Diabetic foot

Doctors speak of a diabetic foot or diabetic foot syndrome when the feet of diabetics become ill. Open wounds, ulcers, inflammations or dead tissue (necroses) can be seen on a diabetic foot.

The diabetic foot is a common secondary disease of Diabetes mellitus. Poorly adjusted diabetics often develop damaged nerves (diabetic polyneuropathy ) andpoorblood flow (ischemic diabetic foot). These diseases mean that about every third person affected develops a diabetic foot.

In order to prevent infections and, in the worst case, an amputation, diabetics should check their feet daily and consult their doctor even if there are minor changes.

Diabetic foot: causes

The actual cause of diabetic foot syndrome is an injury to the foot. However, diabetes mellitus can cause a harmless pressure point to develop into a widespread wound or ulcer:

• Patients with poorly controlled diabetes have consistently high blood sugar levels . This damages your blood vessels and nerves. If the nerves in the foot are disturbed, those affected can no longer feel their foot properly and thus no longer fully perceive pain. Those affected do not notice pressure points from tight shoes or small cuts that occur when walking barefoot. 
• The sensory disturbances can cause muscle strength to decrease and the patient's feet to deform. A common example are the so-called claw toes. The toes are so bent that they cannot reach the ground. This causes problems when walking and can lead to further pressure points and sores.
• Damage and constrictions in the blood vessels mean that the foot is poorly supplied with blood . There is a risk that not enough oxygen will reach the tissue. As a result , cells die and a so-called gangrene develops: dead and blue discolored tissue. Gangrene can affect small areas, individual toes, or the entire foot.
• The circulatory disorders also make wounds more difficult to heal .
• High blood sugar levels can also affect the metabolism of the bones. Bone tissue in the foot can die and break down. Doctors speak of a Charcot foot.
• Bacteria can easily invade open wounds and cause inflammation. In addition, the immune system of those affected is often weakened. This make it easier for the foot to become infected.

Diabetic foot: symptoms

The symptoms of a diabetic foot are complex and range from small pressure points to dead parts of the foot. The following signs are possible:

• Numbness
• No feeling for warmth or cold
• Tingling, "pins and needles"
• Pain, stinging, or burning sensation in the feet
• Pain when walking, especially in the calves
• Dry skin, no perspiration
• Swelling and redness
• Calluses
• Injuries
• Open wounds
• Ulcers on the toes, back of the foot, or the sole of the foot (malum perforans)
• Misalignments such as claw toes
• Blue discolored area (gangrene)
• Broken bones or a collapsed foot (Charcot foot)

Doctors divide the symptoms of diabetic foot into different stages. They are based on the so-called Wagner-Armstrong classification.

The Wagner classification describes the depth of the wound on a scale from 0 to 5:

• 0: The patient has a pressure point that can develop into a wound.
• 1: The affected person has a superficial wound on the foot. Doctors speak of diabetic foot in the early stages.
• 2: The wound has developed into an ulcer that extends to the tendons and capsules.
• 3: The affected person has an ulcer that also affects the level of the bones and joints.
• 4: The wound has developed so far that parts of the foot have died.
• 5: The entire foot has died.

With the Armstrong classification, however , doctors classify the diabetic foot according to inflammation (infection) and insufficient blood flow (ischemia). You use the scale A to D:

• A: Foot without ischemia and infection
• B: foot with infection
• C: foot with ischemia
• D: foot with ischemia and infection

Diabetic foot: treat

Depending on how far the wounds have progressed, different doctors will treat the foot. If the patient has only slight symptoms (up to Wagner scale 1) or either inflammation or insufficient blood flow (up to Armstrong scale C), the family doctor can take care of the diabetic foot.

If the wounds get worse, the affected person should go to a foot clinic. Here an interdisciplinary team of so-called podiatrists (medical podiatrists), orthopedists, diabetologists and angiologists (vascular specialists) treats the complaints. The patient can receive outpatient care here. This mean that he does not have to stay in the foot clinic overnight.

If the diabetic foot continues to deteriorate (from Wagner scale 2 or Armstrong class D), the patient should go to a center of excellence for diabetic foot syndromes . Here the person concerned remains inpatient for a few weeks until his symptoms improve again. A team of various specialists also takes care of the patient in the competence center. 

Regardless of where the patient is being treated, therapy for diabetic foot usually consists of the following elements:

• Wound care
• Pressure relief
• Diabetes treatment
• Orthopedic shoes
• Podiatry therapy (medical foot care)
• training

In some cases these therapy modules are not sufficient and the medical professionals have to operate on parts of the foot. Preventing amputation is the primary goal of the treatment of diabetic foot.

Diabetic foot: wound care

Caring for the wound properly is the most important step after diagnosis. To do this, the doctor first removes dead tissue . Then he cleans the wound and puts on a bandage . Depending on whether the wound is infected and whether it secretes fluid, he can use different wound dressings.

If the wound is infected, the doctor usually also gives an antibiotic in the form of a tablet. If the infection is severe, it makes sense to inject the antibiotic directly into the bloodstream. The doctor must change the dressing every day and clean the wound again.

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