Through a series of complex mechanisms, high blood glucose levels in diabetics damage small blood vessels (microvascular damage) and large blood vessels (macrovascular damage). Damages to small blood vessels make the diabetics’ skin fragile as well as can damage nerves in the legs and feet.
Meanwhile, damages to large blood vessels cause disturbances in blood circulation such that the cells in the feet do not receive adequate blood supply, oxygen supply, and nutrition. This combination eventually leads to the various symptoms of diabetic foot.
Symptoms
The symptoms of diabetic foot vary depending on which part of the leg is affected by the condition.
If there are complications on the nerves then disorders of the nerves occur known as diabetic neuropathy. The symptoms include numbness of the foot, extreme pain or a burning sensation on the foot. Moreover, continuously elevated levels of blood glucose can make the skin very dry making it more vulnerable to breaks and injuries. Calluses and corns on the feet may occur as well.
The narrow blood vessels and disturbed blood circulation make wounds difficult to be healed. In addition, disorders of the blood vessels on the feet, peripheral arterial disease, can cause symptoms such as pain on the calf when walking.
The various complications of diabetes can also lead to ulcers on the feet. Ulcers are deep open wounds. They may also be accompanied by pus or foul smell which if not managed properly can cause bacterial infections in the blood system (sepsis). This can be a very serious condition and may lead to death.
Other than ulcers, patients with the diabetic foot can experience gangrene. This infection is characterized by rotting of the skin, soft tissue, and muscles. Usually, the part of the feet affected by gangrene becomes black, dries, and has a foul smell.
Management of diabetic foot conditions
The management of diabetic foot conditions will require help from a physician. The type of management varies, depending on the degree of damage that has occurred on the foot. In conditions that are not very severe, management generally includes wound care and use of devices to prevent further injuries to the foot. If there are any signs of infections, the physician will generally prescribe antibiotics. In the severe diabetic foot, such as those with gangrene, surgery must be performed. The type of surgery varies, including removal of the tissues that are dead, or even amputation.
In Sri Lanka where many people walk barefoot, the risk of causing injury to the feet is very much higher. If these injuries go unnoticed and untreated especially in a diabetic it may eventually result in amputations if treatment is delayed.
Prevention
- Maintain a controlled blood sugar level by maintaining a proper diet and consuming antidiabetic medications as prescribed by the physician.
- Routine care of the foot. This includes examining the foot daily to evaluate the presence of breaks, wounds, calluses, and others.
- Wash the feet every day with lukewarm water and soft soaps, then dry them by dabbing them with a towel. Avoid soaking the feet as the skin may become drier.
- Use socks and a closed pair of comfortable, well-fitting shoes. This is important to prevent wounds on the feet. Diabetic Footwear is specially designed for this.
- Avoid exercise that causes stress to the feet (e.g. running). Riding an exercise bike or brisk walking in good footwear is advisable.
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