Diabetic foot refers to the infection, ulcer formation and/or deep tissue destruction in the lower extremity of diabetic patients due to the combination of neuropathy and various degrees of peripheral vasculopathy.
During the treatment of the diabetic foot, many hospitals and clinicians often resort to amputation in order to control the patient’s infection. The patient himself is in a passive position in the treatment process, on the one hand, unable to understand the truth and on the other hand, unable to assess the sequelae brought about by the amputation.
In the past, China did not pay much attention to the problem of diabetic foot, mainly because we do not have professionals specializing in diabetic foot in our country. While there are specialized treatment centers abroad for foot problems, there are basically no specialized medical institutions in Asian countries. Most diabetic foot patients in China are scattered in various disciplines, such as dermatology, burns, and vascular surgery and orthopedics, and some even go to the bathhouses on the roadside for pedicures.
Since diabetic foot patients are not seen centrally, so, on the surface, there are not too many diabetic foot patients, but in fact there are not many foot patients. The problems caused by diabetic foot are more serious, because without standardized treatment, some patients develop foot ulcers and infections, and some patients even do not receive good treatment, which eventually leads to amputation.
How does diabetic foot happen?
Due to the long-term hyperglycemic state of diabetic patients, blood viscosity increases, and excessive blood sugar will lead to hardening, brittleness and thickening of blood vessels, and the ability of blood vessel deformation decreases, and blood supply is insufficient; on the other hand, the increase of blood viscosity also leads to inflammation of blood vessels, which, for many reasons, will lead to the formation of blood clots in blood vessels and cause occlusion of blood vessels, resulting in a serious lack of blood supply, malnutrition of organs and poor metabolism. If the body tissues and organs are in this state for a long time, it will easily lead to organ necrosis, and because the “foot” is the farthest from the heart, the occlusion of blood vessels is the most serious phenomenon, which can easily lead to edema, blackening, decay, necrosis, and the formation of foot necrosis.
On the other hand, vascular injury and occlusion can also lead to injury tissue nerve damage, causing the limb vascular phytonuropathy to weaken vasomotor, local tissue resistance is reduced, small trauma can cause infection, and because of local sensory impairment, small lesions can not be treated in time, resulting in rapid expansion of the wound. Also due to limb sensory impairment, it can easily lead to burns. Neuropathy can cause atrophy of the small muscles of the foot, and due to long-term unopposed pulling, claw-like toes are formed (especially the third, fourth and fifth toes).
This deformity makes the metatarsal head a weight-bearing support point for the sole of the foot, and due to friction, there is callus formation, which is highly susceptible to infection and penetrating ulcers, and in severe cases spreads to nearby bones causing osteitis. Due to the loss of deep sensation and impaired joint movement reflexes, the patient unconsciously overloads some joints and loses the protective effect against repeated trauma, making the joints and joint surfaces very irregular and prone to fractures, joint dislocation and subluxation, especially in the metatarsophalangeal joint.
Treatment of diabetic foot
General treatment.
1.Support symptomatic treatment, including restricting activities, reducing weight, elevating the affected limbs to facilitate blood return to the lower limbs and reduce edema.
2, strict control of blood glucose, active correction of ketoacidosis, hypoproteinemia, heart, brain, kidney complications and various adverse factors affecting the healing of gangrene.
3, local debridement to remove necrotic tissue, placement of drainage, routine disinfection and drug changes.
4, strengthen patient education, reasonable foot care and prevention of injury from outside.
Anti-infection: take the secretion from the lesion for bacterial culture as early as possible, treat with common antibiotics first, and change to effective antibiotics after the culture result, in addition to adding anti-anaerobic bacteria drugs.
Treatment of ischemic foot ulcer.
1.For those whose vascular lesions are not very serious or without surgical indications, they can be treated conservatively by internal medicine.
2.For those with serious vascular lesions, on the basis of conservative treatment, vascular revascularization should be performed. The methods include vascular bypass, endarterectomy, tipped large omentum graft, and percutaneous transluminal angioplasty.
