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Overview of Diabetic Foot: Symptoms, causes, prevention and treatment

Dr. Ajay KohliNov 17, 2022

Worldwide, Diabetic Foot conditions are the most common cause of hospitalisation among people with diabetes. The condition is characterised by three cardinal signs: nerve damage, poor blood circulation, and a non-healing wound. Treatment for the Diabetic Foot usually depends on the causative factors. However, preventive measures, such as good foot care and controlling blood sugar spikes, can help avert Diabetic Foot complications and, ultimately, amputation.

Diabetic Foot

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What is Diabetic Foot?

Diabetic Foot is a medical problem in diabetic patients where they experience foot ulcers. The problems of feet often develop when there is damage to the nerves or poor blood circulation. Early-stage diabetic blisters, sores, and other minor foot injuries, when unnoticed and left untreated, become infected eventually and may turn into serious wounds, causing amputation.

Signs and symptoms of Diabetic Foot

If you have diabetes that is not well controlled, you are likely to have foot problems with any of these indications.

  • Change in skin colour and temperature

  • Loss of feeling in the feet

  • Tingling sensation

  • Muscle weakness

  • Hair loss at toes, feet, and lower legs.

  • Development of calluses or corns with dried blood inside

  • Redness and swelling of the ankle

  • Cracks between the toes

  • Wound with or without discharge

  • Ingrown toenails

Sometimes, patients with diabetes are also prone to serious life-threatening complications due to restricted blood flow to the legs and feet. Some complications you want to watch for are as follows.

  • Slow-healing open sores (foot ulcers)

  • Skin and bone infections

  • Fungal infections of the toenail

  • Foul-smelling pus discharge

  • Gangrene (dead, black tissue)

  • Charcot's foot (a disease where high sugar alters or breaks the bones, joints, and soft tissues in your feet)

  • Foot deformities (for example, hammer toes, claw toes, and pes cavus)

  • Leg amputation

Talk to your doctor immediately if you see any of the Diabetic Foot symptoms listed above. Because fast and efficient treatment is essential to prevent foot-related problems you may encounter in future.

Causes of Diabetic Foot

Multiple causes can result in Diabetic Foot problems. But there are two main contributors to the issue.

  • Diabetic neuropathy or nerve damage: About 50% of all patients with diabetes usually have some nerve damage due to consistent higher blood sugar levels, which seems most common in hands, legs, and feet. When you've diabetic neuropathy, it is impossible for you to feel pain due to loss of feeling. As a result, you may not realise a minor cut, blisters, sores, or other problems that may intensify into dangerous wounds, delaying the healing process. 

  • Poor circulation: In addition to nerve damage, people with diabetes can have poor circulation to the feet and legs, making it harder for their wound site to fight off infection and heal. 

Another reason for poor blood circulation to the feet is peripheral vascular disease. In this condition, small blood vessels, like arteries, accumulate plaque over time, making it harder for blood to flow through, leading to poor wound healing and increased amputation risk.

Treatment for Diabetic Foot

Treatment for Diabetic Foot varies from person to person, depending on the cause and severity of the infection. Before treating, your doctor will remove any dead or decaying tissue from the foot and apply topical treatments such as biguanide gel, sulfadiazine cream, or iodine. Also, a wheelchair or crutches may be prescribed to take the weight off the affected foot (offloading).

Most Diabetic Foot conditions usually require antibiotics. However, you may have to complete the entire course to see any significant wound improvement. Less severe infections are often treated with pills as an outpatient, but gangrene or life-threatening complications require hospitalisation and intravenous antibiotics. You may also be prescribed antiplatelet and anti clotting medications if the infection progresses. 

In some cases, customised diabetic shoes, compression wraps, and shoe inserts may be recommended to prevent the thickening of the roughened skin or calluses. Surgery is implicated in improving blood flow to the foot and avoiding amputation if there is a considerable amount of dead tissue surrounding the wound or you have some foot deformity. In more severe cases, however, the entire foot is amputated to remove gangrenous skin and prevent the spreading of infection.

Diagnosis of Diabetic Foot

For early diagnosis of Diabetic Foot, your doctor will ask about your medical history and conduct a thorough physical examination. They will examine your toes, feet, and legs for numbness.

