1.What is diabetic foot?
As early as 1956, foreign scholar Oakley first proposed the term “diabetic foot”, and in 1972 Catterall defined the diabetic foot as “a foot that loses sensation due to neuropathy and vitality due to ischemia, combined with infection”.
In 1999, the World Health Organization defined the diabetic foot as an infection, ulcer formation, and/or destruction of deep tissue in the lower extremities of patients with diabetes due to a combination of neuropathy and various degrees of peripheral vascular disease.
In layman’s terms, patients with diabetes can be considered to have a diabetic foot when they experience foot discomfort, or even ulceration and necrosis, for various reasons.
2.Does diabetic foot occur in all diabetic patients?
Diabetic foot is one of the most common chronic complications in diabetic patients, and there is no exact clinical epidemiological survey data on diabetic foot in China.
In Europe and the United States, there are more precise data on the large-scale investigation of diabetic foot.
More than 15% of diabetic patients will develop ulcers or gangrene of the foot in different stages of diabetes. The lifetime incidence of diabetic foot is as high as 15-20%. Now due to the increasing standard of living, the incidence of diabetes in China is also rising, diabetic foot patients will not be less than this proportion.
3.How long does it take for a diabetic foot to develop?
Generally speaking, the diabetic foot will occur after about 5 years of diabetes, why do you say that diabetes does not say the diagnosis of diabetes, because the incidence of diabetes in China is increasing, but the degree of patient awareness is still insufficient, and the knowledge of the diabetic foot is relatively small. Many clinical patients who have already met the diagnosis of diabetes for many years have symptoms before they are seen, and only then do they know they have diabetes, and have actually been suffering from diabetes for many years when they are seen and diagnosed.
4.Does all diabetic foot eventually have to be amputated?
In the United States, 6.5% of diabetic foot patients require amputation each year, which is more than 10 times the number of non-diabetic patients. About 50% of the annual amputations are in diabetic patients, and more than 85% of the latter are due to deep infection or gangrene caused by worsening ischemic ulcers in the lower extremities. The probability of having a diabetic foot-related lower extremity amputation is 40-50% within two years of the contralateral amputation.
In China, some current data show that the prevalence of diabetic foot is 2.3% in outpatient clinics and 8.6% in wards, with amputation rates as high as 17.3%, with more people over 50 years of age than younger people. In the United States, 86,000 patients are disabled by amputations due to diabetes each year; in our country, the number will be even higher. Some studies have shown that 62% of refractory foot ulcers are associated with vascular disease, and 46% of amputations are associated with vascular disease. But not all diabetic foot patients will be amputated, active early and effective treatment is the best way to prevent amputation!
5.What kind of manifestations does diabetic foot have?
The clinical manifestations of the diabetic foot are diverse, but the causes are caused by neuropathy and vasculopathy, of which the highest incidence is due to both neuropathy and vasculopathy.
Diabetic foot patients with vascular lesions, is due to the impact of diabetes, diabetic patients gradually narrowing or even occlusion of the vascular lumen, lower limb foot ischemia, lack of oxygen, do not get enough nutrients, a series of clinical manifestations, early patients can be manifested as lower limb foot cold, numbness, tingling, calf pain, pain, walking for a period of time after the emergence of the calf foot cold, numbness, tingling, soreness, significantly We call it intermittent claudication when it gets better after resting for a period of time and the above symptoms appear again after walking. In the middle and late stages, patients with severe vascular lesions and severe ischemia in the lower extremities will have pain even when they are not moving, which is called resting pain, and severe patients can also have symptoms such as non-healing rupture and gangrene.
Due to neuropathy, diabetic patients will have tingling, burning pain, numbness, dullness or loss of sensation in the foot, and the feeling of stepping on cotton under the foot. Patients who also have combined neurovascular lesions usually have all of the above manifestations, coldness, numbness, tingling, aching calf, pain, dullness or loss of sensation, and intermittent claudication in the lower extremity of the foot. Patients in the middle and late stages have symptoms such as resting pain, non-healing rupture and gangrene.
