How much you know about diabetic foot

  Diabetic foot is a chronic, progressive foot lesion that occurs in diabetic patients, affecting microvasculature, nerves, tendons, and bones, caused by vasculopathy, neuropathy, local infection, and a variety of predisposing factors, and is one of the chronic complications of diabetes and a major cause of disability from diabetic amputation. Diabetic patients are prone to injury due to dullness or loss of sensation in the lower limbs and feet caused by neuropathy, resulting in foot ulcers, infection, and gangrene.  More than 15% of the approximately 150 million people with diabetes worldwide will develop foot ulcers or gangrene at some point in their lives. Amputations due to diabetic foot are 15 times more common in non-diabetic patients, and approximately 50% of the amputations occur each year in diabetic patients, and more than 85% of these diabetic amputations are due to deep infection or gangrene resulting from worsening foot ulcers. Because diabetic patients are prone to foot injury and have low resistance due to impaired leukocyte function and cellular immunity, they have a greater chance of infection than the general population. The common causative agents of mild soft tissue infections are aerobic streptococci, etc. When the infection invades deep tissues, it is more common to see a mixture of bacteria. Bacterial cultures of wound secretions or swabs commonly show Staphylococcus aureus, followed by Streptococcus and Escherichia coli, as well as Streptococcus spp. and Synechococcus spp. Anaerobic bacteria and fungal infections of the foot are also often the gateways for bacterial invasion.  In patients with severe ischemic diabetic foot, undergoing percutaneous angioplasty has a higher cure and limb salvage rate than undergoing vascular bypass grafting. In a report of 900 cases, 50% to 60% of N artery-distal vessel bypasses had a 5-year patency rate of almost 76%, and 87% of affected limbs could be saved within 5 years. Early peripheral revascularization enhances foot microcirculation and provides better access to nutrients and antibiotics for neurologic and neuroischemic foot ulcers. Diabetic patients have a higher survival rate after arterial reconstruction.