Diabetic foot

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What is a diabetic foot?

A diabetic foot is a long term complication of diabetes mellitus and includes conditions that develop and affect the feet of an individual with diabetes mellitus. This is usually as a consequence of damaged nerve supply (diabetic neuropathy), peripheral arterial disease, or a combination of the two.

Is diabetic foot a medical emergency?

It is not a medical emergency, although early intervention is warranted to prevent complications and morbidity.

Causes of diabetic foot

It develops as a result of reduced peripheral nerve function and diabetic neuropathy, which causes a reduced ability to feel pain. This can exist along with a reduced and poor blood circulation to the extremities. This works in two ways, as it firstly hinders the ability to recognize minor injuries, and secondly, these injuries go on to become serious infections as a result of the poor blood supply and delayed wound healing.

Risk factors for diabetic foot

The following are the risk factors:

  • Uncontrolled diabetes
  • Improper care of feet and poor foot hygiene
  • Improper footwear
  • Smoking

Triggering factors

It can be triggered by a small injury that may go unnoticed.

Signs & symptoms of diabetic foot

The symptoms and signs of a diabetic foot may include the following:

  • Change in skin color and temperature
  • Swelling of the foot or ankle
  • Pain in the legs
  • Foot ulcers: Open sores on the feet that are slow to heal
  • Draining of fluid from the sores or ulcers
  • Ingrown toenails
  • Fungal infection of the nails or in-between the toes
  • Corns, calluses, bunions
  • Dry and cracked skin
  • Foul odor from the feet

It may present with the following types of infections:

  • Cellulitis
  • Deep Skin and soft tissue infections
  • Acute Osteomyelitis
  • Chronic Osteomyelitis

Investigations

The following investigations may be done:

  • Laboratory tests -
    • CBP & ESR
    • Fasting Blood Sugar and HbA1c
    • Gram Stain & Culture Tests
  • Imaging tests -
    • Plain X-ray
    • CT & MRI
    • Bone Scans

Diagnosis of diabetic foot

A diagnosis of diabetic foot is established based on medical history, clinical evaluation, and results of the investigations done.

Diabetic foot treatment options

The treatment of diabetic foot depends on the severity of the condition and the type of infections or complications that are present. It may include medical and surgical management. Vascular management, infection management and prevention, and pressure relief are essential in the management of a diabetic foot.

A. Medical management

Medical management of a diabetic foot may include the following:

  • Antibiotic Therapy: Usually systemic (Intravenous) antibiotic therapy is required and the antibiotic that is used depends on the microorganism causing the infection.

B. Interventional including surgery and indications for surgery

Interventional procedures such as follows may be required in the management of a diabetic foot that has progressed to chronic osteomyelitis are:

  • Surgical Debridement: To remove infected bony fragments and soft tissue
  • Amputation: May be required for individuals with an extensive infection that cannot be controlled with medical management or surgical debridement

C. Role of diet/exercise/lifestyle changes/preventive measures

Some measures that can be taken to prevent this disease may include the following:

  • Keeping diabetes under control
  • Maintaining proper feet hygiene:
    • Such as washing feet with warm water and mild soap every day
    • Drying feet well after washing, especially between the toes
    • Check feet every day for sores, blisters, redness, calluses, cuts, nicks, etc.
    • Keep the skin of the feet moisturized as advised by a medical practitioner
    • Check toenails for infections every week, and ensure that the nails are properly trimmed and maintained
    • Wear proper-fitting shoes that cover the toes
    • Strictly avoid walking bare feet
    • Avoid wearing tight-fitting shoes
    • Avoid exposing feet to extreme hot or cold temperatures
    • Keep feet up while sitting or sleeping to help with the drainage of blood
    • Wiggle and move toes and ankles to keep the blood flowing to the feet
    • Avoid sitting cross-legged for prolonged periods
  • Cessation of smoking
  • Regular visits to a podiatrist

Complications

The following complications may be seen:

  • Severe skin and bone infections
  • Abscess formation
  • Gangrene formation
  • Bone deformities
  • Charcot's foot
  • Amputation

Prognosis

The prognosis for a diabetic foot depends on the severity of the complications that are associated with it. The cellulitis has a better prognosis than chronic osteomyelitis, and the morbidity and mortality increase when systemic infections, peripheral artery disease, ischemic heart disease, decreased kidney function are present in an individual with a diabetic foot.

When to contact the doctor or hospital/how to identify the emergency or complications?

It is advisable to seek medical attention if any of the signs and symptoms of a diabetic foot are noticed.

Indications for hospitalization if required

Hospitalization may be required for the management of a diabetic foot that presents with complications such as infections.

Screening methods

It is advisable for all individuals with diabetes mellitus to schedule regular visits with a Podiatrist to have their feet examined, in addition to following proper self foot care.

Suggested clinical specialist/departments to consult for this condition

It will be attended by specialists from the departments of diabetology/endocrinology, infectious diseases, and general surgery.

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