Diabetic foot is a serious problem that occurs in one out of every seven diabetics at some point in their lives. The diabetes disease, which directly affects over 10 million people in Turkey, can lead to the formation of wounds on the feet due to nerve damage and circulation disorders. This condition, which starts with a simple crack or wound, can progress to infection and tissue loss if not treated appropriately. Therefore, recognizing the symptoms of diabetic foot and making an early diagnosis is vital. In this article, you will find answers to questions about how diabetic foot wounds occur, what symptoms to pay attention to, and how diabetic foot treatment is carried out.
What is Diabetic Foot?
Definition of Diabetic Foot
The general term for health problems that develop in the feet of diabetic patients is diabetic foot. Nerve and vascular damage caused by prolonged high blood sugar leads to wounds, infections, and tissue loss in the feet. This condition affects approximately 40-60 million diabetics worldwide and poses a significant medical and economic threat.
About 15% of diabetic patients encounter wounds on their feet at some point in their lives. Neuropathy is present in 90% of diabetic foot ulcers. It has been determined that 6% of hospitalized diabetic patients are in the hospital due to foot ulcers.
How Does Diabetic Foot Develop?
Two main mechanisms play a role in the formation of diabetic foot. The first is nerve damage known as neuropathy. High blood sugar gradually affects the nerves in the feet, leading to peripheral neuropathy. In this case, loss of sensation occurs in the feet, and the person does not feel pain, temperature changes, or wounds.
Sensory neuropathy is characterized by a glove-sock distribution. Initially, symptoms such as tingling and prickling are observed. In later stages, complete loss of sensation occurs. A foot that has lost its sensation is at great risk in tight shoes or on hot surfaces.
In addition, motor neuropathy causes weakness in the foot and leg muscles and tension in the tendons. The toes curl in a hammer shape, resulting in a claw foot appearance. These deformities in the foot create new pressure points.
The second mechanism is circulation disorders. Diabetes leads to problems such as thickening and narrowing of the vessel walls, causing peripheral artery disease. Reduced blood flow means that the feet do not receive enough oxygen and nutrients. This situation increases the risk of non-healing wounds and tissue death.
Autonomic neuropathy disrupts the reflex function of the foot vessels. As a result, there is a constant pooling in the foot arteries and veins. Additionally, there is a loss of function in the sweat glands, leading to dryness and peeling of the foot soles. Cracks in the skin become gateways for microorganisms.
Risk Factors for Diabetic Foot
Poor blood sugar monitoring is the most important risk factor for the development of diabetic foot. Uncontrolled high blood sugar prepares the ground for circulation disorders by damaging the vessels and nerves.
Long-term diabetes is also an important risk factor. The longer diabetes has existed, the more damage it causes to the nerve and vascular systems. Smoking narrows blood vessels, disrupting blood flow and worsening circulation problems.
Being over 65 years old is among the risk factors. High cholesterol, a history of previous foot wounds, loss of sensation in the foot, and deformities are other risk factors. Inadequate foot care and improper shoe selection also increase the likelihood of developing diabetic foot. The presence of several of these risk factors together significantly increases the likelihood of wound formation.
What are the Symptoms of Diabetic Foot?
At the onset of symptoms, patients often do not notice minor complaints. The loss of sensation caused by nerve damage leads to many problems being detected late. When you feel burning, numbness, and tingling in your feet, you should be aware that you are entering a period where diabetic foot wounds may begin.
Early Symptoms
Constant tingling, numbness, and prickling in the feet are important early symptoms. Your feet may burn at night while sleeping, and you may not feel the ground while walking. Burning and numbness may start at the tips of your toes and then progress upwards. This is referred to as glove-sock type numbness because numbness occurs up to the point where the glove and sock end.
Skin issues such as dryness, cracking, and peeling are frequently observed. Dry and cracked skin may develop on the heels. Your feet may feel colder or warmer than normal. Changes in skin color, such as paleness or bruising, may indicate serious circulation disorders.
Pain in the legs may begin while walking and gradually intensify, requiring you to rest. Cramps may occur in the calves and feet. Thickening of the nail structure, ingrown toenails, and hardened areas on the skin are other symptoms to watch for.
Advanced Symptoms
Non-healing wounds develop on the bottom or upper parts of the foot. A small wound, if neglected, can become a very large and problematic wound. Redness and pain occur around the wound. Swelling and warmth may be felt in the foot or ankle.
Signs of infection include foul-smelling discharge, inflammation, and purulent discharge. Excessive redness, swelling, pain, and tenderness indicate that the infection is progressing. The quality of life of patients significantly decreases due to infected and severely painful wounds on their feet.
Warning Signs to Watch For
Changes in skin color on the feet, especially bruising and blackening, require immediate intervention. Swelling in the foot or ankle, temperature changes in the feet, and cooling are serious warning signs.
If a diabetic foot infection spreads to the bloodstream and causes a life-threatening sepsis condition, symptoms such as fever, chills, fatigue, and uncontrolled very high blood sugar levels may occur. If intervention is delayed, shock may develop in advanced stages. If you notice any of these symptoms, you should immediately consult a specialist.
