How to prevent this dangerous complication of diabetes, how to treat it, how to choose the right shoes and take care of the feet
Diabetes is one of the most common diseases in the world, and diabetic foot syndrome is a serious complication that develops due to changes in nerves, blood vessels, skin and soft tissues, bones and joints. It manifests itself in the form of purulent-necrotic processes, ulcers and osteoarticular lesions.
Diabetic foot is the main cause of lower limb amputations in diabetic patients! However, if the complication was diagnosed on time, then amputation can be avoided in more than 80% of cases. The chances of “catching” him at an early stage are much greater for those who are constantly close to a sick person — his loved ones. In this article, we talk in detail about how to do this.
The text was prepared based on the materials of the webinar by Kristina Osotova, a care specialist of the ANO “Workshop of Care”
Diabetes: briefly about the disease
Diabetes mellitus is an endocrine disease associated with impaired glucose uptake. This is due to the insufficiency of the hormone insulin. There are two types of diabetes mellitus: the first and the second.
With type I diabetes, insulin is not produced due to the fact that the cells of the pancreas are destroyed. Its symptoms:
- Frequent urination, the development of polyuria (an increase in the volume of urine excreted);
- Constant thirst;
- As a result — dehydration, fatigue, dizziness, low blood pressure, pale skin.
These symptoms may appear and disappear depending on the level of sugar in the blood.
Type 2 diabetes is associated with the fact that the body either does not produce enough insulin, or the body is immune to it. Symptoms in the initial phase may be absent altogether. The disease may be detected accidentally during a routine examination, or when the first symptoms associated with complications of diabetes mellitus appear.
Other types of diabetes mellitus are also rare. They may be associated with genetic defects affecting the function of pancreatic cells, with pancreatic diseases (pancreatitis), the action of toxins or drugs, with pregnancy (gestational diabetes, which passes after childbirth).
Diabetes-foot: what is it?
Diabetic foot syndrome, or diabetic foot, is a specific condition of the foot in diabetes mellitus that occurs against the background of impaired nerve and vascular function.
Symptoms: lesions of the skin, soft tissues, bones and joints of the foot. In the advanced stage, bone and joint changes occur, trophic ulcers form on the feet, as well as purulent-necrotic wounds.
The mechanism of development of diabetic foot: due to high blood sugar levels, the sensitivity of nerve endings decreases. A person can rub his leg, injure it and not notice it. Then there is a violation of blood circulation, then the joints are affected “along the chain” and, finally, an infection joins – inflammation, suppuration, necrosis, etc. occurs.
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The main risk areas in a patient with diabetes mellitus:
- The upper surface of the fingers (shoes are most often pressed there);
- Plantar side of the thumb;
- Sole of the foot;
Diabetic foot syndrome can be neuropathic (a consequence of impaired nerve function), ischemic (a consequence of impaired blood vessels, impaired nutrition of foot tissues) and ischemic-neuropathic (mixed) forms.
- Signs of the neuropathic form of diabetic foot:
- Dry skin of the feet;
- The foot is warm to the touch (this sign will help determine the form of the diabetic foot: a warm foot — with the neuropathic form of the syndrome, a cold foot — with ischemic);
- Specific deformation of the feet and fingers (not found in all);
- Pulsation on the arteries of the feet is preserved (blood flow is preserved, but innervation is disrupted, i.e. the supply of organs and tissues with nerves, which ensures their connection with the central nervous system);
- The ulcers that form are most often painless (due to a malfunction of the nerve endings).
Signs of the ischemic form of diabetic foot:
- The skin is dry, flakes off between the fingers;
- There are cracks, poorly healing calluses;
- Pallor, cyanosis of the skin on the legs;
- The foot feels cold to the touch (due to circulatory disorders);
- The resulting wounds and ulcers are painful;
- Pain when walking;
- Stabbing pains in the legs, a feeling that “goosebumps” are running down the legs;
- Gangrene of the finger or part of the foot is often found, which can lead to amputation.
If you miss the onset of the disease, there are likely to be complications that are difficult to treat.
Sharko ‘s foot
One of the most severe complications of diabetes mellitus is diabetic osteoarthropathy or “Charcot’s foot”.
The mechanism of formation of “Charcot’s foot”: bones become brittle, multiple fractures occur, which a person does not feel due to a decrease in sensitivity. After fractures, the bones fuse incorrectly, deformity of the foot occurs. Tissue nutrition worsens, pressure on the foot is redistributed, and ulcers appear in places of pressure.
How is Charcot’s foot treated?
It is necessary to unload the affected leg so that the person does not step on it, the affected leg should be turned off as much as possible from the walking process.
If an infection has joined, inflammation has occurred, antibacterial therapy is needed.
Wearing special orthopedic shoes.
An operation during which pathological bone splices are eliminated.
Ulcers in diabetic foot
There are several stages of diabetic foot syndrome.
Stage 0. The leg is severely deformed, but there are no ulcers.
The main task at this stage is to ensure the integrity of the skin, prevent cracks, tears of the skin on the foot, where infection can get and cause inflammation. To do this, you need to properly care for the skin, including roughened skin, nails, and unload the feet as much as possible.
