Diabetic foot (DF) is an infection, ulcer and/or deep tissue destruction of the foot caused by the combination of neuropathy and various degrees of peripheral vascular disease in the distal lower extremity in diabetic patients. It is one of the most serious and most expensive chronic complications of diabetes to treat and can lead to severe amputation and even death in severe cases.
The relative risk of lower extremity amputation in diabetic patients is 40 times greater than in non-diabetic patients. Approximately 85% of amputations are triggered by foot ulcers. Approximately 12-25% of diabetic patients will develop diabetic foot disease during their lifetime. Prevention and treatment of foot ulcers can significantly reduce the rate of amputation and death.
The underlying pathogenic factors in diabetic foot are peripheral neuropathy, lower extremity vasculopathy and infection. Together, these factors can lead to ulceration and gangrene of the tissues.
(i) Risk factors for diabetic foot
1, medical history: previous history of foot ulceration or amputation; social status of living alone; poor economic conditions; inability to enjoy health insurance; barefoot walking, poor vision, bending difficulties, old age, combined nephropathy, etc.
2, neuropathy: numbness, tingling or pain in the lower extremities, especially pain at night, or decreased or absent sensory touch or pain sensation.
3.Lower limb vascular lesions: intermittent claudication (walking-pain-rest-relieving), cold feet, resting pain; significant weakening or loss of dorsal foot artery pulsation; dark red skin related to body position.
4, skin: dark red, purple color; markedly decreased temperature; edema; abnormal toenails; callus; ulcers; dry skin; skin erosion between the toes.
5.Bone/joint deformity: hawk’s toe, hammer toe, bony protrusion, joint mobility disorder.
6.Shoes/socks: unsuitable shoes and socks.
(II) Screening of diabetic foot
1.Observation of skin integrity, presence of color change, dry crack, sweating, deformity and infection, etc.
2, neuropathy examination: 10g nylon wire tactile examination, 128Hz tuning fork examination of vibration sensation, fine needle examination of two-point discrimination sensation, temperature threshold measurement, foot pressure measuring instrument.
3, lower limb vascular lesion examination: lower limb artery palpation, ABI or TBI measurement, transcutaneous partial pressure of oxygen (TcPO2), vascular ultrasound, angiography or CT, nuclear magnetic angiography.
(iii) Prevention of diabetic foot
1, at any time, do not walk barefoot to avoid damage to the skin of the foot.
2, when washing your feet, try the water temperature with your hands first, and the water temperature should be below 37℃ or less to avoid scalding of the feet caused by high water temperature. After washing the feet should be dried between the toes with a towel. Diabetic neuropathy manifests itself more severely in the foot, and many patients have reduced sensation in the foot, while the sensation in the hand is normal.
3, wear clean and comfortable cotton socks, socks too tight will affect the blood circulation of the foot.
4.Shoes should be wider and more breathable. Before wearing shoes, you should pay attention that there should be no foreign objects in the shoes. The heel of the shoe should not be too high. It is recommended that high-risk groups wear special shoes for diabetic foot.
5, when cutting toenails, should be flat cut, not to cut toenails and damage the nail furrow skin, or even cause nail furrow infection.
6, when the foot skin is dry, it is recommended to use lubricants or skin care ointment, but not between the toes.
7, the soles of the feet, such as calluses (hyperkeratotic tissue, also known as corns), do not handle themselves, should ask professionals to handle.
8, patients should regularly allow medical personnel to check the foot.
9, once blistered, cracked, cut, scratched or painful, the patient should inform the medical staff.
10.Quit smoking, smoking can cause vasoconstriction, and serious smokers are prone to peripheral vascular lesions.
11.Control blood sugar and blood pressure as well as possible.
(iv) Treatment of diabetic foot ulcers
1, neurological ulcers: mainly foot decompression, control of blood glucose up to the standard, while performing nerve nutrition, anti-oxidative stress, improve microcirculation, nerve repair and other drug therapy.
2. Ischemic ulcers: attention should be paid to solving lower limb ischemia, and medical treatment includes controlling blood sugar, blood lipids and blood pressure to reach the standard, antiplatelet aggregation, improving circulation and vasodilatation and other drug treatments. Severe patients can undergo minimally invasive interventional therapy or angioplasty to improve blood supply to the lower extremities.
3. Ulcer treatment: Thorough debridement and removal of infected and necrotic tissues, use of special dressings, drugs, negative pressure wound therapy, artificial skin and standardized antibiotics to promote ulcer healing.