Diabetic foot: What it is, Symptoms and Treatment
Diabetic foot is one of the main complications of diabetes that occurs when the person has diabetic neuropathy, so the person does not feel when a wound, ulcers and other injuries occur on the feet. Due to diabetes, these wounds take longer to heal than normal, so they can cause recurring infections, increasing the risk of foot amputation.
This type of complication is more common when blood sugar levels are not controlled, therefore, one of the best ways to avoid the development of diabetic foot is to follow your doctor’s instructions for the treatment of diabetes.
In addition, to avoid the development of diabetic foot, it is recommended to have a regular foot check-up, which can be done at home, but should also be done by the doctor in the office. If the person already suffers from diabetic foot, it is important to undergo treatment at the health center or hospital, as well as to wear comfortable footwear and maintain adequate foot hygiene.
Main symptoms of diabetic foot
The symptoms that a person with diabetic foot commonly manifests are:
- Pain or loss of sensation in the foot;
- Swelling;
- Bad smell in the lower extremity;
- Redness of the foot;
- Pus discharge from wounds;
- Changes in skin temperature.
It is important that the person remains attentive to these changes, since the manifestation of any of these symptoms is a reason to consult the doctor and for him to carry out a detailed evaluation of the foot in search of other alterations in order to begin the appropriate treatment and avoid progress of this alteration.
Read Related: Diabetic Neuropathy: What it is, Symptoms and Treatment
How the diagnosis is made
The diagnosis of diabetic foot is made by the general practitioner or internist, endocrinologist or vascular surgeon and is based on the manifestation of signs and symptoms presented in the lower extremity. However, the doctor can use clinical instruments and/or request other studies to confirm the diagnosis, such as the Rydel-Seiffer Tuning Fork, which is used for the production and detection of a vibration that the patient must perceive; as well as an Echo-Doppler exam, in which ultrasound is applied to evaluate blood flow in the large arteries and veins in the arms and legs.
Risk factors for developing diabetic foot
The people who are most likely to develop diabetic foot are those who have poor control of the disease and do not regularly visit the doctor for an evaluation.
Among the main risk factors that a person has for the presentation of diabetic foot are: having a diagnosis of diabetes for at least 10 years, a history of ulcers or amputation of a lower limb, alterations in the toenails, presence of diabetic neuropathy, in addition to the fact that it occurs more frequently in men.
Also Read: Diabetes: Types, Symptoms and Treatment
Rating scales for diabetic foot
Currently there are two scales used to determine the stage of diabetic foot involvement, the Wagner scale and the University of Texas scale. The Wagner classification has begun to be replaced by the Texas classification, the latter being the one that currently has the greatest acceptance among the medical community.
Wagner classification
- Grade 0 : Foot at high risk, without wound or ulcer;
- Grade I : Superficial ulcer;
- Grade II : Deep ulcer, tendon involvement;
- Grade III : Ulcer with bone involvement;
- Grade IV : Localized gangrene;
- Grade V : Gangrene of the foot.
Texas Ranking
This scale classifies injuries based on depth and the presence of infection or ischemia in the foot, which is:
| Grade 0 | Grade 1 | Grade 2 | Grade 3 | |
| Stage A | Completely epithelialized pre- or post-ulcer lesions | Superficial wound that does not involve tendon, capsule or bone. | Penetrating injury to tendon or capsule | Penetrating wound to bone or joint |
| Stadium B | Infection | Infection | Infection | Infection |
| Stage C | Ischemia | Ischemia | Ischemia | Ischemia |
| Stadium D | Infection and ischemia | Infection and ischemia | Infection and ischemia | Infection and ischemia |
It is important for the doctor to classify diabetic foot injuries, since through this the medical treatment and care that the person should have can be evaluated and even a possible foot amputation can be considered.
How Diabetic foot treatment is performed
The treatment will depend on the signs and symptoms presented by the person, in addition to the stage that the doctor has identified to start the therapeutic plan. For those people with the presence of a deep ulcer, the doctor may indicate intensive treatment that can be performed in the hospital, requiring the person to remain hospitalized.
In addition, among the different types of treatment are the protection of ulcers through temporary footwear; revascularization in people with signs or symptoms of ischemia; healing and debridement of necrotic tissue, use of antibiotics; good control of blood glucose values and frequent debridement with a scalpel, if necessary. In the most severe cases, the doctor may indicate amputation of the infected foot or leg.
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Diabetic foot care
The main care that a person should take with a foot affected by diabetes are:
- Cut your nails in a straight line, trying not to leave protruding edges or peaks;
- Check your feet daily, looking for blisters, nail fungus, changes in color or temperature, signs of dry skin and calluses.
- Correct washing and drying, every day with neutral soap and with special care in the areas between the fingers;
- Use of socks that have no seams or springs and are made of cotton;
Likewise, the application of creams and talc should be considered in case of sweating; the cream should not contain perfume or menthol, as it can irritate the skin. It is important to take this care and do it every day to avoid infections and complications.
Appropriate Footwear for Diabetic Foot
The type of shoes that should be used if you have diabetic foot must have specific characteristics to avoid complications and promote the health of the person’s extremities.
The footwear must be made of natural material, preferably bovine leather, without seams that could come into contact with the foot, the sole must be made of flexible and wide rubber, in addition to being non-slip. After purchasing them, the person should try to wear the new shoes for 30 minutes a day until they get used to them.
Main complications of diabetic foot
The most frequent complications of diabetic foot are infection of the lower limb, pain or numbness in the area, and ischemia. The main and most serious complication of diabetic foot is the amputation of the lower extremity, that is, the surgical cutting of either just the foot or the leg. This is due to the presence of ischemia or the development of an infection that causes treatments to be unsuccessful.
In addition, because diabetic neuropathy is an advanced stage of diabetes mellitus, the person may present vision problems such as blindness and even alterations in the kidneys that lead to treatment with dialysis or hemodialysis after surgery. The most common diabetic foot infection is osteomyelitis, which can lead to skin amputation if the disease is poorly controlled.