Any wound on the foot of a person with diabetes mellitus is, in the long run, an ulcer.
Stage 1. There is skin damage, but the wound is superficial (does not affect tendons, muscles, bones), is not infected.
The purpose of treatment in this case is to ensure the purity of the wound surface to accelerate healing. At this stage, it is important to prevent the infection from joining.
How to treat a wound with diabetic foot syndrome?
First— with an antiseptic solution or a water-based gel. For example, Prontosan gel, Prontosan solution, Chlorhexidine, Miramistin.
Antiseptic solutions for wound treatment should in no case contain alcohol! Zelenka, iodine, fucorcin will not work! Alcohol solutions burn and dry the skin, as a result, the wound does not heal. They contain dye, paint over the skin, so it will be difficult to assess the condition of the wound. For example, under the “green” you will not be able to recognize the necrosis site that has appeared in time.
The next step is to apply an absorbent wet bandage to the wound. For example, a bandage Askina Foan, Askina Sorb, Askina Transorbent, Cutinova Hydro, or other dressings. Such a bandage creates a moist environment in the wound, which promotes rapid healing and restoration of skin cells.
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The wound should not dry out. Instead of special dressings, you can use gauze napkins moistened with an aqueous solution of iodine or with a water-based ointment, for example, iodoperone.
The third stage is the application of a fixing bandage on top: polyurethane or adhesive. It will not let the absorbent bandage slip off, will allow you to keep a moist environment in the wound and protect the wound from the ingress of microorganisms, dirt, water.
Examples: Askina Derma, Hydrophilum. Advantages of a polyurethane bandage: it is transparent, so that you can see under it what condition the wound is in; and vapor permeable, which means that the wound will “breathe”, air exchange with the external environment will be preserved. With such a bandage, you can walk in shoes, even wash your feet.
The main thing is that a favorable microclimate is formed under it for wound healing.
All polyurethane dressings are easily separated from the skin: they do not need to be torn off, soaked, they do not cause discomfort to the patient.
Stage 2. An unidentified wound.
The damage is getting deeper, but deep muscles, tissues and bones are not yet affected.
The goal is to remove the rejected tissues (areas of blackening, necrosis, peeling), because they interfere with wound healing; to prevent bacterial load, suppuration of the wound.
We treat the wound with a water-based antiseptic.
We apply an absorbent bandage, which creates a moist environment and absorbs exudate (separated from the wound), if there is one.
We apply a fixing bandage (polyurethane / adhesive) on top.
Stage 2. An infected wound.
- Signs of infection and inflammation:
- pain (maybe);
- pus, yellow scab.
If the wound is infected, an antibacterial stage is added to the treatment regimen.
Wound treatment with a water-based antiseptic.
If there are areas of dead skin, necrosis (black dense crusts), they need to be removed. Special gels, for example, Askina Gel or Hydrosorb Gel, which cleave necrosis, will help in this. The gel is applied to the necrosis site, sealed on top with an adhesive or polyurethane bandage. After some time (1-2-3 days), you can remove this bandage together with necrotic tissues, which are painlessly separated from the wound.
In the presence of inflammation (pus), an antiseptic absorbent dressing should be applied, for example, Askina Calgitrol. There is coal in its composition, it disinfects the wound. You can use a bandage with silver, which also kills harmful microflora in the wound.
On top is a fixing bandage (polyurethane or adhesive).
Daily dressings are not necessary. The instructions for any bandages indicate how many days the bandage can be left on the wound (for example, for 3 or 5 days).
Stage 3. The wound is deep, affects bones and joints.
Starting from the third stage, the wound is treated only with a saline solution: 0.9% sodium chloride, it is sold in any pharmacy. The wound affects bones and joints, and the effect of antiseptic solutions on joint tissues is undesirable.
There are two scenarios for wound treatment at stage 3 of diabetic foot syndrome.
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Scenario one. There are dead tissues without abundant discharge from the wound. In this case, we dissolve the necrosis by applying special gels to the wound, and a polyurethane bandage on top. After a couple of days, we remove the bandage along with the dead tissues. We apply an antiseptic dressing, because the lesion reaches deep layers, there is an infection in any case.
Scenario two. There are no dead tissues, but there is abundant discharge from the wound: the wound is constantly “flowing”, bandages and clothes get wet. In this case, the solution is spongy absorbent dressings. They will absorb the discharge from the wound. On top — a polyurethane or adhesive bandage that fixes and protects.
Stage 4. An infected wound. The development of osteomyelitis.
At this stage, the wound is so deep that bone inflammation develops (osteomyelitis), bone tissue begins to break down. The goals of treatment are the same as in all previous stages. The scenario of the first steps is the same:
- We treat the wound with saline.
- We remove the rejected necrotic tissues, they will interfere with healing (we use a sponge bandage);
- We reduce the bacterial load on the wound with the help of antiseptic dressings;
- If exudate (discharge) is released from the wound, we apply an absorbent bandage.
