Diabetic foot

What is diabetic foot?

This is a direct complication of arterial disease (PAD) and/or diabetic neuropathy of the lower extremities. The complex of diabetic lesions of the lower extremities, such as infection, ulcers on the fingers and feet, and damage to the bones of the foot, is called diabetic foot syndrome.

Due to the dysfunction of peripheral nerves associated with diabetes (diabetic neuropathy), diabetic patients have a reduced pain threshold and sensitivity of the lower extremities. This means that minor injuries can go unnoticed for a long time and gradually progress and develop into an ulcer. Research estimates the prevalence of foot ulcers in diabetics to be between 15 and 25 percent.

Nerve damage may be associated with peripheral arterial disease (PAD), which leads to impaired blood flow to the extremities (diabetic angiopathy). About half of patients with diabetic foot ulcers also have peripheral arterial disease (PAD).

If foot wounds are delayed in healing, infection can occur and spread to the bones and joints in the area, which can lead to amputation of the limb. Inflammation of the foot – the most common cause of non-traumatic amputation in patients with diabetes.

What are the symptoms of diabetic foot?

• loss of sensation;
• pins and needles sensation;
• non-painful blisters or sores;
• change in color and temperature of the skin of the feet;
• red stripes;
• abrasions with or without discharge;
• stains on socks.

What prevention options are there for diabetic foot care?

• inspect your feet daily;
• wash your feet daily;
• wear comfortable shoes and socks;
• stimulate blood flow to the feet;
• be careful when cutting your nails, it is advisable to have this done by a qualified pedicurist;
• protect your feet from extreme temperatures;
• visit your doctor regularly for foot examinations;
• control your blood sugar levels;
• avoid smoking.

What are the options for diabetic foot care?

• use suitable shoes;
• Wash or wipe your feet with wet bandages daily to ensure a moist environment around the wound;
• clean the wound;
• avoid pressure on the wound area;
• removal of dead skin and tissue from the wound;
• use antibiotics in case of infection;
• ensure optimal blood sugar control;
• assess and correct arterial insufficiency.

What are the current options for vascular intervention in the legs?

Indications for surgical or endovascular intervention (catheterization) on the blood vessels in the case of lesions of the arteries of the lower extremities, which include pain at rest or at night, ulcers on the toes and feet, and necrosis of foot tissue.

Vascular surgery is performed under general anesthesia. The vascular surgeon bypasses the affected part of the artery of the lower limb. A bypass can be a patient's vein or a synthetic vessel implanted into an artery to bypass the blockage. The operation lasts several hours and requires subsequent hospitalization for several days.

Endovascular treatment (catheterization) is performed under local anesthesia. An invasive radiologist creates an access in the groin area through which he inserts a thin tube (catheter) into the artery and delivers it to the blockage. A small amount of contrast agent is injected so that the doctor can clearly see the affected arteries. Then, by inflating the balloon and sometimes placing a shunt (as in cardiac catheterization), the lumen of the narrowing or occlusion is restored and thus improves blood flow to the foot. The tiny access window on the skin is covered with a patch. This procedure is usually completed in less than two hours.

Endovascular treatment is critical to promote ulcer healing and prevent amputation. The faster and more effectively we can restore blood flow to the foot, the higher the chances of wound healing.