Everyone is no stranger to diabetes, especially those who have it in their family. What are the consequences of long-term diabetes? You may not know very well. Those who are careful may already know the answer from the topic I have talked about, it is diabetic foot.
It has been reported that more than 15% of the approximately 230 million people with diabetes worldwide will develop foot ulcers or gangrene at some time in their lives. Amputations due to the diabetic foot are 15 times more common in non-diabetic patients, and approximately 50% of the annual amputations are diabetic, with more than 85% of the latter being due to deep infection or gangrene caused by worsening foot ulcers. Although not as rapidly fatal as cardiovascular disease, the diabetic foot is prone to disability and rapid decline in quality of life. In the United States, the number of lower extremity amputations in diabetic patients exceeds 50,000 per year, the first of non-traumatic amputations and accounting for more than half of all amputations, the diabetic foot has seriously affected the quality of life of diabetic patients. In recent years, China is a country with a high incidence of diabetic foot, the average hospitalization day for diabetic foot is 46 days, and the average hospitalization cost is 35,000 yuan, which is about four times the average hospitalization cost of diabetes!
Here we will talk about what is diabetic foot. Modern medicine first used the term “diabetic foot” in 1956. It is considered to be a foot with loss of sensation due to diabetic vasculopathy, ischemia, and neuropathy, combined with infection, called “diabetic foot”. According to the World Health Organization (WHO), the diabetic foot is defined as a diabetic patient with a combination of neuropathy and various degrees of peripheral vasculopathy resulting in infection, ulcer formation, and/or deep tissue destruction in the lower extremity. The diabetic foot is a systemic disease that has both the clinical manifestations of diabetic medical disease and the signs and symptoms of surgical disease such as extremity ulceration and infection.
Why are diabetic patients prone to develop diabetic foot? I will talk about the pathogenesis below.
The pathology of diabetic foot is based on two major chronic complications in diabetic patients, namely vasculopathy and neuropathy. As the body continues to be in a state of high blood glucose and protein non-enzymatic glycation, lipid metabolism disorders, high viscosity and high coagulation of blood and the characteristics of the lower limb circulation, many factors make the arteries of the lower limbs of diabetic patients prone to vasculopathy, thickening of the walls and narrowing of the lumen, while microvascular and microcirculation also have different degrees of impairment, and the blood supply to the lower limbs gradually decreases; while diabetic neuropathy will lead to the end of the limbs Once damaged, the above pathophysiological changes make it difficult to repair and control the infection, and finally develop into foot gangrene.
What are the main symptoms of diabetic foot?
The main symptoms of diabetic foot are lower limb pain and skin ulcers, which can be manifested as intermittent claudication, lower limb rest pain and foot gangrene from mild to severe. In the early stage of the disease, the skin of the foot is pale when the lower limb is elevated, the dorsum of the foot is cold, the arterial pulsation of the dorsum of the foot is weakened or even disappears, intermittent claudication, and then simply cannot walk, and the pain is unbearable when walking, and later there is also pain at rest, and in severe cases, the patient can have trouble sleeping at night because of the pain. If the disease develops further, gangrene can appear on the lower limbs, especially on the feet, and the wounds do not heal over time.
What are the clinical manifestations of diabetic foot?
1. Itchy, dry, non-sweaty skin. Little fine hair, black color with pigmentation. Cold extremities, or puffiness or dryness.
2, abnormal sensation of the extremities, including tingling, burning pain, numbness, dull sensation or numbness, feet on cotton feeling. There may be duck walk, intermittent limp, resting pain, and difficulty in squatting and standing up.
3.The muscles at the extremities are malnourished, atrophied, poorly tensed, and prone to ligament damage, bone destruction, and pathological fractures.
4. Arch foot, flogging toe, chicken scratch toe, Charcot joint, etc. may appear.
5.The arterial pulsation of the extremity is weakened or disappeared, vascular murmur can be heard at the narrowing of blood vessels, and the reflex is weakened or disappeared.