If a specific smell comes from the wound — sharp, unpleasant – this may indicate the addition of a serious bacterial infection. In this case, antibiotics will be needed.
Remember: only a doctor can prescribe any medications!
Surgical intervention may be necessary: removal of inflamed tissues to prevent the spread of inflammation. It is impossible to cure osteomyelitis at home. The postoperative wound should be treated with saline.
The use of antiseptic gels and solutions is undesirable!
If it is not possible to use special bandages
You can use gauze bandages, wetting them, depending on the purpose of treatment, with iodopyron, an aqueous solution of iodine; or napkins soaked in ointments (iodine ointment, oflomelid ointment, iodopyron in the form of ointment, etc.).
So that the gauze bandages do not dry out, do not stick to the wound and do not damage it when removed, you need to glue them on top with a bandage (a film fixing or fixing bandage on a non-woven basis). A bandage and a patch will not work: they will not create the moist environment inside necessary for wound healing.
When treating a wound at any stage, it is important to remember that the basis for rapid wound healing is the preservation of a moist environment in it. The wound should not dry out! Water is involved in all processes in the human body, including the restoration of the skin.
Wound treatment should be consistent and regular!
When to contact a surgeon?
As soon as you notice the first signs, immediately consult a doctor!
If the leg is very swollen, areas of maroon color have appeared, large areas of necrosis, fingers or areas of the foot turn black — medical help is urgently needed! You may need a full-fledged operation!
The longer the wound remains without surgery, the higher the risk of infection in the blood and the development of sepsis (blood poisoning). This is a serious condition, which in most cases leads to death.
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Prevention of diabetic foot
Preventing the development of diabetic foot syndrome is much easier than treating it.
It is necessary to monitor the condition of the feet. Every evening before going to bed, examine the feet for the presence of calluses, corns, cracks between the fingers, even small injuries. Any, even microscopic damage to the skin is an “entrance gate” for infection.
It is necessary to normalize the blood sugar level. The higher it is, the longer the healing takes.
It is important to choose the right shoes.
Shoe parameters to consider:
Shoes should be made of soft materials (soft leather, soft suede).
It is advisable to use orthopedic insoles: they evenly distribute the load on the entire foot, and if there are no areas of excessive compression where blood does not enter, there is less risk of ulcers.
A stable sole will prevent falls, damage to the bones of the foot and soft tissues.
Shoes should be closed (for example, you can not wear flip-flops, they rub the skin between your fingers, and infection can easily get there).
Nothing in shoes should rub (hard, poorly stitched seams are taboo).
It is important to choose shoes according to size. Narrow shoes squeeze the foot, the blood supply worsens. It is better to choose shoes a little looser.
We will have to give up high heels: they are unstable, plus it is a big load on the feet — every centimeter of the heel adds several kilograms of load on the spine.
It is important to lace the shoes correctly: the lacing should be parallel, the laces should not cross. Crossed laces can easily be tightened too tightly, which will lead to a violation of blood supply, skin damage, ulcers.
If possible, make orthopedic shoes to order, especially for your loved one with diabetes and under his foot.
How to choose comfortable shoes if the sensitivity of the foot is reduced: a person does not feel whether the shoe is pressing him or not?
Ask your loved one to put his foot on the cardboard, circle the foot with a pencil or pen, cut out the resulting “insole”. In the store, it will be possible to check shoes with its help: whether it fits or not, bends, “walks”, etc.
Foot care for diabetes mellitus
Basic rules of care:
Wash your feet daily with warm water, wipe with a soft towel, not forgetting the interdigital spaces.
Inspect the feet daily to prevent damage, corns, cracks. A person with diabetes can independently examine the feet with a mirror (you need to put the mirror on the floor, place the foot above the mirror so that the skin on the sole is visible).
Keratinized skin areas need to be treated with pumice stone (in no case cut off with scissors or a blade!).
Dry skin areas after washing should be lubricated with a bold foot cream (very oily cream should not be used: it forms a film on the skin, air exchange is disrupted).
The interdigital spaces cannot be smeared with cream! This place is poorly ventilated, as a result, diaper rash may occur.
It is necessary to process the nails very carefully so as not to injure the fingers: use a file, and if you trim the nail, then at a right angle, without cutting the corners, especially on the big toes. This will help to avoid ingrowing of the nail, traumatization.
Wear clean socks daily.
If your feet are frozen, you need to wear warm socks without tight elastic bands. Steaming in hot water, the use of hot water bottles is prohibited! If a person is elderly, he has an ischemic form of diabetes foot syndrome, he may not feel too high a temperature and get burned.
You can not walk barefoot and wear shoes on bare feet. This increases the risk of skin injury and, as a result, the development of ulcers.
Daily do gymnastics for the shins and feet: rotation of the feet, massage of the feet and shins, etc. The task is to improve blood flow.
If a finger or foot has been amputated…
If there is an open wound at the site of the suture after amputation, treat it with aqueous antiseptic solutions and use the bandages mentioned above, depending on the situation. In case of serious complications (necrosis, the wound looks unhealed), contact the surgeon urgently: you may need a repeat operation.