Diabetic foot syndrome is one of the most severe complications of diabetes. Treatment is carried out together with the doctors of the Diabetic foot office, vascular surgeons, surgeons of purulent surgery departments, orthopedic doctors.
The diagnosis of “diabetic foot syndrome” is made in the presence of infection, ulcers and/or destruction of the foot tissues.
Driving reasons:
- impaired blood circulation and neuropathic diseases. With these disorders (angiopathy and neuropathy), sensitivity decreases, and the patient does not notice minor damage to the skin of the feet. Troophy (tissue nutrition) suffers, which leads to poor healing of the skin damage, easily joining infections during damage, the formation of ulcerative defects, and over time - to the deformations of the foot, impaired shock -absorbing function, destruction (destruction) of the bones of the foot;
- injuries. Unknown shoes, an ingrown nail cause skin damage. Unnoticed by the patient, due to reduced sensitivity, microtrauma can cause ulcerative defects. Often, due to impaired sensitivity, the patient does not notice severe damage (cuts, punctures, burns).
Risk factors in patients with diabetes are increased if there are concomitant diseases or the following conditions:
- vascular diseases - varicose veins, thrombosis;
- the foot is deformed - flat feet or valgus deformation;
- abuse of alcohol or nicotine;
- wearing tight, uncomfortable shoes;
- Chronic hyperglycemia
Explicit signs of diabetic lesions of the lower extremities in diabetes can be absent up to several years.
As the condition worsens, specific symptoms appear:
- lameness;
- swelling and swelling of the legs;
- severity in the legs when walking;
- numbness of the legs;
- dry skin of the lower part of the limbs;
- deep cracks in the feet - inflamed and heal for a long time;
- the appearance of a small rash or ulcers;
- a feeling of heat in the legs when touching;
- frequent corns and blisters;
- Changing the color of the foot - redness, blue, pale. The redness around the wounds is especially dangerous - they talk about the infection.
The diabetic foot looks different. Most often, a limb of bright red color with corns and small wounds. Sometimes yellowed, ingrown nails are striking in the eyes.
As the state worsens, the clinical picture is aggravated. Specific symptoms occur. The neuropathic diabetic foot is characterized by a stable arterial pulse, an increase in the pain threshold and the absence of a change in skin color. The ischemic diabetic foot is manifested by the necrosis of the foot and fingers, pale of the skin, cold limbs. With a mixed form, arthrosis and arthritis develops, but the patient does not feel unpleasant phenomena. Disabilities of the joints are possible, but due to low sensitivity, the patient does not feel changes.
The first thing to do with any alarming symptoms is to sign up for a doctor. An endocrinologist, neurologist, surgeon are diagnosed.
At the reception, the specialist conducts an analysis of sensitivity and palpation, fixes the presence of wounds and cracks on the feet, determines the pulsation in the arteries of the foot.
To establish a diagnosis, a comprehensive examination is prescribed:
- X -ray for assessing the state of bones;
- blood test;
- Doplerography, ultrasound, angiography to determine the state of arteries and veins of the lower extremities;
The treatment is carried out conservative (treating ulcers with antiseptics; taking drugs) or surgical (depending on the severity of the lesion).
With diabetes, certainFoot care rules:
- In time, pay attention to the dryness and cracks of the skin of the feet, poor healing of wounds and cuts, a decrease in sensitivity or pain in the legs when walking, at rest, in a dream, cold legs, edges on the legs
- Every evening, inspect the packed surface of the foot and the gaps between the fingers;
- Wash your legs daily with soft soap and warm water (water temperature-36-37 ° C), then wipe dry;
- use softening and preventive creams;
- Correctly trim the nails (if necessary, resort to the help of a specialist-proper), avoiding growing into soft tissues;
- prevent corns, inflammation, cuts, burns and other damage;
- wear only comfortable, correctly selected shoes; putting on shoes or socks check them for the presence of foreign objects inside;
- Every day wearing clean socks or stockings without tight rubber bands and rude seams.
It is forbidden:
- warm your legs with a heating pad, “soar” legs (the duration of a warm bath is no more than 5 minutes);
- Use a knife or blade to remove corns and “corns” (small hyperkeratosis is removed using fine pumice or special legs brilliants without steaming the skin)
- walk barefoot;
- wear socks with a tight elastic band (the elastic band should not leave a trace on the leg);
- sit on the leg;
- apply softening creams and balsamic ointments to the wounds and between the fingers, use corn -layer plasters;
The first aid medicine cabinet should include a disinfecting solution (0.05% chlorhexidine, 1% dioxidine, 0.02% furatsillin), a set of disposable sterile gauze napkins, a set of napkins with an antiseptic, a bandage, an elastic non -woven patch. In cuts or scuffs in the feet - rinse the wound with an antiseptic solution and apply a sterile bandage, fixing it with a bandage or non -woven patch. You can not use: iodine, alcohol, concentrated 75% solution of potassium permanganate, diamond greens, which slow down the healing process.
Selection of shoes:
- Shoes choose 1-1.5 sizes larger (from the calculation for special insoles, taking into account deformation, edema of the legs);
- It is advisable to choose shoes from soft genuine leather with comfortable fasteners;
- You should not walk for a long time in new, not multiple shoes or model shoes (you must have change shoes)
- In the presence of various deformations of feet, fatigue and pain during prolonged standing or walking, special unloading insoles are needed.
Endocrinologist of the Minsk City Clinical Endocrinological Center V.V. Kuzmich