3, for patients with gangrene at rest with pain and extensive vascular lesions can not be revascularized, should be decisive amputation, before amputation is best to perform angiography to determine the plane of amputation.
4, hyperbaric oxygen therapy (HBD), hyperbaric oxygen can improve the vascularization of new tissue, increase the synthesis of collagen, improve the bactericidal effect of neutrophils, and also promote the synthesis of platelet-derived factor, which has the effect of promoting wound healing.
5, traditional Chinese medicine treatment, with obvious antibacterial effect, enhance the muscle resistance to germs, and play its effect of eliminating evil and supporting righteousness, anti-inflammatory and detoxification, to poison out, reduce swelling and analgesia, decay and muscle, accelerate local blood circulation, etc., promote the growth of fibroblasts, and promote rapid healing of the wound.
Treatment of neuropathic foot ulcers.
1, change the abnormal stress of the foot: 90% of neuropathic ulcers can be healed by reasonable conservative treatment. The key to treatment is to reduce the pressure caused by the primary disease, to understand the pressure distribution by means of a foot manometer, and then to use special orthopedic shoes or orthoses to change the pressure in the patient’s foot.
2.Improve nerve function: B vitamins and nerve growth factor can be used to promote nucleic acid and protein synthesis of nerve cells and promote myelin formation for axonal regeneration.
3.Covering dressing: dressing can prevent further damage to the wound, reduce the risk of infection, maintain wound healing, ideal environment. Antibiotic dilution, vitamin mixture can be chosen.
Amputation: active conservative treatment still occurs gangrene, should be promptly amputated, amputation site should be accurately estimated, local circulation should be made to choose, to ensure good circulation height.
There is now autologous stem cell transplantation – vascular regeneration therapy, which can establish abundant collateral circulation around the diseased vessel and fundamentally improve ischemia at the extremity.
What to check for when doing a complication screening
All patients who come to the hospital should be evaluated for complications of diabetes. Because many complications cannot be detected without examination, patients are asked to have an evaluation, for example, to see if there is retinopathy in the eyes, if there are diabetic heart problems, if there is diabetic nephropathy, and also to see if there is vascular disease in the lower extremities, to see if there are diabetic feet, if there are deformities in the feet, mycotic infections, foot odor, etc.
Therefore, diabetic patients do complication screening from head to toe to do a comprehensive assessment, including blood sampling, check fasting blood sugar, postprandial blood sugar, including cholesterol, triglycerides, kidney function, liver function and other tests are very comprehensive. We advocate to come to a patient, as long as the diabetic patients, should do this aspect of the examination, in order to understand the overall situation of the patient, the next step according to the patient’s situation to choose the appropriate treatment plan, this examination does not need to do more, once a year is enough, or once every two years, the usual examination, only check the finger blood can be.
What podiatry patients need to pay attention to in terms of diet
In principle, there are no deliberate requirements in terms of diet, podiatry patients need to increase a little bit of nutrition, of course, if the kidney function is not good, to properly control the intake of protein. Patients with diabetic foot (especially those with co-infection) are not advocated to restrict their diet too strictly because they need to increase their physical strength and nutritional support, but they cannot have high blood sugar, then they should be controlled by insulin.
What patients with foot ulcers need to pay attention to in daily life
If a diabetic patient has a broken foot ulcer, the first thing is not to walk, you can use a wheelchair. Old walking is not good for the healing of the plantar wound. The second is to reduce pressure. We know that calluses will appear if the hands are working, and if the calluses on the bottom of the foot are thick, there is a possibility of pressure ulcers. This patient should wear special shoes, padded with special insoles, to choose shoes and socks according to the actual situation of the patient.
Currently hospitals can do such special shoes and socks in conjunction with orthopedics, and in Europe and the United States diabetic foot patients can have custom-made shoes if they have ulcers, and such costs are reimbursable. Hong Kong can also make special shoes, pads and socks for diabetic patients, and these costs are reimbursable. It costs the government a little bit of money, but because this allows the patient’s ulcer to heal and avoids amputation, the government ends up saving money. If there is a diabetic foot patient in the family who needs an amputation, it is not a problem for him alone, but many people have to accompany him.
