Diabetic Foot

Diabetic Foot Ulcer

What is diabetic foot? Diabetic foot ulcer is one of the most common complications seen in patients with chronic or long term uncontrolled diabetes mellitus. Both type 1 and type 2 diabetes can cause foot infections as these individuals have compromised blood supply secondary to high blood glucose levels. In addition to microvascular disease, local trauma and pressure may lead to various diabetic foot infections ranging from simple, superficial cellulitis to chronic osteomyelitis. Diabetes mellitus causes damage to blood vessels and peripheral nerves which lead to increased risk of foot problems mainly due to these two conditions: 1. peripheral artery disease, and 2. peripheral neuropathy.

Peripheral artery disease (PAD), or sometimes referred to as peripheral vascular disease or peripheral artery occlusive disease, is a disease of the large arteries. There is obstruction or narrowing of large arteries caused by atherosclerotic plaques. This can also due to inflammatory processes leading to stenosis or formation of an embolus or thrombus. The disease does not include arteries within the coronary, aortic arch vasculature and the brain. Patients with peripheral artery disease will experience intermittent claudication (pain in the calves during exercise and improves with rest), numbness or cramping of the muscles due to decreased blood flow to the lower extremities. Also, there will be diminished growth of hair and nails on the affected limb, noticeable color change (bluish purple or paleness), and sores or wounds that heals slowly or does not heal. In severe cases, lack of oxygen delivery to tissues can lead to tissue death (gangrene).

Diabetic Foot Pictures

Below are some of the sample pictures of diabetic foot wound.

 

 

 

 

Diabetic Foot Pain Symptoms

Peripheral neuropathy refers to damage to the peripheral nerves which may impair movement, sensation, organ function depending on the type of nerve affected. Symptoms of peripheral neuropathy include painful cramps, fine muscle twitching (fasciculations), degeneration of bones, muscle loss, hair and skin changes and decreased sensation in the nerves making it hard to perceive injuries due to lack of feeling. Motor nerves, sensory nerves or autonomic nerves all can be affected. Motor neuropathy can cause muscle weakness or impaired balance and coordination. Sensory neuropathy can cause reduced position sense, decreased sensitivity to changes in temperature and pain, numbness to touch, spontaneous tingling sensation or burning pain or severe pain from normally nonpainful stimuli (e.g. light touch) termed as allodynia. Autonomic neuropathy may produce a wide range of symptoms depending on the nerves affected. Common symptoms include abnormal blood pressure, poor bladder control and decreased ability to sweat normally.

Aerobic gram-positive cocci, particularly Staphylococcus aureus, are the predominant pathogens seen in diabetic foot infections. However, chronic wounds or those who have recently received antibiotic therapy may also be infected with gram-negative rods or anaerobes for those with foot ischemia or foot gangrene.

Diabetic Foot Care

Diabetic patients with infections are hard to treat because these individuals have microvascular disease which limits the access of the phagocytic cells to the infected area. This results in a poor concentration of antibiotics in the area of infection leading to poor wound healing.

Therefore, patients with diabetes must be educated to recognize the problems early and must be fully aware on how to prevent foot problems even before they occur. They should know when to call a doctor and how to recognize when the condition becomes serious enough to seek emergency care. With all the treatment and management, good control of blood sugar level is still the most important and the best way to prevent diabetic complications.

Causes of Diabetic Foot

Aside from what was mentioned earlier, below are some additional causes of diabetic foot

1. Improper footwear is a common cause of diabetic foot problems.
2. Trauma to the foot
3. Poor blood circulation
4. Infections such as athlete’s foot and ingrown nail.
5. Smoking disrupts small vessels in the legs and feet.

Diabetic Foot Problems

Risk Factors and Mechanism of Injury

Risk Factors	Mechanism of Injury
Peripheral Motor Neuropathy	Abnormal foot anatomy such as clawing of toes, subluxed joints which leads to excess pressure in one area of the foot, callus formation and ulcer
Peripheral Sensory Neuropathy	Loss of protected sensation which results to unattended minor injury.
Peripheral Autonomic Neuropathy	Lack of sweating which results to dry, cracked skin
Neuro-osteoarthropathic Deformity (e.g. Charcot Disease)	Abnormal anatomy resulting in high pressure in the midplantar area
Vascular Insufficiency	Impaired oxygen delivery, impaired tissue viability and delivery of neutrophils leading to poor wound healing
Maladaptive Patient Behavior	Inadequate patient education, inadequate adherence to precautionary measures; improper foot care; inappropriate activities
Hyperglycemia and other metabolic derangements	Impaired immunological function and wound healing; excess collagen cross-lonking

Diabetic Foot Examination

Clinical Classification of Diabetic Foot or PEDIS GRADE

PEDIS stands for perfusion, extent or size, depth or tissue loss, infection and sensation.

