Among the four specific chronic complications in diabetic patients – ophthalmopathy, nephropathy, podiatry, and peripheral neuropathy – diabetic foot lesions are one of the most common and serious complications. The diabetic foot is a foot lesion specific to diabetes caused by peripheral neuropathy, vascular disorders, and infection, either alone or in combination. Five percent of diabetic patients have an amputation due to diabetic foot, which is 15 times the amputation rate of non-diabetic patients. More than 57% of amputations in non-trauma patients are caused by diabetes. Some diabetic foot patients are reluctant to amputate, but as it progresses, infection in the foot can spread through the bloodstream to the entire body, causing sepsis and eventually life-threatening conditions.
Characteristics
First, there are more men than women with diabetic foot. Amputation patients are generally 40 to 60 years old, and most of them are single or divorced, and their families take little care of them.
Second, the patients smoke a lot. Diabetic foot lesions absolutely require a smoking ban because smoking can aggravate vascular lesions, aggravate foot ulcers, and may even cause life-threatening sepsis.
Main causes
1, lower limb vascular lesions caused by diabetes. There are microangiopathy and macroangiopathy. Diabetic foot mainly invades the dorsal foot artery, anterior tibial artery and N artery, etc., generating plaque, which in turn causes obstruction. Micro and small arterial lesions are mainly micro arterial thrombosis caused by embolism, trauma, infection or spasm of micro arteries, which affects the blood supply to the lower limbs and feet and often manifests as calf cramps.
2. Peripheral neuropathy caused by uropathy. Patients start with symptoms of numbness in the feet after walking for a while, then pain, and then intermittent claudication which is very common. The blood vessels are blocked or narrowed, the blood supply condition becomes poor, it hurts when you walk, it gets better when you sit for a while, but then it hurts again when you walk for a while. The first symptom of neuropathy is numbness, then pain, and in more severe cases, loss of pain sensation and loss of temperature and sensation (superficial sensation and deep sensation). If there is external bacterial infection on top of this, the condition will become more and more serious.
3.Infection. Diabetic foot is susceptible to bacterial infection, co-infection is the initiating factor to aggravate the development of gangrene, early Staphylococcus aureus, mycobacterial infection more, in the middle and late stages of infection with intestinal flora, 25% is anaerobic bacterial infection. Bacterial multiplication inevitably causes ischemia and hypoxia in the terminal tissues, creating favorable conditions for the growth of anaerobic bacteria, which can aggravate the disease.
Clinical manifestations
In the early stage, there are cold feet, pale, bruised or edematous skin, cramps and pains, the pain is aggravated when walking, and the wound appears to be long-lasting. If the patient does not feel injuries such as cuts, burns, and bruises, the risk of serious foot disease is greatly increased. The most serious form is diabetic foot gangrene, which has water oozing out of wet gangrene and in dry gangrene, large pieces of tissue look like they are falling off. These are both very serious vascular nerve complications.
Treatment
Diabetic foot treatment with medication is divided into two levels: medication and surgery.
1, drugs: Ekai or Guangle, whose ingredients are pancreatic kininogenase tablets, can be used to treat all diabetic complications, the disadvantage is that it is poorly targeted. Cilostazol (PEDA), Kaiser, etc., are more effective for diabetic foot and diabetic vascular lesions.
2.Surgery: Interventional surgery or open surgery revascularization is feasible according to the condition, but there are still a considerable number of difficult to avoid amputation.
Prevention
Avoid washing feet with scalding water. As soon as a normal person’s foot touches scalding water, it will immediately retract, which is a protective mechanism. Patients with diabetic feet, however, have poor temperature awareness and tend to get scalded and blistered. Once the blisters break down and become infected, it is a serious diabetic foot ulcer.
Wash your feet with warm water of 38 to 40 degrees Celsius. Diabetic patients are not suitable to go to the foot bath, because the foot bath can bring scrapes and abrasions, in case there is a little scratch, the consequences are unimaginable. Wash your feet should use neutral soap and a towel with good absorbency.
Wear loose, soft shoes. Bad shoes and socks can cause foot deformities, and constant friction on the feet can easily produce “corns” or increase ulcers. Diabetic patients should wear cloth shoes, moccasins and sports shoes, not plastic shoes, which are too hard, but preferably special orthopedic shoes with a longer, higher, wider toe and straighter toes. Socks should be soft, well-fitting, breathable and absorbent. Socks should be changed and washed every day, and it is better to wear cloth socks.
Take care of your feet often and cut your toenails regularly. But you can not cut too deep, too deep will lead to nail fungus, bleeding, not cut and will lead to too much bacterial growth, will also be inflamed. Calluses should be repaired slowly, and “corns” should be treated by a specialist. The skin should be kept lubricated to prevent the formation of ulcers and secondary infections. Prevent trauma, check the foot every day to see if there are blisters, abrasions, cracks, local skin redness and swelling, and whether there are “corns” and calluses. Patients with diabetic feet must go to the hospital for prompt medical attention once damage occurs to the foot.
Elevate the lower extremities frequently to promote venous reflux. Avoid sitting with your legs crossed for long periods of time. If there is a serious foot lesion, we do not advocate strenuous physical exercise and avoid doing some strenuous weight-holding exercises. You can choose to take a walk for not too long.
Foot injury rescue and treatment
If a diabetic patient’s foot is accidentally injured, the correct treatment for a small wound is to wash the wound with water or salt water, gently wipe it dry, cover it with a medical dressing, and change the dressing every day. It is best to visit a hospital.
The most basic thing is: blood sugar must be fully and strictly controlled, especially when it is not very high, but there are more serious complications, it must be strictly controlled, even treated with insulin early. Self-check your feet every day and go to the hospital at least once a year to check your feet and treat any problems promptly. In addition, calf cramps at night, which is likely a very early manifestation of diabetic foot lesions.