It is worth noting that because some diabetic foot patients also have nerve lesions, their nerve sensation is poor, so when the clinical manifestations of vascular lesions appear, the symptoms are often mildly disregarded, and the best time to seek treatment is missed.
6, what is the difference between diabetic foot caused by vascular lesions and diabetic foot caused by neuropathy?
Diabetic foot with vascular lesions is usually characterized by cold feet, numbness and intermittent claudication, and the main manifestation is the weakening or disappearance of arterial pulsations in the foot. In neuropathy-dominant diabetic foot, the foot is usually warm, pain is not obvious, and the arterial pulsation of the foot is good.
7.How to check whether I have diabetic foot?
Patients who have had diabetes for more than 5 years must pay attention to the possible occurrence of diabetic foot, the patient had better go to the hospital, and after that it is better to go to the hospital every six months, and at the same time do the examination of the blood vessels of the lower limbs.
8, diabetic foot ulcers how to do?
Many diabetic foot are caused by trauma to the foot, if the wound appears to be infected or long dyed without healing symptoms, should promptly consult a doctor for professional treatment. In normal life, if blisters, cuts, redness, hardening, rupture, local fever, local coldness and other symptoms appear on the lower limbs, patients should immediately inform medical personnel and go to the hospital as soon as possible, never disinfect themselves at home or whatever. Diabetic patients with a small foot ulceration may cause the risk of amputation and disability.
9, what is the lower extremity vascular examination?
Lower extremity vascular examination includes a lot of, after the professional vascular doctor to do lower extremity vascular examination, screening after doing lower extremity vascular pressure measurement, B ultrasound, enhanced CT, etc..
10.How to detect diabetic foot early?
First of all, we should pay attention to the awareness, do not think that the numbness and coldness of the foot is not a big problem, we must pay attention to the possible occurrence of diabetic foot, if there is a cold foot, numbness, intermittent claudication and other symptoms must be early and timely hospital consultation.
11.How to treat diabetic foot?
For diabetic foot ulcers, the previous treatment was limited to controlling blood sugar, applying antibiotics, activating blood circulation and removing blood stasis, and cleaning and changing medication. Since the fundamental blood flow problem is not solved, the foot tissue is still in a negative nutritional state and the treatment is not effective. Moreover, the treatment time is long and costly. 25% of patients with claudication without any invasive treatment will inevitably develop chronic severe limb ischemia (CLI) within 4-7 years, and the annual incidence of amputation for CLI patients without hemodynamic reconstruction is about 10%.
The underlying cause of diabetic foot is tissue ischemia caused by arterial lesions in the lower extremities, and the main pathological change of arteries is atherosclerosis formation; the cause of neuropathy and infection is also ischemia; therefore, the treatment of diabetic foot should start from blood transport reconstruction. The currently applied drugs can only temporarily relieve the symptoms, and the symptoms will recur again after stopping the use of drugs. To treat the root of the disease, active interventional treatment of the lesioned blood vessels to make them open again is the fundamental treatment.
The successful reconstruction of blood flow in ischemic limbs can improve the nutrition of ischemic tissues, accelerate the metabolism of tissues, including the recovery of nerve function, improve the ability of local tissue repair and resistance to infection in diabetic foot (DF), make the infection easy to control, make the foot ulcer heal, and improve the rate of limb preservation; studies have shown that the coexistence of infection and ischemia increases the amputation rate by nearly 90 times. Treatment for diabetic foot vasculopathy includes vascular bypass, stem cell transplantation, and interventional therapy.
The scope of vascular bypass is narrower, more traumatic and risky. However, the vascular lesions of diabetic foot (DF) mostly involve the small arteries of lower limbs, resulting in arterial stenosis or even occlusion without outflow tracts, and most of them cannot be bypass grafting; or because the lesioned vessels are thin, the grafted vessels are prone to thrombosis after surgery, resulting in surgical failure; in addition, because of surgical indications, comorbidities, complications, bypass failure and preservation of saphenous vein for coronary artery bypass grafting, surgical bypass grafting can only be applied to A small number of patients. Thus, the limitations of the procedure may exclude the patients who would benefit the most. As a result, very few patients are suitable for bypass surgery and success rates are extremely low. Interventional diabetic foot therapy is currently the most advanced, safest and most definitive treatment internationally.