Stages of Diabetic Foot and Diagnosis Methods
Knowing the stage of the wound plays a critical role in treatment planning. Wounds detected in the early stage can heal with simple methods, while in advanced stages, the risk of tissue loss and amputation increases. For this purpose, doctors use various staging systems.
Stages of Diabetic Foot
The Wagner Classification is the most commonly used system for evaluating diabetic foot wounds. This classification is divided into six categories based on the depth of the wound and the presence of necrosis:
Stage 0: Healthy skin condition, no wound yet but risk factors are present.
Stage 1: Superficial ulcer, skin integrity is compromised.
Stage 2: Deep ulcer, the wound has caused more tissue damage.
Stage 3: Ulcer with bone involvement, the infection has reached the bones.
Stage 4: Forefoot gangrene, toes or the tip of the foot are affected.
Stage 5: Total foot gangrene, there is significant tissue loss in the foot.
Additionally, systems such as PEDIS and UTSA are also used. The PEDIS classification evaluates perfusion, wound size, depth, infection, and sensory status together. The UTSA classification relates the depth of the wound to ischemia and infection.
How is Diabetic Foot Diagnosed?
The diagnosis process begins with taking a detailed history. The doctor inquires about the duration of diabetes, blood sugar control, smoking habits, and whether the patient has had previous foot wounds. Symptoms such as numbness, burning, and tingling are recorded.
During the physical examination, the skin of the foot is carefully examined. Wounds, calluses, color changes, swelling, redness, and increased temperature are checked. Foot pulses are evaluated, and weak pulses indicate circulation disorders.
To detect nerve damage, sensory tests are performed. The monofilament test is the most commonly used method. A thin filament is lightly pressed on specific points of the foot. If the patient cannot feel this pressure, nerve damage is suspected. Vibration sensation and reflexes are also checked to determine the presence of neuropathy.
What Tests are Performed?
Doppler ultrasound examines blood flow in the leg vessels. If there is vascular obstruction, wound healing is significantly delayed. If necessary, advanced imaging methods such as tomography or magnetic resonance angiography are used.
Blood tests are conducted to investigate signs of infection. White blood cell count and inflammation markers are examined. Blood sugar and HbA1c levels are evaluated. If deep infection is suspected, X-rays or magnetic resonance imaging are performed. These methods are important for detecting bone infections.
How is Diabetic Foot Treated?
The main goal of treatment is to ensure wound healing, control infections, and functionally protect the patient’s foot. A multidisciplinary approach is required in diabetic foot treatment. Specialists from different branches such as orthopedics, internal medicine, vascular surgery, infectious diseases, and plastic surgery work together.
Wound Care and Dressing
Wound care is a critical part of treatment. First, the wound must be cleaned regularly. Wet dressings should be done once or twice a day with saline solution. This method keeps the wound surface moist, reduces bacterial count, and cleans the ulcer surface.
It is essential to surgically remove the parts referred to as necrotic tissue from the wound area. Debridement not only involves the removal of necrotic tissues but also helps assess the depth of the wound and determine bone involvement. Since putting pressure on the wound will delay healing, orthopedic measures should be taken to prevent pressure.
Antibiotic Treatment
The presence of infection is an important factor that complicates the treatment of diabetic foot. Medication treatment should be initiated for infected diabetic foot ulcers. Oral antibiotics are given for mild infections, while intravenous antibiotics are administered for severe infections.
The choice of antibiotics is made based on the type of wound and the laboratory results of samples taken from the wound tissue. The treatment duration can vary from one week to six weeks. Antibiotic treatment should continue until the signs of infection improve.
Surgical Treatment Methods
Surgical intervention is required, especially in cases of gangrene formation, severe infection, or deep wounds. The vessels supplying the leg and foot should be quickly examined for obstructions, and if narrowing is present, revascularization of the foot should be achieved through endovascular or surgical interventions.
The balloon angioplasty method can be used to inflate a balloon catheter sent through the vessel at the site of narrowing. The surgical bypass method can also be performed using veins taken from the patient’s own leg for bridging surgery. Thanks to early intervention and effective treatment protocols, limbs can be saved in 70% to 85% of patients.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy is one of the adjunctive treatment methods used for diabetic foot wounds. The patient inhales oxygen at high pressures, which alleviates the oxygen deficiency in the wound area. Thus, wound healing is accelerated, and the risk of infection decreases.
Blood Sugar Control and Diabetes Management
Careful control of blood sugar levels is the first step in treatment. High blood sugar will delay wound healing and increase the risk of infection. Appropriate diet and insulin therapy should be arranged to keep patients’ blood sugar within normal values.
Diabetic Foot Care and Prevention Methods
Taking precautions before the formation of diabetic foot wounds is much more effective than treatment. Daily foot care and proper shoe selection play a critical role in preventing complications. In this section, you will find answers to questions about how to care for diabetic feet.
How to Perform Daily Foot Care?
Every evening, wash your feet with warm water and mild soap. Check the water temperature with your hand, as you may not fully perceive the temperature due to nerve damage. The water temperature should be around 37°C. Do not soak your feet in water for a long time.
