Definition of diabetic foot.
Foot infection, ulceration and or deep tissue destruction associated with distal nerve abnormalities and varying degrees of peripheral vasculopathy in the lower extremities (as defined by the WTO)
Diabetic foot epidemiological survey
In Western countries, 5-10% of diabetic patients have varying degrees of foot ulcers and 1% of diabetic patients have amputations.
Diabetes is the leading cause of amputation in many countries.
The rate of lower limb amputation in diabetic patients is 40 times higher than in non-diabetic patients.
Of the 60,000 non-invasive surgeries performed each year in the United States, 50% are performed on diabetic patients.
Diabetic foot epidemiological survey
The prevalence of diabetic foot in hospitalized diabetic patients in China is 1.6%-6.4%.
In recent years, the number of patients with diabetic foot ulcers and foot gangrene is increasing.
The economic burden of diabetic foot
One-third of the annual medical care for diabetes in the United States is spent on the treatment of glycopathy foot disease. The cost of medical treatment for amputation is even higher. The average cost is $25,000 in the United States and $43,000 in Sweden.
In 2000, the per capita hospitalization cost of diabetic foot inpatients in China was about 15,000 yuan, and it has been increasing in recent years, and in some economically developed areas, the figure is even higher.
Predisposing factors of diabetic foot
Common triggers.
Scratching the skin between the toes or on the foot due to itchy skin
Ulcers, ruptured blisters, burns, collision injuries, pedicures
Injuries and new shoe abrasions, etc.
The International Diabetic Foot Working Group has categorized the risk factors for the development of diabetic foot
The International Diabetic Foot Working Group summarizes the risk factors for the development of diabetic foot as follows
① Peripheral neuropathy
② Peripheral vascular disease
③ Skin abnormalities
④ Foot deformity
⑤ Past history of foot ulcers or amputations
⑥ Smoking
Wagner classification of diabetic foot
Grade 0: presence of risk factors for the development of foot ulcers, but no ulcers
Grade 1: superficial skin ulcers without infection
Grade 2: deeper ulcers, often combined with soft tissue inflammation, without abscesses or infection of the bone
Grade 3: deep infection with bone histopathy or abscess
Grade 4: limited gangrene (toe, heel or forefoot dorsum)
Grade 5: gangrene of the whole foot.
Prevention of diabetic foot
1. regular examination of the risk factors for diabetic foot and elimination of known risk factors.
2. strict control of blood glucose and strengthening of blood glucose monitoring.
3.Guiding patients on foot care.
4.Wear appropriate shoes and socks
Education for diabetic patients
Daily examination of feet and lower limbs
Wash feet with soap and warm water every day
The front of the toenail should be cut and filed smoothly
Wear clean, dry socks
Wear verified, loose-fitting shoes
Report foot problems to your doctor early and regularly
Go to the hospital early if foot trauma or infection occurs
Go to the hospital early when diabetic foot occurs
Diabetic foot care
Five steps for preventive care of diabetic foot
Step 1 Wash your feet with warm water
Wash your feet with warm water (less than 37 ℃) for 5-10 min daily, and gently dry them with a soft, light-colored towel after washing,
Especially between the toes;
Step 2 Check the feet
After washing the feet, carefully check the skin of both feet, especially check the skin between the toes, the soles of the feet, and the parts that are easily squeezed for skin cracks, blisters, cuts, redness, discoloration, high skin temperature, corns, ringworm, calluses, etc., and whether the dorsal artery pulsation and skin sensation are normal;
Step 3 Apply emollient cream
For dry skin, especially in winter, apply emollient cream after washing the feet to keep the skin soft and moist and prevent skin cracking, but be careful not to apply it between the toes;
Step 4 Foot massage
After the examination, the palm of the large and small fissure muscle from the tip of the foot to do massage of the feet and lower extremities, bilateral foot and calf massage 3-5 min, 1 time each day in the morning and evening to promote blood circulation in the feet and lower extremities;
Step 5 Lower limb exercise
Exercises to promote blood circulation in the lower limbs include:
① lift the heel: lift the heel, put it down, repeat 20 times;
② lift the toe: lift the toe and bend it down, repeat 20 times;
③ bending: hands on the chair to do bending exercise, repeat 10 times, bending the lower the better the head, the back as straight as possible;
④Chair exercise: cross your arms in front of your chest and repeat the sitting and standing action 10 times;
⑤ Resistance exercise: the patient’s arms are stretched out flat against the wall, not more than shoulder height is appropriate, feet together with heels on the ground, straighten the body, the body weight on the arms support, and then the arms straight, bending, repeat this action 10 times, 1 to 2 times a day.
Emergency treatment after diabetic foot injury
For small wounds, the following measures can be taken.
Wash the wound with saline; gently wipe dry
Do not apply dark colored medications, such as gentian violet or red saline, as the color of the medication will cover the signs of wound infection
Avoid using strong stimulating disinfectants such as iodine
Cover with medical dressing; change dressing daily