12.What is diabetic foot interventional therapy?
As early as 1912, Carrell had the idea of “intravascular cannulation”, and in 1953, Seldinger, a Swedish physician, created the technique of percutaneous puncture cannulation, which made endoluminal surgery more convenient and safe because it was not necessary to incise the blood vessel. Vascular surgeon Thomas Fogarty first invented the intravascular balloon catheter in 1963, and on January 16, 1964, Charles Dotter, chief of radiology at Oregon University Hospital, used a coaxial catheter system to successfully reopen an atherosclerotic lower extremity artery occlusion in an octogenarian woman, performing the world’s first PTA. 1974 Grunzing’s invention of the double-lumen capsule catheter for endoluminal angioplasty made this treatment more popular.
In 1969, Dotter introduced the concept of endovascular stenting and published the first series of animal experiments on “metal endarterectomy tubes” in pigs. In 1983, Dotter and Cragg reported the results of experiments on thermal memory alloy endoprostheses made of nickel-titanium alloy wire, marking a new era in the systematic study of endoprostheses. 1985, Palmaz used a seamless stainless steel tube engraved by laser skeletonization. Engraving combined with balloon expansion was introduced into the body.
Since then, balloon expansion catheters (balloon) and various stents (Stent) have been developed, making the technology more mature. Endovascular treatment is a new minimally invasive treatment that has been widely carried out at home and abroad and is a major breakthrough in the treatment of peripheral vascular diseases. Endovascular treatment has accounted for 50-80% of peripheral vascular diseases in some countries and is rapidly replacing traditional surgical treatment. Endoluminal treatments for diabetic peripheral vascular disease mainly include percutaneous transluminal angioplasty, stenting and plaque removal.
Interventional treatment for diabetic foot includes percutaneous transluminal angioplasty (balloon dilation), stent placement, and vascular endoluminal grafting (repair/isolation); the continuous progress of this technology is an enrichment and improvement of the traditional treatment model, which is increasingly benefiting patients with vascular diseases. With the development of science and technology, interventional therapy has become a new and effective treatment for severe lower limb ischemia.
Specifically, interventional treatment of diabetic foot involves the application of a small balloon to dilate the occluded or narrowed vessel after passing a tiny guidewire through the occluded vessel with minimal trauma, so that the vessel is reopened and the blood flow to the ischemic tissue is restored, achieving the fundamental goal of treatment. This technology has been carried out abroad for a long time, and after this technology is carried out in our department, we have successfully relieved the pain of many diabetic foot patients and prevented them from amputation.
13.What are the advantages of interventional diabetic foot treatment?
Small trauma, small risk, high safety patients almost no pain; obvious curative effect, immediate results, often just after the completion of interventional treatment, the patient has not stepped off the stage, reported DD foot warm, no pain! Quick recovery, 24 hours after surgery can be out of bed; even if the condition is unfortunately aggravated, it can still be treated twice; reduce the rate of amputation and the level of amputation, for the later treatment to gain valuable time.
Interventional endovascular therapy can significantly improve blood flow in patients with lower extremity ischemia. Now there is a concept of “direct blood flow”. The so-called “direct blood flow” refers to the blood flow to the anterior tibial artery and posterior tibial artery that can reach the foot directly, while the peroneal artery can only reach the ankle and must rely on the side branches to communicate with the vascular network of the dorsum and plantar arch of the foot.
14.What are the indications for interventional treatment?
The diabetic foot with vascular lesions is the main indication for treatment, and patients with early, middle and late clinical stages can be treated with interventional therapy. We recommend early treatment, i.e. active treatment before the appearance of intermittent claudication or the presence of symptoms, to avoid severe disease leading to other organ lesions or vascular occlusion and serious loss of treatment opportunities. Diabetes is a systemic impact disease, and patients with diabetic foot are often combined with different degrees of cardiac and cerebrovascular pathologies, such as: heart attack, angina pectoris, cerebral infarction, etc. These are suitable for interventional treatment because of their high safety and low risk.
15.What kind of patients are not suitable for interventional treatment?
