Diabetic foot syndrome

The diabetic foot syndrome is a severe complication of diabetes mellitus, in which either the nerves or the blood vessels in the foot are damaged. This can lead to circulatory disorders and / or pressure sores. In severe cases, the functionality of the foot can be severely impaired; sometimes even amputations occur.

What is Diabetic Foot Syndrome?

Diabetic foot syndrome is not uncommon in diabetes mellitus patients. It is divided into two different categories. Neuropathic foot syndrome is a damage to the nerves that causes pressure sores, numbness or ulcers on the foot.

The muscles are weakened and the functionality of the foot is impaired. In the ischemic foot, the blood flow to the foot is disturbed. As a result, entire parts of the affected tissue can die and, in the worst case, have to be amputated.

The neuropathic foot occurs significantly more frequently than the ischemic foot; the ratio is around 70% to 30%. The necessary medical treatment depends on the type of diabetic foot syndrome.

causes

The causes of diabetic foot syndrome are initially an existing underlying disease, diabetes mellitus. Especially patients whose blood sugar level is permanently high or subject to strong fluctuations suffer from the so-called diabetic foot.

The excessively high glucose level in the body disrupts the metabolism, which in the long term damages the nerves, arteries and blood vessels. In the case of smoking diabetics, the risk of a diabetic foot syndrome is increased again, since the blood circulation is impaired by the nicotine.

The symptoms can be made worse by shoes that are too tight, as pressure points or ulcers arise due to incorrect pain perception, but are not recognized early.

Symptoms, ailments & signs

With this syndrome, those affected suffer from serious complaints that significantly limit and reduce the quality of life. First and foremost, there are significant disturbances in blood circulation, which mainly occurs in the legs and feet. This can lead to disorders of sensitivity or even paralysis in these areas, so that those affected often also suffer from restricted mobility and are dependent on the help of other people in their everyday lives.

The everyday life of the person concerned is made considerably more difficult. Muscle wasting can also occur in the feet, so that even when walking or standing there can be severe pain in the feet and also in the legs. The pain can also occur at night and lead to sleep problems and irritability in the person concerned.

Furthermore, various inflammations and infections occur on the feet, which can even cause ulcers. These are associated with severe pain and redness. The feet of those affected are often cold because they are not supplied with enough blood. In severe cases, the foot even has to be amputated if direct treatment of the symptoms is not possible.

Diagnosis & course

The risk of suffering from a poorly healing wound is particularly high if the blood circulation is impaired at the same time. Deep skin sores (ulcerations) can extend further and further into the foot and can also be colonized with MRSA germs, which can prevent normal wound care and healing.

Since diabetic foot syndrome is a disease without a uniform clinical picture, it is crucial for the attending physician to first talk to the patient. Subsequently, targeted examinations can be used to check the sensitivity to pain or the condition of the arteries.

An x-ray of the feet can also be helpful.The course of the disease depends on the type of diabetic foot syndrome. The neuropathic foot can usually be treated well, provided the ulcers are not too severe. In the case of ischemic feet, on the other hand, there is a risk that part of the foot will have to be amputated if the blood supply is poor for a long time.

Complications

Diabetic foot syndrome is one of the typical complications of longstanding diabetes mellitus. Due to the permanently increased concentration of the sugar, smaller vessels are constricted over time, which disrupts the blood flow and leads to a reduced supply of various organs. Nerves in particular are affected by an insufficient supply (diabetic neuropathy).

This leads to the death of the nerves. Touch and pain stimuli can no longer be properly perceived. This leads to complications, especially on the foot, since wounds there are not properly perceived, which can always enlarge in the course and irreversibly destroy the tissue. In the worst case, the foot can die and has to be amputated (diabetic foot syndrome).

In addition, the wound can become infected. The resulting inflammation can spread systemically and lead to sepsis. This can degenerate into life-threatening shock, which can lead to multiple organ failure. The retina can also be affected by diabetes (diabetic retinopathy).

This leads to impaired vision in the affected person, which can even lead to blindness. In addition, the kidneys are typically affected by diabetes (diabetic nephropathy). This can fail over time and the quality of life is impaired. In some cases, dialysis or even a transplant is required.

When should you go to the doctor?

Diabetic foot syndrome is one of the most serious complications that diabetes mellitus can have. If the sugar concentration in the blood is too high, smaller vessels constrict, which leads to an insufficient supply of the nerves and tissue in the foot. Those affected should consult a doctor at the first sign of a diabetic foot. If the disorder is not adequately treated in a timely manner, the risk that the foot will ultimately have to be amputated increases significantly.

In the early stages, the diabetic foot becomes noticeable through the following symptoms: circulatory disorders that are accompanied by tingling and numbness, constantly cold feet, increased callus formation, small ulcers or other inflammations that spread on the foot or toes.

These symptoms, most of which are completely harmless to healthy people, must necessarily be presented to a doctor in diabetics. Because of the poor blood circulation in the feet, even small injuries or corns do not heal on their own. Instead, there is often a strong colonization of the wounds with bacteria and a permanent progression of the inflammation.