Self-examination and care of diabetic foot
1.Control of blood sugar
Diabetic foot is mainly due to diabetes causing peripheral vascular and neuropathy of the limb secondary to infection, and controlling blood sugar is an effective means to slow down the occurrence of peripheral vascular and neuropathy. And high blood sugar is also prone to infection, so strict control of blood sugar is a very critical step. Especially type 2 diabetic patients on the early use of insulin.
2.Lose weight
Proper weight loss can reduce the pressure on the foot. Avoid skin injuries at the extremities. So elderly diabetic patients should not feel free to walk barefoot even on the smooth floor indoors.
3.Foot care
The home care of the foot should not be neglected, choose the right shoes and socks. It is advisable to be wide, soft and comfortable, and not to wear tight shoes. In addition, because the recurrence rate of diabetic foot is very high, it is very necessary to adhere to outpatient treatment. Patients should go to the relevant hospital as soon as possible once the injury to the foot reappears, no matter how mild it is. In addition, after the elderly have diabetic foot, the inconvenience of movement often makes them depressed, as their children, more spiritual comfort is particularly important.
Diabetic patients must be cautious when washing their feet. On the one hand, the skin of the foot is unable to judge the water temperature due to abnormal sensation, so that the foot does not know how to avoid harm, on the other hand, the micro change so that the skin blood vessels can not expand normally, the reduction in blood supply also makes the skin does not have enough blood to take the heat away so that the heat in the local aggregation of burns. Severe patients do not know when they are scalded, making the scald further aggravated.
4, the use of diabetic foot orthopedic shoes have benefits
Diabetic foot patients with peripheral neurovascular disease are prone to foot deformities, commonly claw toe, high arched foot and bunion, etc. The weight-bearing of the foot produces new pressure points when walking, which is an important cause of diabetic foot. The use of orthotics and orthopedic shoes can greatly reduce the occurrence of foot gangrene.
5.Healthy lifestyle can reduce the occurrence of diabetes by 40%
Correct bad habits to prevent the deterioration of the disease. The cause of diabetes is complex, it is related to genetic factors certain viral infections, the body’s immune function, poor diet, certain drugs, excessive mental stress, smoking, other endocrine disorders, etc.. After suffering from diabetes, overeating should be strictly prohibited, strive to quit smoking, avoid excessive tension, especially should avoid staying up late and overworked to prevent the deterioration of the disease.
6, pay attention to the maintenance of the foot, the use of special foot cream for diabetes
Diabetic foot problem looks like a foot problem, in fact, diabetic foot is a manifestation of systemic complications of diabetic patients, including neuropathy and vascular disease, some patients also combined with diabetic nephropathy, fundus lesions, heart disease, we found that, on average, a diabetic foot patients to have more than three complications, therefore, the treatment of diabetic foot should be considered as a whole, to control blood sugar and blood pressure, while Also improve the patient’s nutritional status and peripheral blood supply, all aspects of the problem should be taken into account, and then the treatment of the foot, only in this way can the diabetic foot be handled well.
7, diabetic patients with dry feet need more attention
About 75-80% of diabetic patients suffer from low oil in the skin leading to dryness and cracking, and dry feet have an extremely high risk of developing into serious skin problems. Therefore, preventing dry feet is a high priority for people with diabetes. Studies have proven that dry foot skin is deficient in epidermal lipids and moisturizing factors, which combine with keratinocytes to form a natural moisturizing barrier, the stratum corneum, on the surface of the skin.
If this layer is disrupted, the skin loses too much water. Skin that lacks hydrolipidic emulsions is also considered dry skin. Therefore, skin care products for dry skin should replenish both the missing oil and moisture to keep the oil and water balance. For example, German experts have developed the Jevo Lipogen Foot Cream, which has been dermatologically tested and proven to be suitable for diabetic patients, while the skin-friendly lipids extracted from sea buckthorn and avocado oil have been proven to be effective in regulating the lipid content of the stratum corneum and relieving dry skin.