After washing, dry between your toes one by one. Wet or damp areas can prepare the ground for fungal infections. If you use a white towel, it will be easier to notice any bleeding or discharge.
If your foot skin is dry, apply a moisturizing cream. However, do not apply cream between your toes. The spaces between the toes should remain dry. Creams should be applied to the heels and the top of the foot.
Cut your nails straight after bathing while they are soft. Do not round the corners or cut too close to the skin. Use a good quality nail scissors for nail trimming. If your vision is poor, ask someone close for help or consult a healthcare facility.
Check your feet daily with the help of a mirror. You can use a mirror to see the soles of your feet or ask for support from someone close. Look for redness, swelling, cuts, color changes, blisters, or whitening between the toes. If you see any of these signs, consult a doctor immediately.
Do not cut or file calluses yourself, as this increases the risk of infection. Do not use callus medication. Callus treatment should always be done by a specialist.
Choosing the Right Shoes
Shoe selection is vital in preventing the formation of diabetic foot. Shoes with orthopedic insoles distribute pressure evenly, reducing the risk of calluses and injuries.
Choose shoes with a wide fit. The toe area should be wide enough for your toes to move comfortably. Models with pointed toes or high heels are definitely not suitable. The heel height should not exceed 2-3 cm.
Choose shoes with a soft, seamless interior. Raised seams can cause friction. Leather or breathable natural materials should be preferred. Synthetic materials can cause sweating in the feet.
The sole of the shoe should be flexible, lightweight, and non-slip. It should have shock-absorbing properties. Laced or Velcro models hold your foot more securely.
Go shoe shopping in the afternoon. Your feet will swell during the day, so you will choose the right size at this time. Try on both shoes and walk to check for comfort.
Wear the new shoes for 1-2 hours on the first day, gradually increasing the duration. Before wearing shoes, check by hand for any foreign objects inside.
What to Do to Prevent Diabetic Foot?
Never walk barefoot. Do not walk barefoot at home or outside. Even when swimming, use protective shoes.
Protect your feet from hot or cold sources. Do not place heating pads, hot water bottles, or get close to radiators, as these can cause serious burns.
Wear cotton or wool socks every day. Nylon socks can cause sweating in the feet. The sock elastic should not be tight. Seamless models should be preferred.
Regularly monitor your blood sugar. Have an HbA1c test every three months. Do not smoke, as it disrupts blood circulation. Exercise regularly and support circulation with ankle movements.
Frequently Asked Questions About Diabetic Foot
Diabetics and their relatives often have many questions about diabetic foot. In this section, you will find answers to the most frequently asked topics.
Does diabetic foot heal on its own?
No, it cannot heal without appropriate treatment. If a diabetic foot wound is noticed, you must consult a healthcare facility immediately. Uninformed interventions at home can accelerate infection.
What happens if diabetic foot is not treated?
The infection progresses, gangrene may develop, and amputation may be necessary. If diabetic foot problems are not detected early, they can lead to the spread of infection, tissue loss, and limb loss.
What kind of shoes should be preferred for diabetic foot?
Soft, wide, and breathable orthopedic shoes are recommended. Shoes should be comfortable and wide enough to allow toe movement. Attention should be paid to ensure even weight distribution in the shoe.
Do diabetic foot wounds cause pain?
Due to nerve damage, pain may not be felt, so caution is necessary. In patients with severe nerve damage, even very deep and infected wounds can be painless. The absence of pain does not mean that the problem is not serious.
At what stage of diabetic foot is amputation required?
Generally, the risk of amputation increases in the 4th or 5th stage. However, with early intervention and proper care, this risk can be significantly reduced. Amputation is always a last resort.
How long does it take for diabetic foot wounds to heal?
It can take from a few weeks to several months depending on the size of the wound and the treatment. The healing time varies based on the depth of the wound, circulation status, and the patient’s overall health condition.
Which doctor should be consulted for diabetic foot?
Consultation should be made to specialists in endocrinology, dermatology, general surgery, or diabetic foot clinics. Successful treatment usually requires coordinated work from multiple specialties.
How should diabetics wear socks?
Cotton or wool socks are recommended. Tight socks should not be used. Seamless models should be preferred.
Is diabetic foot only seen in the elderly?
No, it can be seen in any age group with long-term uncontrolled diabetes.
Can diabetic foot be prevented?
Yes, it can be prevented with regular foot care, blood sugar control, and proper shoe use. Early detection of any symptoms helps prevent serious complications that may arise in the future.
In Summary, Diabetic Foot
Although diabetic foot is a serious problem, it is a preventable condition with the right information and care. Regularly monitor your blood sugar, examine your feet daily, and choose appropriate shoes. Even a small wound should not be neglected, as early intervention greatly reduces the risk of amputation.
As a diabetic, protecting your foot health is entirely in your hands. Simple daily habits can change your life. If you notice any symptoms, consult your doctor immediately. Remember, prevention is always easier and more effective than treatment.
Diabetic foot is a serious problem seen in diabetics. Read our article to learn about its symptoms, diagnostic methods, and treatment options. Early diagnosis is vital.
