The diabetic foot (or neuropathic foot) is one of the most common complications of diabetes. It is an extremely debilitating disease, which causes anatomo-functional alterations of the foot and ankle.
It manifests itself with the onset of lesions and ulcers in the feet which, in the most serious cases, can also lead to amputation of the limb. The diabetic foot is determined by the malfunctioning of the nervous system (neuropathy) and of the cardiovascular one (arteriopathy). Both of these conditions are derived from diabetes.
In the case of diabetes, and in the presence of suspicious signs and symptoms, it is therefore very important to consult your doctor immediately. A quick diagnosis of the diabetic foot, in fact, allows to implement the necessary measures, to avoid the worsening of this pathology.
Obviously, it is even more important to act at the base, i.e. avoiding the onset of metabolic diseases such as diabetes. A healthy lifestyle, made of regular physical activity and a correct diet, allows a good control of glycaemia and other cardiovascular risk factors, thus reducing the possible onset of diabetic foot.
The definition of the World Health Organization (WHO) says that the diabetic foot is “the condition of infection, ulceration and / or destruction of deep tissues, associated with neurological anomalies and various degrees of peripheral vasculopathy of the lower limbs”.
In other words, the diabetic foot is that set of foot injuries caused on the one hand by diabetic neuropathy (malfunctioning of the nervous system), and on the other by arteriopathy (malfunctioning of the cardiovascular system) diabetic.
Both of these late complications of diabetes cause poor sensitivity to the lower limbs, which gives rise to two different pathologies …
Neuropathic foot: The diabetic foot is defined as neuropathic when the damage is neurological, or diabetes has damaged the nerve fibers, sensory and motor of the limb.
Ischemic foot: The diabetic foot is defined as ischemic when the damage is due to arterial vascular deficiency, for which the person is subject to a reduction in blood flow to the lower limbs.
The causes of the diabetic foot
As already specified, this pathology is a chronic complication of diabetes mellitus.
There are several complications that can arise due to diabetes: we are talking about cardio logical pathologies, kidney failure, problems related to the nervous system and even blindness.
Yet the diabetic foot, due to the ulcerative lesions it causes on the lower limbs, involves one of the biggest risks for the health of those suffering from diabetes. Moreover, it is also one of the most common complications: the WHO estimates that about 15% of people with diabetes will have to deal with foot injuries that require specific medical treatments.
Symptoms
The symptoms and consequences of the diabetic foot are slightly different in the case of neuropathic or ischemic foot.
In the case of neuropathic foot, a nervous loss has occurred, a gradual loss of thermal, tactile and painful sensitivity occurs. The patient is no longer able to feel harmful stimuli for the foot, such as excessive heat, or a shoe that is too narrow, so he does not even notice the possible damage that is occurring. The patient suffering from diabetic neuropathy, not being promptly aware of skin lesions, can therefore incur wounds and infections that, if neglected, can spread and evolve into tissue necrosis.
In the case of ischemic foot, damage is caused instead by poor blood circulation in the lower limbs. Plaques of cholesterol form on the arteries, which tend to narrow the lumen (the central cavity), reducing the supply of oxygen to the tissues. The consequence is a peripheral obstructive vasculopathy, which gives rise to an ischemia. Ulcerative lesions therefore occur, due to insufficient nourishment for the tissues poorly supplied by the so obstructed vessels. When the blood circulation is compromised, the foot cannot react to conditions such as cold, cuts or infections, becoming more prone to alterations of the shape and dryness of the skin that leads to injuries.
The most common symptoms include:
Tingling and unusual sensations in the feet, such as electric shocks;
Reduced sensitivity to the feet (sensory neuropathy);
Difficult scarring;
Deformation of the feet;
Cuts and injuries to the skin that tend not to heal;
Alteration of the color of the skin of the feet;
Feet always cold;
Bacterial foot infections.
Complications
The most common and widespread complication due to the diabetic foot are ulcerative lesions, which usually develop in the toes or plantar area of the feet. In turn, these ulcers can cause gangrene in the affected limb, which is the death and decomposition of the tissue, due to the interruption of blood flow to that part of the body.