PEDIS Grade	Clinical Symptoms	Severity
1	No signs of infection; superficial full-thickness ulcer	Uninfected
2	More than 1 inflammatory markers (redness, pain or tenderness, purulence, warmth or induration); erythema of size 2cm or lesser around the ulcer; limited to skin or subcutaneous only; loss of sensation	Mild
3	Characteristics of mild infection and ≥1 of the following: cellulitis >2 cm, lymphangitis, extension beyond superficial fascia, deep-tissue abscess, involvement of muscle, tendon, joint, or bone and gangrene	Moderate
4	Presence of infection plus systemic toxicity or presence of metabolic instability, characterized as fever/chills, confusion, azotemia, tachycardia, hypotension, vomiting, leukocytosis, severe hyperglycemia, acidosis	Severe

Diabetic Foot Infection Guidelines

1. Self foot exam. Examine your foot daily and also after any trauma (even very minor trauma) to your feet.
2. Use water-based moisturizer everyday to prevent dry skin and cracking. Avoid applying in between toes.
3. Wear cotton or wool socks. Avoid elastic stocks because they impair circulation.
4. Wear sturdy, comfortable shoes to protect your feet. Avoid tight fitting shoes.
5. Regular exercise improves circulation and will improve bone and joint health.
6. Quit tobacco smoking.
7. Blood sugar control.

Diabetic Foot Management and Treatment

Diabetic patient with foot wound should be assessed by physician, preferably by multidisciplinary foot-care team. Assessment should include the depth and the tissue involved, presence or absence of ischemia, evidence of inflammation, foot deformity and sensation. Infected wound should be cleaned and debrided. Appropriate wound care and proper foot care should be emphasized. No antimicrobial therapy needed for non-infected wound.

For non healing wounds, check the patient’s wound care compliance and re-evaluate wound care management. You can send tissue specimen for culture by aspiration, biopsy or curettage. Correct any metabolic disorders and reduce limb edema. Consult vascular surgeon for perfusion status. Consider additional imaging like MRI or CT scan.

Start empirical antimicrobial therapy and evaluate patient after 24 hours. If the infection is improving and causative agent is isolated, change regimen to the one with the safest and narrowest spectrum to reduce adverse effects. If infection is not improving, consider the need for surgical procedures.

Remember that providing optimal wound care and appropriate antibiotic treatment are crucial for healing. This includes proper wound cleansing, debridement of any foreign substances and off-loading of pressure. In addition, patients with infected wounds require careful follow-up to ensure effectivity of the selected medical and surgical treatment.

Diabetic Foot Cream

Shikai Borage DiabetiCare, Foot Cream – 4.2 Oz

Neoteric Advanced Healing Cream, 4 Ounce

Diabetic Book

Levin and O’Neal’s The Diabetic Foot with CD-ROM, 7e

Diabetic Foot Care: A Guide for Patients and Healthcare Professionals

Diabetic Footwear

Having the right choice of footwear for diabetic people is very important. Remember our feet must never be injured or ever just scratch in any accident. That’s why Doctors recommend patient to buy a different kind of socks, slippers and shoe that is specifically made for diabetic patients.

Below are some of the most recommend by doctors:

Diabetic Socks

Socks are important footwear for every people, it is a garment that protects for our feet, it is normally made from wool, cotton, or nylon.

Below are some recommend diabetic socks choice for every doctors:

MediPEDS Men’s 8 Pack Diabetic Crew Socks with Non-Binding Top, Black, Shoe Size: Men 9-12 / Women 10-13

Diabetic Socks for Men

Below are some of the top choices made from doctors recommending diabetic patient in buying diabetic socks for men.

12 Pairs Physicians Choice Diabetic Socks 10-13 Black

Diabetic Socks for Women

Below are some of the top choices made from doctors recommending diabetic patient in buying diabetic socks for women.

Dr. Scholl’s Women’s 2 Pack Diabetes Circulatory Crew Socks, White, 9-11 Sock/4-10 Shoe

Diabetic Shoes

Shoes are one of the most important footwear for every people, it is a tool that will cover and protect for our feet, normally it is made of leather, with a sturdy sole and not reaching above the ankle.

Below are some recommend diabetic socks choice for every doctors:

Diabetic shoes for Men

Below are some of the top choices made from doctors recommending diabetic patient in buying diabetic shoes for men.

Propet Men’s MPED3 Pedwalker 3 Oxford,Black,14 XX (US Men’s 14 EEEEE)

Diabetic shoes for Women

Below are some of the top choices made from doctors recommending diabetic patient in buying diabetic shoes for women.

New Balance Women’s W940V2 Running Shoe

Diabetic Slippers

Slippers is a comfortable slip-on shoe that is worn inside the house. That’s why, it is consider to be an important diabetic footwear for diabetic patients.

Below are some recommend diabetic slippers choice for every doctors:

Diabetic Slippers for Men

Below are some of the top choices made from doctors recommending diabetic patient in buying diabetic slippers for men.

Foamtreads Men’s Physician Slipper,Charcoal,13 W US

Home-X Memory Foam Unisex Slippers

Diabetic Slippers for Women

Below are some of the top choices made from doctors recommending diabetic patient in buying diabetic slippers for women.

Womens Extra Extra Wide Width Adaptive Slippers – Diabetic – Dusty Rose 8

 

Womens Edema Slipper for Swollen or Bandaged Feet – Light Pink