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 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 properly. 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 diabetics is diabetic foot. Nerve and vessel 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 diabetic patients encounter wounds on their feet at some point in their lives. Neuropathy mechanisms are 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 affects the nerves in the feet over time, leading to peripheral neuropathy. In this case, there is a loss of sensation in the feet, and the person does not feel pain, temperature changes, or wounds.
Sensor neuropathy has a glove-sock distribution pattern. 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.
Additionally, motor neuropathy causes weakness in the muscles of the feet and legs, and tension in the tendons. 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 prevents sufficient oxygen and nutrients from reaching the feet. This situation increases the risk of non-healing wounds and tissue death.
Autonomic neuropathy disrupts the reflex functioning of the foot vessels. As a result, there is constant pooling in the foot arteries and veins. Additionally, there is a loss of function in the sweat glands, leading to dryness and peeling on the soles of the feet. Cracks in the skin become entry points for microorganisms.
Risk Factors for Diabetic Foot
Poor blood sugar monitoring is the most important risk factor in the development of diabetic foot. Uncontrolled high blood sugar prepares the ground for circulation disorders by damaging blood vessels and nerves.
Long-term diabetes is also a significant 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 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 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?
In the beginning, 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 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 upward. This is called glove-sock style numbness because numbness occurs up to the point where the glove and sock end.
Skin dryness, cracking, and peeling are common issues. Dry and cracked skin develops on the heels. Your feet may feel colder or hotter than normal. Paleness or bluish discoloration in the skin may indicate serious circulation 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 out for.
Advanced Symptoms
Non-healing wounds develop on the bottom or top areas 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 in the foot or ankle are observed.
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 Out 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 life-threatening sepsis, symptoms such as fever, chills, fatigue, and uncontrolled very high blood sugar levels may be observed. 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 Diagnostic 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 asks about the duration of diabetes, blood sugar control, smoking habits, and whether there have been 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 is used to examine 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 there is suspicion of deep infection, X-rays or magnetic resonance imaging are performed. These methods are important for detecting bone infections.
How is Diabetic Foot Treated?
The primary goal of treatment is to ensure wound healing, control infections, and functionally protect the patient’s foot. A multidisciplinary approach is required in the treatment of diabetic foot. 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 necrotic tissue from the wound area. Debridement not only involves the removal of necrotic tissues but also helps in assessing the depth of the wound and determining bone involvement. Since applying pressure to 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.
Antibiotic selection is made based on the type of wound and the laboratory results of samples taken from the wounded tissue. 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 necessary, especially in cases of gangrene formation, severe infection, and deep wounds. The vessels supplying the leg and foot should be quickly examined for obstruction, 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. Surgical bypass can also be performed using veins taken from the patient’s own leg for bridging surgery. Thanks to early intervention and effective treatment protocols, 70% to 85% of patients can have their limbs saved.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy is one of the adjunctive treatment methods used for diabetic foot wounds. The patient is administered oxygen at high pressures to address the oxygen deficiency in the wound area. This accelerates wound healing and reduces the risk of infection.
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
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?
Every evening, wash your feet with warm water and mild soap. Check the water temperature with your hand, as you may not fully perceive 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 one by one. Areas left wet or damp create a breeding 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 too close to the skin. Use quality scissors for nail cutting. If your eyesight is poor, ask for help from someone close 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 your toes. If you see any of these symptoms, 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 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 spacious, allowing 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.
Select shoes with a soft, seamless interior. 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 swell during the day, so you will choose the right size at this time. Try on both shoes and check their comfort by walking.
Wear the new shoes for 1-2 hours on the first day, gradually increasing the time. Before wearing the shoes, check by hand for any foreign objects inside.
What to Do to Prevent Diabetic Foot?
Never walk barefoot. Do not go barefoot at home or outside. Even when entering 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 are preferred.
Regularly monitor your blood sugar levels. Get 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 questions.
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?
The infection progresses, gangrene may develop, and amputation may be necessary. If diabetic foot problems 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 that the weight distribution of the foot is even inside 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 treatment. The healing time varies according to 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 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 occur 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 develop later.
In Summary, Diabetic Foot
Although diabetic foot is a serious problem, it is a condition that can be prevented 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 patient, 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.
