The problem of the Diabetic Foot
A bad or underestimated diabetic foot exposes the patient to ulcers, bleeding sores and infections which, in the long run, can spread to neighboring tissues and cause gangrene.
The main objective of the treatment of the diabetic foot is undoubtedly to prevent the plantar ulcer and, in the case of an ongoing infection, to stem the pathogenic insult within the shortest possible time.
Diagnosis
The management and frequent monitoring of the diabetic patient are essential to minimize the risk of chronic complications, including the neuropathic foot.
The clinical evaluation of the patient with diabetes includes a series of tests:
- Medical history and physical examination: the patient's medical history and physical examination are the patient's business card. In this way, the doctor realizes the seriousness of the situation: the physical examination includes the evaluation of the patient's vital signs (body temperature, heart rate, blood pressure and respiratory rate), the sensitivity test for hands and feet (often altered in the diabetic) and the examination of the circulation of the lower limbs.
- Laboratory tests (blood tests), important for determining an ongoing infection or the presence of other blood disorders. Depending on the severity of the problem, the specialist may prescribe more detailed analyzes to the patient, such as liver enzyme tests and kidney function tests.
- Radiography: indicated to examine the possible presence of damage to the bones (eg arthritis) or foreign bodies in the soft tissues (eg the presence of gas in the soft tissues may indicate a state of ongoing gas gangrene).
- Ultrasound: if necessary, the doctor may request the patient suffering from diabetic foot the Eco Doppler to assess the status of blood vessels (morphology and structure analysis).
- Angiogram: useful screening test to obtain the representation of the body's blood vessels by infusing a contrast agent in the vessels.
Care and treatment
Given the seriousness of the condition, the treatment of the diabetic foot requires a multidisciplinary evaluation that includes a team composed of diabetologists, podiatrists and surgeons.
Patients affected by diabetes should follow all the instructions provided by the doctor to implement an effective prevention program that can minimize the risk of foot injuries, such as corns, infections and anything else (for more information, read "diabetic foot: what to do and what not to do ").
Short review to understand ...
As we know, diabetes causes serious neuropathic damage to the patient, such as to alter the ability to perceive pain and thermal changes at the level of the feet; consequently, the patient does not realize the presence of any plantar lesions which, progressing, can give rise to very dangerous ulcers. These lesions struggle to heal due to poor circulation in the lower limbs (arteriopathy).
According to this, it is easy to understand how the treatment of the diabetic foot is based first of all on the local cleansing of the ulcer, on the treatment of the infection and, clearly, on the prevention of possible damages and complications.
- The non-medication of the ulcerative lesion in the diabetic foot drastically reduces the chances of recovery, exposing the patient to the risk of gangrene, therefore of amputation of the foot.
Diabetic foot therapy involves the concomitant use of:
- Specific antibiotics against the pathogen that caused the infection: in general, patients suffering from diabetic foot with current infection are treated with intravenous injections of broad-spectrum antibiotics (eg penicillin, metronidazole, aminoglycosides). Infections of moderate or mild severity can instead be treated with an oral therapy, that is by mouth (the patient will still have to be hospitalized for a few days).
- Sterile bandages and gauzes, very useful for stopping any small bleeding from lesions, wounds or ulcers, and therefore blocking the entry of bacteria into the lesion.
- Pain therapy: in the presence of severe pain at the level of the foot, the patient can take - after consulting a doctor - analgesics and painkillers.
- Arterial revascularization, to improve blood circulation in the lower limbs.
- Surgical debridement: invasive treatment that involves the surgical removal of the infected tissue.
- Hyperbaric oxygen therapy: this is a medical practice capable of providing higher levels of oxygen than normal, in order to inhibit the proliferation of anaerobic bacteria and promote wound healing.
When to consult a doctor
The diabetic patient's moral obligation is to seek medical attention as soon as signs and symptoms are observed or perceived at the level of the feet.
The patient should always note on a notepad all the alterations observed and perceived at the extremities: in this way, any subsequent diagnosis by the doctor is facilitated.
It is therefore essential to seek medical attention in the following circumstances:
- Presence of any trauma to the level of the feet (calluses, ulcers, scratches)
- The patient feels pain or tingling in the legs
- The diabetic patient is feverish: fever (or a simple low-grade fever) is often one of the first symptoms of an infection
- Itching of the feet (alleged foot fungal infection index)
- Sensitivity alteration of the feet and constant tingling
- Presence of red patches on the skin of the legs and / or feet (possible index of inflammation or infection in progress)
- Difficulty walking
- Obvious deformation of the feet
- Redness, inflammation and swelling at the level of a toenail: it is a possible indicator light of an ingrown toenail (the main cause of diabetic foot infections causing gangrene).