This is why these ulcers can be more or less dangerous depending on the degree of arteriopathy: the less blood the limbs receive, the more difficult the scarring and the higher the risk of gangrene. A vicious circle could indeed be triggered, leading to continual bleeding or infection. If left untreated, the infection can spread to underlying tissues, including bones (osteomyelitis).
The infection of an open ulcer is the most serious complication of the diabetic foot: this is the cause of most of the amputations, with loss of the whole foot. Still according to WHO estimates, more than 50% of all major amputations are performed on diabetic patients and in 84% of cases they are due to a foot ulcer that does not heal and worsens.
Finally, we must not forget that the diabetic foot is considered a very significant indicator of cardiovascular disease, which has very negative effects also on the heart and brain. It is actually a real symptom of a more widespread cardiovascular disease, which can put you at risk for ischemic heart disease.
At the base of an effective treatment, there is a correct and early diagnosis: analyzing the foot with regularity and timeliness allows in fact to avoid the worsening of the pathology.
To reduce the risk of more serious damage, such as amputations, constant therapy is essential, to be carried out in conjunction with periodic blood glucose checks and all the other tests prescribed by the doctor of confidence.
Pharmacological therapy must be combined with a series of fundamental precautions to limit the development of serious complications.
Diet
Since the diabetic foot is a complication of diabetes, nutrition plays a fundamental role, to avoid the worsening of both diseases.
The diet for diabetics must be limited in the consumption of sugars (especially simple ones) and saturated fats. It is also very important that the daily diet is rich in fibers (which allow a slower absorption of sugars, controlling blood sugar levels) and is accompanied by regular physical activity.
Moreover, the diabetic patient must try to be regular in meals, so as to keep the blood sugar level as stable as possible, and to control the glycemic index of the foods he brings to the table. By glycemic index, we mean the capacity of a given food that contains sugars to raise the blood sugar following its intake. For example, rice and pasta have more or less the same sugar content, but rice starches are more easily absorbed, causing the glycemic index to rise.
Knowing the glycemic index of foods is essential for a diabetic, because it allows a better food choice.
Tricks and remedies
To treat but also prevent the onset of the diabetic foot, it is very important to pay close attention to the feet, without ever underestimating the problems. In fact, very serious situations can arise from apparently insignificant injuries. For this reason, in case of suspicious symptoms, it is preferable to avoid treating yourself and contact your doctor.
In addition to constant blood glucose control, there are some tricks of foot hygiene that you can take …
Carefully examine the feet every day, even between the fingers, checking for the presence of calluses, blisters, small cuts;
Clean the feet with warm water and neutral soap, so as to avoid alterations in terms of PH and temperature;
Always take care to maintain accurate foot hygiene;
Pay close attention to the choice of shoes. They must be comfortable and breathable, not narrow, but not wide, without irregular seams that can cause discomfort. At the same time, they must be protective of the foot for potentially damaging impacts;
Keep the toenails well-tended, but avoid the use of scissors and choosing cardboard files, which eliminate the risk of injury;
Wear socks and socks that are always clean, changing them several times a day;
Never walk barefoot, not even on the beach;
For a correct support of the foot, it is better to use orthotics, whose use must however take place after consultation with your trusted specialist;
Do not cut or pierce any blisters;
Do not expose your feet directly to sources of strong heat;
Avoid shoes with heels or wooden soles;
Do not smoke. Smoking affects blood circulation and can cause the disease to worsen;
Try to keep your feet well hydrated.
Physical exercise and sport
It could be thought that, since it is a pathology that affects the feet, sport is not a recommended activity in the case of a diabetic foot.
Instead, it is important to exercise moderately and regularly, both to combat diabetes and to promote blood circulation in the lower limbs.
When choosing a physical activity, it is important to follow the instructions relating to sports in the condition of diabetes, choose appropriate footwear and always pay attention to the state of the foot after training.
Prevention
The best way to prevent the diabetic foot is to monitor the original pathology, or diabetes, first of all by paying attention to one’s diet. Then, regular checks are important, allowing you to immediately notice any manifestations of complications.
In the case of diabetes, you can prevent the diabetic foot by following some guidelines, which are …
Identification of the foot at risk;
Regular control and analysis of the foot at risk;
Education in foot hygiene, both for the patient and for family members;
Attention to the choice of appropriate footwear;
Possible early treatment of pre-ulcerative lesions.
