diabetic foot.
Ischemic gangrenous foot: This form is caused by arterial circulatory disorders. The tissue dies off over a large area. 20 - 30 % of patients with a diabetic foot are affected by this form.
It becomes more difficult when mixed forms occur. This is the case in up to a third of diabetics. In these patients, a diabetic foot is caused by a combination of polyneuropathy and a circulatory disorder of the foot.
Diabetics are very susceptible to circulatory disorders, which can lead in particular to ulcers on the feet © H. Brauer | AdobeStock
It all starts with excessively dry skin. This unusual dryness of the foot is a typical early warning sign of a neuropathic foot. Severe calluses and pressure sores are a further indication of this type of diabetic foot.
These symptoms are usually accompanied by numbness. Due to the slow destruction of the nerves caused by diabetes, even deep open ulcers are not painful. Those affected often do not realize that they are injured or suppress the wound.
Early education about the health risks should therefore be an important part of treatment for diabetics. A thorough foot inspection is the only way to recognize a neuropathic foot as quickly and reliably as possible.
Not all components of the clinical picture necessarily occur. In summary, the neuropathic diabetic foot is characterized by these symptoms:
For successful healing, the doctor cleans the wounds thoroughly and removes necrotic tissue. A silver-activated charcoal dressing is often used to prevent the wound from becoming infected. Systemic antibiotic therapy also has a supportive effect.
Depending on how severely the surrounding tissue is damaged, surgical measures are often not ruled out. These include the removal of dead bone tissue or minor amputations, i.e. a small amputation below the ankle.
Unlike the neuropathic foot, an ischemic gangrenous foot is always very painful. Most patients already have peripheral circulatory disorders when they are diagnosed with diabetes. As a result, the foot is no longer supplied with sufficient oxygen and the tissue dies.
The ischaemic gangrenous foot is characterized by
Severe pain, even with minor exertion, is the first indication of the disease. Ischaemic gangrenous feet often affect
The most significant characteristics are
The doctor first conducts a patient interview(anamnesis) and a physical examination. This usually includes
on.
Redness around the wound indicates inflammation and must be clarified by means of suitable laboratory tests. X-rays help the doctor to view the foot skeleton in detail.
The diabetic foot is often characterized by inflammatory markers. Poorly controlled diabetics often have elevated blood sugar levels. A blood test is therefore an important indicator.
Diabetic foot syndrome (DFS) must always be treated by an experienced team in an outpatient foot clinic. Such a team consists of
together. With their help, a treatment strategy can usually be developed to avoid the dreaded amputation.
Amputations as a result of a diabetic foot have been on the rise recently:
Polyneuropathy is usually treated jointly by diabetologists and neurologists.
If even minor deformities without calluses are found, the treating doctor prescribes "diabetes-adapted shoes". These shoes offer more space for the toes and also have soft padded insoles to prevent pressure points.
If the foot bones are misaligned or there are ulcers, the foot is stabilized by additional measures in the shoe.
A bandage shoe or special plaster cast can initially help with poorly healing wounds. If the wounds still have not healed after two months, surgical correction of the foot must be considered.
The primary aim of the operation is to correct the deformity and thus the bone pressure that led to the wound. As with hammer toe surgery, tendons, for example, are also moved in diabetic feet to compensate for the deformity.
In the case of particularly advanced deformities and severe inflammation, some bones usually have to be partially removed.
Inflammation is the greatest danger with the diabetic foot.
Severe and protracted or frequently recurring infections in the diabetic foot can often only be controlled by amputation. However, in many cases there are other treatments that are primarily intended to preserve the foot.
Mild infections without tissue destruction (necrosis) can be treated by immobilizing the foot and treating it with antibiotics. If the inflammation progresses, it is necessary to remove the focus of infection and, if necessary, amputate parts of the foot.
The later treatment is initiated, the greater the tissue damage will be and the more tissue will have to be removed
In order to avoid further complications, the patient must be mobilized again very quickly after the operation.
To support wound healing, diabetics must learn to adjust their blood sugar correctly after a successful operation. They should also get plenty of exercise.
If you follow a few simple rules, you can significantly reduce your risk of developing a diabetic foot. The following measures relating to hygiene, prevention and everyday behavior will reduce your personal risk:
Injuries to the foot require daily wound checks by a doctor if you have diabetes. If the injury does not heal or becomes infected, see a doctor quickly.
Diabetes can affect various organs. Diabetics receive comprehensive and competent care at a specialist diabetology practice. The necessary know-how is pooled here to provide you with a wealth of expert knowledge and refer you to other specialists if necessary.
Chronic wounds and other changes to the shape of the feet can be serious complications of diabetes mellitus. Around a quarter of all diabetics develop a foot ulcer in the course of their lives. Even today, the popular belief that such ulcers will never heal persists. In fact, they take longer to heal and can sometimes lead to complications.
If optimal therapy is provided and all treatment options available today are used, a "diabetic foot" can be cured. This may also apply to wounds that have been present for years.
However, success also depends on the close interdisciplinary cooperation of the medical team.
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