Diabetic foot, as early as in China’s ancient medical books, has been recorded in the Yellow Emperor’s Classic of Internal Medicine, which states that “the thick taste of the paste and beam will lead to big furuncles on the feet”. Modern medicine first used the term “diabetic foot” in 1956. It is believed that the disease is due to diabetic vasculopathy and loss of sensation due to ischemia and neuropathy in the extremity, and the foot combined with infection is called “diabetic foot”.
The main serious consequences of diabetic foot problems are foot ulcers and amputations. Of all non-traumatic lower extremity amputations, 40-60% are done in diabetic patients. It has been clinically established that approximately 85% of diabetic patients have foot ulcers prior to amputation, 50-70% of diabetic patients have gangrene at the time of amputation, and 20%-50% have co-infection.
In the majority of patients, amputation is necessary because there is a combination of deep infection and ischemia.
Since diabetic foot is so terrible, what are the causes of the formation of diabetic foot?
1.Long-term hyperglycemic state
Due to the long-term hyperglycemic state of diabetic patients, blood viscosity increases, and too much blood sugar leads to hardening, brittleness and thickening of blood vessels, reduced ability of blood vessel deformation and insufficient blood supply.
On the other hand, the increase of blood viscosity also leads to inflammation of blood vessels, which will lead to the formation of blood clots and occlusion of blood vessels, resulting in a serious lack of blood supply, malnutrition and poor metabolism of organs. Occlusion phenomenon is also relatively the most serious, it is easy to cause edema, blackening, decay, necrosis, the formation of necrosis of the foot.
2.Vascular injury and occlusion
Resulting in injury tissue nerve damage, causing the limb vascular phytonuropathy makes vasomotor weakness, local tissue resistance is reduced, tiny trauma can cause infection, and because of local sensory impairment, tiny lesions can not be treated in time, resulting in rapid expansion of the wound. At the same time, due to limb sensory disorder, it also easily leads to scalding.
3.Neuropathy
Neuropathy can cause small muscle atrophy of the foot, due to long-term non-confrontational pulling, the formation of claw-like toes [especially the third, fourth and fifth toes]. This deformity makes the metatarsal head become a weight-bearing support point for the sole of the foot, and due to friction, there is callus formation, which is prone to infection and penetrating ulcers, and in severe cases spread to the nearby bones causing osteitis. Due to the loss of deep sensation and impaired joint movement reflex, the patient unconsciously overloads some joints and loses the protective effect against repeated trauma, making the joints and joint surfaces very irregular and prone to fractures, joint dislocation and subluxation, especially in the metatarsophalangeal joint.
4.Diabetic microangiopathy
Vasculopathy can lead to the destruction of skin nutrient blood flow reserve, which can also cause neurotrophic disorders, aggravate neurological impairment and lead to ulcer formation.
5, 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.
6.Metabolic factors
Poor blood glucose control is a risk factor for diabetic foot. And good glucose control is also important for wound healing; dyslipidemia and diabetic peripheral vascular disease are closely related; dyslipidemia is an important factor leading to atherosclerosis, which promotes the occurrence and development of peripheral vascular disease, thus increasing the risk of diabetic foot (DF).
7.Smoking
Smoking is a risk factor for diabetic peripheral vascular disease and diabetic peripheral neuropathy, and most people believe that smoking has a relationship with the occurrence of diabetic foot.
8, other factors
Men, old age, obesity, lack of relevant education of patients, alcohol consumption, poor psychosocial conditions, corneal hyperkeratosis and other factors are closely related to the occurrence of foot ulcers, in addition to hypertension is also a risk factor for diabetic foot.
So how to prevent the occurrence of diabetic foot?
1, develop good habits, regular medical checkups, and actively prevent diabetes: with the improvement of living standards, the incidence of diabetes is gradually increasing, one of the reasons lies in the change of living habits and dietary habits. Strengthening exercise and actively preventing diabetes can prevent the occurrence of diabetic foot from the source.
2, often check your feet: many diabetic foot are caused by foot trauma, if the wound appears infected or long dye does not heal symptoms, should promptly consult a doctor for professional treatment. In ordinary life, if the lower limbs appear blisters, cuts, redness, hardening, breaking, local fever, local cold and other symptoms, patients should immediately inform the medical staff.
3, pay attention to the maintenance of the foot.
(1) insist on soaking the feet with warm water less than 37 degrees every day and rubbing each other with foot massage appropriately; trim the toenails carefully and grind the edges smooth; do not use hot water bags or hot water bottles to warm the feet to prevent burns. Available thick socks and blankets to keep warm.
(2) Do not handle corns, calluses or Youzi by yourself; do not play barefoot.
(3) Try to choose cotton socks, the edge of the socks should not be too tight; avoid wearing small shoes, hard-soled shoes, high-heeled shoes, and sports to wear sports shoes.
(4) Maintain hygiene in shoes, wash soles and socks regularly; keep shoes dry and actively prevent foot odor.
(5) Lubricants or skin care ointments that should not be used between the toes; never use chemicals or creams to remove keratinized tissue or calluses.
For the treatment of diabetic foot, traditional conservative treatment, simple drug replacement is less effective and the amputation rate is higher. Mostly using a combination of Chinese and Western medicine treatment, in the different stages of the development of the disease, take different treatment measures, the
1, treatment of the primary disease (active control of blood sugar).
2, combination of Chinese and Western medicine to improve circulation and control infection.
3, reconstruction of vascular access (including intra-arterial drug injection, stem cell therapy, interventional therapy, diversion surgery treatment).
4, trauma treatment (including early, middle and late diabetic foot drug changes and pre, middle and post-surgical trauma treatment).
5.For advanced diabetic foot, amputation treatment is adopted to prolong life and improve quality of life.