Diabetic foot: diagnosis, care and treatment

The Problem of the Diabetic Foot

Probably, the diabetic foot constitutes the most disabling complication of neglected chronic hyperglycemia: it is a pathological condition that negatively affects the patient's quality of life, so much so as to require scrupulous and constant hygiene of one's feet supported by frequent medical checks.
A maltreated or underestimated diabetic foot exposes the patient to ulcers, bleeding sores and infections which, in the long run, can spread to neighboring tissues and cause gangrene.
The main objective of the treatment of the diabetic foot is undoubtedly to prevent plantar ulcer and, in the case of ongoing infection, to stem the pathogenic insult within the shortest possible time.

Diagnosis

Frequent management and monitoring of the diabetic patient are essential to minimize the risk of chronic complications, including neuropathic foot.
Clinical evaluation of the patient with diabetes includes a series of tests:

1. Medical history and physical examination: the patient's medical history and physical examination are the visiting card of the patient. In this way, the doctor realizes the seriousness of the situation: the physical examination includes the evaluation of the patient's vital signs (temperature body, heartbeat, blood pressure and respiratory rate), the sensitivity test of the hands and feet (often altered in the diabetic) and the examination of the circulation of the lower limbs.
2. Laboratory tests (blood tests), which are important for determining "any infection or the presence of other blood disorders. Depending on the severity of the problem, the specialist may prescribe the patient more in-depth analyzes, such as enzyme tests. liver and kidney function tests.
3. Radiography: indicated to examine the possible presence of damage to the bones (eg arthritis) or foreign bodies in the soft tissues (eg the presence of gas in the soft tissues can indicate a state of gaseous gangrene in progress).
4. Ultrasound: if necessary, the doctor may ask the patient with diabetic foot for an Echo Doppler to evaluate the state of the blood vessels (morphology and structure analysis).
5. Angiogram: screening test useful for obtaining the representation of the blood vessels of the organism by infusing a contrast medium into the vessels.

Care and treatment

Given the severity of the condition, the treatment of diabetic foot requires a multidisciplinary evaluation that includes a team of diabetologists, podiatrists and surgeons.
Patients with diabetes should follow all the instructions provided by the doctor to implement an effective prevention program capable of minimizing the risk of foot injuries, such as calluses, infections and so on (for further information, read "Diabetic foot: what to do and what not to do ").

Short review to understand ...
As we know, diabetes causes serious neuropathic damage to the patient, such as to alter the ability to perceive pain and thermal changes in the feet; consequently, the patient does not realize the presence of any plantar lesions which, as they progress, can give rise to very dangerous ulcers. These lesions struggle to heal due to poor circulation in the lower limbs (arteriopathy).

According to this, it is well understood how the treatment of the diabetic foot is based above all on the local cleaning of the ulcer, on the treatment of the infection and, clearly, on the prevention of any damage and complications.

• Failure to treat the ulcerative lesion in the diabetic foot drastically reduces the chances of healing, exposing the patient to the risk of gangrene, therefore of foot amputation.

Therapy for diabetic foot involves the concomitant use of:

1. Specific antibiotics against the pathogen that caused the infection: in general, patients with diabetic foot with active infection are treated with intravenous injections of broad spectrum antibiotics (eg penicillin, metronidazole, aminoglycosides). Infections of moderate severity. or mild can be cured with oral therapy, or by mouth (the patient will still have to be hospitalized for a few days).
2. Sterile bandages and gauze, very useful for stopping any small bleeding from lesions, wounds or ulcers, and therefore hindering the entry of bacteria into the lesion.
3. Pain therapy: in the presence of severe pain in the foot, the patient can take - after consulting a doctor - analgesics and painkillers.
4. Arterial revascularization, to improve blood circulation in the lower limbs.
5. Surgical debridement: invasive treatment that involves the surgical removal of infected tissue.
6. Hyperbaric oxygen therapy: this is a medical practice capable of providing oxygen levels higher than normal, in order to inhibit the proliferation of anaerobic bacteria and promote wound healing.

When to see your doctor

The moral obligation of the diabetic patient is to contact the doctor as soon as abnormal signs and symptoms are observed or perceived in the feet.
The patient should always write down on a notepad all the alterations observed and perceived in the extremities: in this way, the possible subsequent diagnosis by the doctor is facilitated.
It is therefore essential to consult a doctor in the following circumstances:

• Presence of any trauma to the feet (calluses, ulcers, scratches)
• The patient feels pain or tingling in the legs
• The diabetic patient is feverish: fever (or a simple low-grade fever) is often one of the first symptoms of an "infection
• Itchy feet (presumed index of fungal infection affecting the feet)
• Altered sensation in the feet and constant tingling
• Presence of red patches on the skin of the legs and / or feet (possible index of inflammation or infection in progress)
• Difficulty walking
• Obvious deformation of the feet
• Redness, inflammation and swelling of a toenail: this is a possible indicator of an ingrown toenail (the main cause of gangrene-causing diabetic foot infections).

More articles on "Diabetic Foot: Diagnosis, Care and Treatment"

1. Diabetic Foot
2. Diabetic foot: what to do and what not to do