Diabetic foot is one of the most serious complications for diabetic patients, and those who have diabetes should be alert to the occurrence of diabetic foot. Once the foot has developed “pulsed paralysis and gangrene”, there is a possibility of amputation and treatment. In order to avoid the development of diabetic foot and to protect the foot, diabetic patients should learn about the dangers of diabetic foot and prevent it. So what causes the occurrence of diabetic foot?
1, diabetic peripheral neuropathy
Diabetic peripheral neuropathy is the most common risk factor for the occurrence of diabetic foot. Diabetic neuropathy can involve the sensory nerve, motor nerve and autonomic nerve, sensory neuropathy is more glove-like distribution of sensory abnormalities, and even sensory loss, so that the patient’s sense of protection against temperature, pain, pressure, etc. is reduced or lost, in the presence of external factors such as burns, foreign bodies, trauma, etc., the lack of protection of the foot will occur foot ulcers. Motor neuropathy can cause impaired proprioception, atrophy of the foot muscles, loss of balance between muscles, and thus destruction of the normal structure of the foot, making it easy to form abnormal stress points when the foot is stressed, which eventually leads to the formation of ulcers. Autonomic neuropathy, so that the foot blood flow regulation is impaired and the foot skin sweating and temperature regulation abnormal, resulting in dry, cracked skin, skin fissures then become the entrance to microbial infection, thus the occurrence of diabetic foot.
2.Diabetic peripheral vasculopathy
Diabetic peripheral vasculopathy is an independent risk factor for the occurrence of diabetic foot and amputation. The initial clinical screening methods include touching the dorsalis pedis artery and measuring the ankle-brachial index (ABI). It has been shown that weakened arterial pulsations in the foot and reduced ABI values are independent risk factors for foot ulceration and amputation. Compared with non-diabetic patients, diabetic vascular lesions have early onset, diffuse lesions, rapid progression and high incidence. These atherosclerotic plaques and thrombosis cause luminal narrowing and occlusion, resulting in distal limb ischemia, so that tissues cannot get enough oxygen and nutrients, and cannot discharge metabolic waste in time, which means that therapeutic drugs cannot reach the lesion effectively.
In addition, the formation of blood vessels in the diabetic foot ulcer wound is also reduced, which is another form of ischemia in the lesioned tissue and increases the risk of amputation. Abnormal biomechanical changes in the foot are associated with the development of foot ulcers and amputations. These changes include increased plantar pressure, abnormal bone changes, and limited joint motion.
Also, bunion, hindfoot pronation, claw toe, and anterior displacement of the plantar fat pad of the flexor tendon can cause increased pressure at a point in the foot, which can lead to ulcer formation. Restricted joint activity can lead to increased pressure on the plantar metatarsal muscles, which can easily lead to foot ulcers.
3, previous foot ulcers or amputation history
A study in the United States showed that a history of previous foot ulcers, or amputations, is an independent risk factor for the occurrence of diabetic foot.
4. Loss of protective sensation
Diabetic peripheral neuropathy can lead to loss of protective sensation in the foot. Vibratory perception threshold (vpt) and 10g monofilament examination are simple and effective methods for initial screening of dpn, and abnormalities in both indicate abnormal sensation and loss of protective sensation in the foot. Insensitivity to 10g monofilament has been shown to be an independent risk factor for diabetic foot, and studies have shown that increased vpt values are a major predictor of foot ulcers, and vpt is considered to be the strongest predictor.
5.Diabetic microangiopathy
Diabetic microangiopathy mainly includes: diabetic nephropathy, diabetic retinopathy. Diabetic nephropathy and diabetic retinopathy are risk factors for diabetic foot ulcers. A Polish study showed that the incidence of diabetic foot (type 1 diabetes) patients with combined diabetic nephropathy was 70%. Vasculopathy can lead to the destruction of the skin nutrient blood flow reserves, which can also cause neurotrophic disorders and aggravate neurological damage, leading to ulcer formation.
6.Metabolic factors
Poor blood sugar control is a risk factor for diabetic foot. And good blood glucose control is also important for wound healing. Observing the effect of high blood glucose on foot ulcer healing, the results show that the healing rate of ulcers is high in patients with stable or decreasing glycosylated hemoglobin control. Lipid metabolism disorders are closely related to diabetic peripheral vascular disease, and studies have shown that in patients with diabetes combined with pad, lipid disorders are more pronounced with elevated triglycerides and lower HDL cholesterol. Lipid metabolism disorder is an important factor leading to atherosclerosis, promoting the occurrence and development of pad, thus increasing the risk of diabetic foot.
7.Smoking
Smoking is a risk factor for diabetic peripheral vascular disease, diabetic peripheral neuropathy, most people believe that smoking has a certain relationship with the occurrence of diabetic foot, but how closely linked has not seen a large sample of research reports, further research is needed.
8, other factors
Factors such as male, old age, obesity, lack of relevant knowledge of the patient, alcohol consumption, poor psychosocial condition, and corneal hyperkeratosis are closely related to the occurrence of foot ulcers, and also hypertension is a risk factor for diabetic foot.
Diabetic patients should pay attention to the causes of diabetic foot and all the hazards of diabetic foot, protect their feet and control their blood sugar to avoid suffering from diabetic foot, which will bring inconvenience to their life and work.