Even small injuries to the foot of diabetics must therefore be disinfected and professionally treated. A patient should do this under the guidance and supervision of a doctor, especially since antibiotics often have to be prescribed in addition. The doctor will also explain to the patient any other necessary preventive measures.

Doctors & therapists in your area

Treatment & Therapy

Once the attending physician has determined what type of diabetic foot syndrome it is in the individual case, he can initiate appropriate therapy. The neuropathic foot is primarily treated in such a way that the wounds that have occurred are disinfected and bandaged.

Do not put pressure on the ulcers. Antibiotics are usually prescribed to help. Once the wounds have healed, the skin on the feet needs constant care and cream. A cream that contains urea is particularly suitable for this. This prevents the skin from drying out, so that no new ulcers form.

In addition, wide and breathable shoes should always be worn. Special orthopedic shoes may be necessary. An ischemic foot is treated with drugs that increase blood flow. A bypass can also be used under certain circumstances. If the damage to the tissue is already well advanced, it may be necessary to amputate the affected parts. Often the toes are affected; In the worst case, the entire lower leg can be removed.

Basically, however, you should make sure in advance that the blood sugar level is not permanently elevated. At the latest when a diabetic foot syndrome occurs, it is imperative to regulate the blood sugar level so that the disease does not worsen.

Outlook & forecast

The prospect of healing for diabetic foot syndrome depends on the severity of the symptoms. The more pronounced the symptoms, the more unfavorable the further course. If the patient also suffers from a disturbance of the blood flow, the prognosis worsens even more.

In severe cases, amputation occurs. A distinction is made between removal of the toes, parts of the foot or lower and upper leg amputations. By wearing suitable footwear or proper foot care, the patient can himself contribute to the improvement of existing complaints. With foot massages for diabetes patients, blood circulation is specifically stimulated and promoted.

Foot injuries are more common with tight-fitting shoes or foreign bodies in the shoes. These have a bad influence on the forecasting. The healing of pressure points is more difficult in diabetics, as there are increased circulatory disorders.

The prognosis is particularly unfavorable in patients who suffer from neuropathic and vascular symptoms. In most of these cases, the leg has to be amputated. In about half of all cases, after four years the amputation of the first leg is also followed by an amputation of the second leg. This has a strong influence on the quality of life and promotes the outbreak of mental illness.

prevention

The diabetic foot syndrome can be prevented in particular by giving up cigarettes and maintaining a stable blood sugar level. In addition, the skin of the feet should always be well creamed and cared for, even if there are no symptoms. You should also pay attention to wide and comfortable shoes and stockings. Flexibility exercises with the feet can be carried out regularly to help prevent the development of a diabetic foot syndrome in good time.

Aftercare

Follow-up care for diabetic foot syndrome differs depending on the severity and treatment method. In any case, it is important to see a podiatrist and a diabetologist regularly to prevent further complications. If the wound is superficial, it is usually sufficient to relieve the foot until it has completely healed. Pressure-reducing shoes can contribute to this. In addition, prescribed creams and ointments should be used as directed by the doctor.

If the wound becomes infected, prescribed antibiotics must always be taken as directed by the doctor. This also applies if symptoms of an infection are no longer recognizable. Consult a doctor before stopping antibiotics. If parts of the foot have been amputated, special follow-up care is necessary. In the first few days after the operation, the relevant area must not be stressed.

After that, a rehabilitation phase is necessary. Their length depends on how much of the foot is left after the amputation. A physiotherapist also trains the perception and mobility of the residual limb. This is used for better handling of a later prosthesis. The surgical wound itself must be cared for as directed by the doctor. If necessary, antibiotics must also be taken.

You can do that yourself

An adaptation of the behavior in everyday life and self-help measures should already start before the diabetic foot syndrome, because the disease is in most cases caused by a poorly controlled blood sugar concentration in diabetes mellitus. A permanently excessively high and strongly fluctuating blood sugar concentration leads to damage to the vessel walls of the arteries and veins as well as damage to the nerves, so that neuropathies can also develop in the feet.

If diabetes has already been diagnosed, strict monitoring and control of the blood sugar concentration as a self-help measure is very effective in preventing diabetic foot syndrome as far as possible. The preventive measures are independent of whether the diagnosed diabetes is acquired type 2 or the genetically determined and much rarer type 1.

Another precautionary measure concerns smokers and lovers of alcoholic beverages. Smoking and excessive consumption of alcoholic beverages increase the negative effects of fluctuating and generally too high blood sugar concentrations. It is therefore advisable to keep smoking and alcohol consumption to a minimum or to refrain from nicotine consumption altogether.

Well-coordinated skin care also has a preventive effect, making it difficult for pathogenic germs to penetrate the skin and cause infections or fungal attack. For self-observation and early detection of diabetic foot syndrome, it is helpful to check your feet for swelling every day, as this is an early indicator and symptom of the onset of the disease.