If you have blisters or open sores, they will also look for signs of an infection, like redness, swelling, discharge, and fever. The shape and structure of your feet are assessed for changes as well. Specific laboratory tests, such as a complete blood cell count and blood sugar test, will hint at the presence and severity of infection.

If needed, your doctor may also order additional ultrasounds and X-rays to see how well your blood flows through arteries and to diagnose bone damage and the presence of foreign bodies in the soft tissues. Gas, if present, usually indicates gangrene.

Make an appointment right away if you think you have a foot infection or any injury. Early consultation with a doctor can reduce your risk of irreversible health problems.

How can I prevent Diabetic Foot?

While managing your blood sugar levels is the key to preventing Diabetic Foot issues, jutting to other measures also inevitably reduces your risk of foot infections. Suggestions include the following.

  • Check your feet for sores, cuts, blisters, corns, or redness.

  • Keep an eye out for the early signs and symptoms of Diabetic Foot problems.

  • Clean your feet and legs regularly with warm water and moisturise them to keep your skin from getting dry or cracking. These will also prevent calluses from forming. 

  • Wear well-fitting protective footwear consistently to reduce pressure on the foot and avoid foot ulcers.

  • Wear moisture-wicking socks all the time to keep your feet protected. 

  • Trim the toenails straight across to prevent ingrown toenails.

  • Do not remove callus or corn with chemical agents, plasters, or other techniques. Seek medical care.

  • Perform foot and ankle-related mobility exercises to increase the range of motions. 

  • Protect your feet from hot and cold. 

  • Never walk barefoot, both indoor and outdoor.

  • Stop smoking.

  • Avoid alcohol.

  • Get your feet checked by a podiatrist or a doctor every six months to test sensation or circulation.

Risk factors for Diabetic Foot

About a quarter of people with diabetes often experience some form of foot problem during their lifetime. However, certain activities that can potentially raise one's risk of developing Diabetic Foot conditions include the following.

  • Progressive nerve damage due to poorly controlled diabetes

  • Poor blood circulation to feet that can make your feet less resistant to infection or healing

  • Not washing the feet often or thoroughly enough

  • Prolonged exposure to cold and wet weather that leads to foot numbness and skin dryness

  • Wearing inappropriate footwear and socks that rub the wrong way, causing blisters or scrapes, which can quickly turn into infected foot ulcers

  • Foot deformities caused by repeated injuries

  • Overweight and obesity

  • Age above 40 years

  • Gender (males are at greater risk of Diabetic Foot complications)

  • High blood pressure and cholesterol

  • Excessive use of alcohol and tobacco

  • History of previous ulceration or amputation of the foot

  • Inadequately trimmed or untrimmed toenails that cause laceration

Frequently Asked Questions (FAQ)

Here’s a list of common questions and answers about Diabetic Foot.

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Why do people with diabetes have swollen ankles and legs?

Generally, people living with diabetes have problems with the circulation that cause fluid build-up in the lower limbs. This fluid build-up causes swelling or oedema of the feet, ankles, or lower leg. Sometimes, the thickening of the arteries under the long-standing influence of high blood sugar may also impair the blood flow to the feet, creating swelling. 

Can Diabetic Foot conditions be cured?

Unfortunately, there isn't any cure available for Diabetic Foot, but some treatments can help slow the progression of the disease and manage symptoms. Treatments typically include antibiotics and surgery. In addition, pain medication may be offered to relieve nerve pain.

How long do Diabetic Foot symptoms last?

Under proper diabetes management and care, it takes about two to three months for the diabetic infection or wound to heal properly. But sadly, in 15 % of the patients who suffer Diabetic Foot ulcers, nearly half of them get hospitalised due to severe complications, and nearly a quarter of them undergo amputation.   

When should I be worried about diabetic feet?

Seek medical aid immediately, if your foot: 

  • Becomes pale 

  • Develop pins-and-needles sensation, like a foot falling asleep

  • Shows heightened pain sensitivity, even to things that are not painful

  • Has lost sensation

  • Feels warm to touch

  • Become swollen with or without pain

  • Has wounds that take longer to heal

References

  1. Diabetes and Your Feet | CDC. Retrieved 17 October 2022, from https://www.cdc.gov/diabetes/library/features/healthy-feet.html

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.

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