6.The skin of the extremity is dry and cracked, or blisters, blood blisters, erosions and ulcers are formed, and gangrene and necrosis of the foot may occur.
Diabetic patients must pay attention to the hygiene and health of their feet and make regular foot examinations. Early detection and early treatment is an effective way to reduce the harm of diabetic foot and improve the quality of life.
How to self-examine to determine if you have diabetic foot?
The first step is to look, which is known as visual diagnosis.
The shape of the foot, toes, toenails, whether there is abnormal extrusion; whether there is callus (i.e. hard callus); whether there are ulcers; foot hygiene and toenail trimming; foot skin color; whether there is swelling; whether there are indentation and redness caused by shoes and socks; whether there is skin breakage and fungal infection between each toe, the surface of the foot, the sole of the foot, and the heel of the foot. Further is to feel, that is, palpation: with the back of the hand on the back of the foot slide, from above the ankle slowly slide to the toes, feel whether there is a temperature change, if you feel the foot skin temperature is cool, suggesting the end of the lower extremity ischemia, hot is suggestive of infection; check whether there is swelling or edema; feel the foot artery boom; test the sensation of abnormalities. If the above are normal, you can exclude diabetic foot. If there is any abnormality, seek medical attention promptly.
For most patients, a specialist can assess the degree of vascular disease by a simple examination. However, when the foot is ulcerated, painful, or the arteries in the foot are very weak and difficult to palpate, an arterial examination is necessary. Blood pressure index [ankle-brachial ratio (API)], ultrasound color Doppler, CTA, MRA and other tests are non-invasive and highly accurate tests that have been carried out in recent years and have been widely used in clinical practice.
Besides, the following examinations are also helpful for early detection of circulatory disorders.
① Transcutaneous partial pressure of oxygen measurement;
②Laser flowmetry;
③ Selective angiography.
Treatment: Diabetic foot is a chronic, progressive, systemic disease. It has both diabetic medical clinical manifestations and surgical signs and symptoms such as local ulceration and infection, and is often preceded or accompanied by acute and chronic complications such as vascular lesions, neuropathy, local infection and other related cardiac, cerebral, renal, fundus lesions, pulmonary infections, and ketosis before the onset of gangrene. Therefore, multidisciplinary examination, diagnosis and treatment are involved. Surgical revascularization surgery and interventional radiology for diabetic foot is one of the new tools in recent years, mainly addressing foot gangrene caused by diabetic macroangiopathy. Different treatment methods are selected according to the location, extent and degree of vascular lesions.
How can I prevent the occurrence of diabetic foot?
First, check your feet daily. Many diabetic feet are caused by trauma to the foot. If a wound becomes infected or does not heal after a long period of time, it should be seen promptly for professional treatment. In ordinary life, if symptoms such as blisters, cuts, redness, hardening, rupture, local fever and local coldness appear on the lower limbs, patients should immediately inform medical personnel.
Further, pay attention to the maintenance of the feet.
(1) adhere to the daily foot soak with warm water, the temperature should be lower than 37 degrees, and appropriate massage with both feet rubbing each other to promote blood circulation on the soles of the feet.
(2) Wash and dry your feet and then carefully trim the toenails with scissors, and smooth the edges.
(3) feet with corns, calluses or Youzi, do not deal with their own, must go to the hospital to find a doctor to deal with.
(4) Do not walk barefoot to prevent being stabbed by foreign objects on the ground.
(5) Try to choose cotton socks, the edge of the socks should not be too tight to avoid strangulation marks on the socks
(6) In cold weather, do not use hot water bags or hot water bottles to warm your feet to prevent burns. Use thick socks and blankets to keep warm.
(7) Avoid wearing small shoes, hard-soled shoes and high-heeled shoes to prevent foot movement from being restricted, and for sports, wear sports shoes
(8) Keep the shoes hygienic, wash the soles and socks regularly.
(9) Keep the shoes dry and actively prevent foot odor.
(10) For dry skin, lubricants or skin care ointments should be used, but not between the toes.
(11) Chemicals or creams should never be used to remove keratinized tissue or calluses.