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 circulatory disorders. This condition, which starts with a simple crack or wound, can progress to infection and tissue loss if not treated properly. Therefore, recognizing the symptoms of diabetic foot and making an early diagnosis is vital. In this article, you will find answers to questions such as how diabetic foot wounds occur, what symptoms to pay attention to, and how diabetic foot treatment is performed.
What is Diabetic Foot?
Definition of Diabetic Foot
The general term for health problems that develop in the feet of diabetics 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 diabetic individuals worldwide and poses a significant medical and economic threat.
About 15% of diabetics encounter wounds on their feet at some point in their lives. Especially, 90% of diabetic foot ulcers have a neuropathy mechanism. 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 affects the nerves in the feet over time, leading to the development of peripheral neuropathy. In this case, loss of sensation occurs in the feet, and the person does not feel pain, temperature changes, or wounds.
Sensorimotor neuropathy is characterized by glove-sock distribution. Initially, symptoms such as tingling and prickling are observed. In later stages, complete sensory loss occurs. A foot that has lost its sensation is at great risk in tight shoes or on hot surfaces.
Additionally, motor neuropathy causes weakness in the muscles of the feet and legs, leading to tendon strains. Toes curl into a hammer shape, resulting in a claw foot appearance. These deformities in the foot create new pressure points.
The second mechanism is circulatory disorders. Diabetes causes problems such as thickening and narrowing of the vessel walls, leading to peripheral artery disease. Reduced blood flow results in insufficient oxygen and nutrients reaching the feet. This increases the risk of non-healing wounds and tissue death.
Autonomic neuropathy disrupts the reflex function of foot vessels. As a result, there is a constant pooling in the foot arteries and veins. Additionally, there is a loss of function in 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 significant risk factor in the development of diabetic foot. Uncontrolled high blood sugar prepares the ground for circulatory disorders by damaging blood vessels and nerves.
Long-term diabetes is also an important risk factor. The longer diabetes has been present, the greater the damage it causes to the nerve and vascular systems. Smoking narrows blood vessels, disrupting blood flow and worsening circulatory problems.
Being over 65 years old is among the risk factors. High cholesterol, a history of previous foot wounds, loss of sensation in the feet, 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. Loss of sensation due to nerve damage leads to many issues being detected late. When you feel burning, numbness, and tingling in your feet, you should be aware that you are heading towards the period when diabetic foot wounds will begin.
Early Symptoms
Constant tingling, numbness, and prickling sensations in the feet are among the important early symptoms. Your feet may burn at night while sleeping, and you may not feel the ground while walking. Burning and numbness start at the tips of the toes and progress upwards. This is called glove-sock type numbness because numbness occurs up to the point where gloves and socks end.
Skin dryness, cracking, and flaking are common issues. Dry and cracked skin occurs on the heels. Your feet may feel colder or hotter than normal. Paleness or bluish discoloration of the skin may indicate serious circulatory disorders.
Pain in the legs while walking begins and gradually intensifies, requiring you to rest. Cramps in the calves and feet occur. 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 areas of the foot. A small wound can become a very large and problematic wound if neglected. Redness and pain occur around the wound. Swelling and warmth in the foot or ankle become noticeable.
Signs of infection include foul-smelling discharge, inflammation, and purulent discharge. Excessive redness, swelling, pain, and tenderness indicate that the infection is progressing. Patients’ quality of life 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 bluish discoloration 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, it can lead to life-threatening sepsis, which may present with fever, chills, fatigue, and uncontrollable very high blood sugar levels. If intervention is delayed, shock may develop in advanced stages. If you notice any of these symptoms, you should consult a specialist immediately.
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 assessing 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 damaged more tissue.
Stage 3: Ulcer with bone involvement, the stage where the infection has reached the bones.
Stage 4: Forefoot gangrene, toes or the tip of the foot are affected.
Stage 5: Whole 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 asks about the duration of diabetes, blood sugar control, smoking habits, and whether there has been a previous foot wound. 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 circulatory 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 is used to examine blood flow in the leg vessels. If there is vascular occlusion, 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 assessed. If there is suspicion of deep infection, X-ray or magnetic resonance imaging is 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 the number of bacteria, and cleans the ulcer surface.
