Related articles: Diabetic Foot
Definition
Diabetic foot is a long-term complication of diabetes. It is characterized by the appearance of skin and sensory changes, ulcerations and infections at the level of the foot, up to the destruction of deep tissues.
In the long run diabetes can lead to alterations of both nervous (neuropathies) and circulatory (vasculopathies) type; such complications can also affect the feet and lower limbs in general. These are two deeply different pictures, also referred to as neuropathic foot and ischemic foot, which often coexist in the same patient.
Frequently, the diabetic foot leads to hospitalization; the risk, if intervened too late, is that of having to amputate part of the lower limb.
Most common symptoms and signs *
- Muscular atrophy and paralysis
- calli
- Intermittent claudication
- Foot pain
- phlegmon
- Sore legs
- Legs tired, heavy legs
- Paresthesia
- Dry skin
- Skin Ulcers
Further indications
The main symptoms of the diabetic foot include pain, tingling and altered sensitivity.
Sensitive neuropathy can lower the pain threshold, making the foot completely numb. The diabetic patient, therefore, may not notice traumas or small wounds (such as blisters, cuts, burns or simple injuries caused by a narrow shoe), due to the reduced thermal sensitivity, pressure and painful stimuli. Motor neuropathy, on the other hand, affects the nerve fibers present in the muscles of the foot and leg, causing muscular atrophy, anomalies in the distribution of plantar load and difficulty in walking. Over time, this can even lead to changes in the structure of the foot: deformities develop and calluses appear (hyperkeratosis) at the points of greatest plantar load. The hyperkeratosis represents an attempt of the foot to defend itself from the hyperpressure. If this is not reduced, a crushing hematoma and an ulcer may form in the area; moreover, the skin of the feet becomes very dry, favoring the development of fissures and other skin lesions.
When the main arteries of the lower limbs are obstructed by an atheroma (therefore a peripheral arteriopathy is established), a "claudication" typically arises, that is a pain that arises in the calf or in the buttock after a few steps and then disappears when we stop. . This symptom depends on the obstruction of the arteries of the legs, which fail to provide the muscles with the blood needed to make the effort to walk. In the diabetic subject affected by both neuropathy and peripheral arterial disease, poor sensory perception can cause the subject to not feel the pain typical of arteriopathy. In these cases, the diabetic foot may be suspected due to the difficulty of the skin lesions to heal. Without an adequate blood supply, the wound repair processes are hindered and the local immune response is reduced.
A serious risk of complication of the diabetic foot, in the presence of an open ulcer, is the possible onset of an infection; this can in fact evolve rapidly leading to destruction from the subcutaneous tissues to the bone (gangrene) and making it necessary to amputate the part. Screening for diabetic foot can reduce this risk: it is essential that a diabetic undergoes periodic clinical checks to check for the presence of risk factors responsible for ulcers.
Diagnosis is based on careful control of the foot (assessment of color, skin temperature, possible presence of lesions, hyperkeratosis or deformity) and can be performed with simple and non-invasive diagnostic methods. If the risk conditions for the development of ulcers are ascertained, the adoption of hygienic-behavioral rules is recommended to prevent the development of lesions. In any case, it is necessary to consult a doctor within 24 hours of the evidence of the injury or the appearance of a foot infection.