Patients with diabetic foot with neuropathy alone are not suitable, but most diabetic foot is combined with vascular disease, so it is recommended to go to the hospital for specific examination. Interventional therapy is safe and widely applicable, and basically all patients with mixed vascular or neurovascular lesions are suitable for interventional therapy. For some early patients who are considered contraindicated for intervention, such as those who have undergone lower extremity surgery, they can also be treated, and for patients with renal failure, we combine preoperative and postoperative dialysis.
16.Why should we treat it early?
Diabetes is a disease that affects all organs of the body, diabetic foot patients are often combined with varying degrees of cardiac and cerebrovascular pathology, such as: heart attack, angina pectoris, cerebral infarction, etc., coupled with the ulceration of the diabetic foot, infection, pain, sleep and eating disorders, etc., the nerves are in a state of high tension, which in the long run will aggravate the pathology of other organs, which is fatal in serious cases. Most of the treatment abroad are no symptoms or only mild claudication patients early patients, China is often serious to a certain extent when the disease is carried out, increasing the cost of treatment, increasing the pain, some patients even did not have time to treat the amputation or sudden death.
17.How much does it cost to treat diabetic foot? How much does interventional treatment cost?
Diabetic foot treatment is very expensive, the average cost of treatment of a single ulcer in the United States is $4,600, and 1/3 of the annual medical costs of diabetes in the United States is spent on the treatment of sugar disease foot disease. The average cost of amputation is even higher, at $25,000 in the United States and $43,000 in Sweden. The average hospitalization day of diabetic foot in 14 tertiary hospitals in China was 26 days, and the average hospitalization cost was 15,000 yuan, which is about 4 times of the average hospitalization cost of diabetes, and the average cost of treating a single foot ulcer for 2 years for outpatients was 28.000 USD.
18.What should diabetic patients pay attention to in order to avoid the occurrence of diabetic foot?
It is necessary to strictly control blood glucose, blood pressure and blood lipids, because these can cause further aggravation of diabetic foot or diabetic foot. 5 years or more diabetic patients are recommended to visit the hospital for regular checkups, and the blood vessels of the lower limbs should be examined once every six months. Normally, you should pay more attention to foot protection in daily life, starting from the details and small points of life, including daily foot washing, nail clipping, choosing shoes, socks, shoes and a series of other issues, all under the guidance of a doctor to do these.
To pay special attention to the maintenance of the foot
(1) adhere to the daily foot soak with warm water, the temperature should be less than 37 degrees, and appropriate massage with both feet rubbing each other to promote blood circulation on the soles of the feet.
(2) Wash and dry your feet and carefully trim the toenails with scissors and grind the edges smooth.
(3) feet with corns, calluses or Youzi, do not handle yourself, must go to the hospital to find a doctor to deal with.
(4) Do not play barefoot to prevent being stabbed by foreign objects on the ground.
(5) Try to choose cotton socks, the edge of the socks should not be too tight to avoid strangulation marks on the socks
(6) In cold weather, do not use hot water bags or hot water bottles to warm your feet to prevent burns. Use thick socks and blankets to keep warm.
(7) Avoid wearing small shoes, hard-soled shoes and high-heeled shoes to prevent foot movement from being restricted, and for sports, wear sports shoes
(8) Keep the shoes hygienic, wash the soles and socks regularly.
(9) Keep the shoes dry and actively prevent foot odor.
(10) For dry skin, lubricants or skin care ointments should be used, but not between the toes.
(11) Chemicals or creams should never be used to remove keratinized tissue or calluses.
19.Does this interventional procedure to address lower extremity ischemia only apply to diabetic foot
The incidence of PAOD is also increasing year by year in China, which has become a serious threat to people’s life and health. Interventional endoluminal therapy can treat various blood flow disorders caused by vascular sclerosis and occlusion.
Also for acute arterial thrombosis, endovascular intervention can be applied for thrombolytic treatment. For deep vein thrombosis, early interventional treatment and placement of vena cava filters can prevent pulmonary embolism, and interventional placement of thrombolysis can open the embolized vessels early and prevent the occurrence of deep vein thrombosis syndrome later.