It is essential to surgically remove the parts referred to as dead 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. Pressure on the wound should be avoided as it will delay healing, and orthopedic measures should be taken to prevent pressure.
Antibiotic Treatment
The presence of infection is an important factor that complicates diabetic foot treatment. Medical 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. The treatment duration varies 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, severe infection, and deep wounds. The vessels supplying blood to the leg and foot should be quickly examined for occlusion, and if there is narrowing, endovascular or surgical interventions should be performed to restore blood flow to the foot.
The balloon angioplasty method can be used to inflate a balloon catheter sent through the vessel at the site of narrowing, relieving the obstruction. Surgical bypass can also be performed using veins taken from the patient’s own leg. With early intervention and effective treatment protocols, 70% to 85% of patients can save their limbs.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy is one of the adjunctive treatment methods used in diabetic foot wounds. The patient is administered oxygen at high pressures to alleviate the oxygen deficiency in the wound area. This accelerates wound healing and reduces the risk of infection.
Blood Sugar Control and Diabetes Management
Careful monitoring of blood sugar levels is the first step in treatment. High blood sugar levels will delay wound healing and increase the risk of infection. Patients should be placed on an appropriate diet and insulin therapy to maintain their blood sugar within normal ranges.
Diabetic Foot Care and Prevention Methods
Preventive measures taken before the formation of diabetic foot wounds are 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?
Wash your feet every evening with warm water and mild soap. Check the water temperature with your hand, as you may not fully sense the temperature due to nerve damage. The water temperature should be around 37°C. Do not soak your feet in water for long periods.
After washing, dry between your toes individually. 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 your toes should remain dry. Creams should be applied to the heels and the top of the foot.
Cut your nails straight after bathing when they are soft. Do not round the corners or cut close to the skin. Use a quality pair of scissors for nail cutting. If your vision is poor, ask for help from someone nearby 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 get support from someone nearby. Look for redness, swelling, cuts, color changes, blisters, or whitening between your toes. If you notice any of these signs, consult a doctor immediately.
Do not cut or file calluses yourself, as it increases the risk of infection. Do not use callus medication. Callus treatment should always be performed by a specialist.
Proper Shoe Selection
Shoe selection is vital in preventing the formation of diabetic foot. Shoes with orthopedic soles distribute pressure evenly, reducing the risk of calluses and injuries.
Choose shoes with a wide fit. The toe area should be wide, allowing your toes to move comfortably. Pointed or high-heeled models are definitely not suitable. The heel height should not exceed 2-3 cm.
Select shoes with a soft, seamless inner structure. Raised seams can cause friction. Leather or breathable natural materials should be preferred. Synthetic materials can cause sweating of 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 time. Before wearing shoes, check for any foreign objects inside by hand.
What to Do to Protect Against Diabetic Foot?
Never walk barefoot. Do not go barefoot at home or outside. Even when swimming in the sea, use protective footwear.
Protect your feet from hot or cold sources. Do not place heating pads, hot water bottles, or get too close to heaters. These can cause serious burns.
Wear cotton or wool socks every day. Nylon socks can cause sweating of the feet. The sock elastic should not be tight. Seamless models should be preferred.
Regularly monitor your blood sugar levels. 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. You must consult a healthcare facility as soon as a diabetic foot wound is noticed. Unconscious interventions at home can accelerate infection.
What happens if diabetic foot is not treated?
Infection progresses, gangrene may develop, and amputation may be necessary. If diabetic foot issues are not detected early, it 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. Care should be taken to ensure even weight distribution in the shoe.
Do diabetic foot wounds cause pain?
Pain may not be felt due to nerve damage, so caution is necessary. In patients with severe nerve damage, even very deep and infected wounds may be painless. The absence of pain does not mean the problem is not serious.
At what stage does diabetic foot require amputation?
Generally, the risk of amputation increases at stage 4 or 5. 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?
Depending on the size of the wound and treatment, it can take from a few weeks to several months. The healing time varies based on the depth of the wound, circulatory status, and the patient’s overall health condition.
Which doctor should be consulted for diabetic foot?
Consultation should be made with 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 appropriate shoe use. Early detection of any symptoms helps prevent serious complications that may arise later.
In Summary, Diabetic Foot
Although diabetic foot is a serious issue, 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 significantly 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, diagnosis methods, and treatment options. Early diagnosis is vital.
