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Diabetic Foot – Causes, Symptoms and Treatment

Diabetic foot is a serious complication of diabetes mellitus caused by nerve damage and poor circulation, leading to wounds, infections, and in severe cases, amputation.

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Things worth knowing about "Diabetic Foot"

Diabetic foot is a serious complication of diabetes mellitus caused by nerve damage and poor circulation, leading to wounds, infections, and in severe cases, amputation.

What is Diabetic Foot?

Diabetic foot (medically known as diabetic foot syndrome) refers to a range of foot conditions that develop as a complication of diabetes mellitus, particularly when blood sugar levels are poorly controlled over a long period. The condition primarily affects the nerves and blood vessels of the feet, resulting in loss of sensation, poor wound healing, and a high risk of infection. Worldwide, diabetic foot is one of the leading causes of non-traumatic lower limb amputations.

Causes

Diabetic foot develops through two main mechanisms of damage:

Diabetic neuropathy: Persistently high blood glucose levels damage the peripheral nerves. As a result, patients gradually lose their ability to feel pain, pressure, or temperature in their feet. Minor injuries or pressure sores often go unnoticed.
Peripheral arterial disease (PAD): Diabetes accelerates atherosclerosis (hardening of the arteries), significantly reducing blood flow to the feet. Poor circulation slows wound healing and can lead to tissue death (gangrene).

Additional contributing factors include:

Ill-fitting footwear
Foot deformities (e.g., hammer toes, hallux valgus)
Dry, cracked skin
Fungal nail infections or ingrown toenails
Poor glycemic control

Symptoms

The symptoms of diabetic foot range from early warning signs to severe complications:

Numbness, tingling, or burning sensation in the feet
Reduced or absent pain sensation
Dry, cracked, or scaly skin
Calluses and pressure sores
Slow or non-healing wounds (ulcers)
Redness, swelling, or warmth in the foot
Foul-smelling wounds indicating infection
In advanced stages: black discoloration indicating tissue death (gangrene)

Diagnosis

Diagnosis of diabetic foot is made through a thorough clinical examination, ideally in a specialized diabetic foot center. The following assessments are commonly used:

Neurological examination: Testing sensitivity using a tuning fork, monofilament, and reflex hammer.
Vascular assessment: Measurement of the ankle-brachial index (ABI) and Doppler ultrasound of the foot arteries to evaluate circulation.
Wound classification: Standardized systems such as the Wagner classification (grades 0 to 5) or the University of Texas classification are used.
Microbiological swabs and laboratory tests if infection is suspected.
Imaging: X-ray, MRI, or CT scan if bone or joint involvement is suspected (e.g., Charcot foot).

Treatment

Managing diabetic foot requires a comprehensive, interdisciplinary approach involving diabetologists, vascular surgeons, orthopedic specialists, wound care nurses, and other healthcare professionals.

Wound Care

Regular professional wound cleaning (debridement), which involves removing dead or infected tissue, forms the basis of treatment. Depending on the wound type, moist wound dressings, antiseptic coverings, or advanced wound therapy systems (e.g., vacuum-assisted closure) may be used.

Pressure Offloading

Consistent pressure relief of the affected foot is essential for healing. This is achieved through specialized offloading shoes, orthotic devices, or plaster casts (total contact cast).

Infection Management

Confirmed infections are treated with targeted antibiotic therapy, administered intravenously for deep infections. In severe cases, surgical intervention may be required to remove infected tissue.

Improving Blood Flow

When peripheral arterial disease is present, surgical or interventional procedures such as balloon angioplasty or bypass surgery can restore adequate blood circulation to the foot.

Blood Sugar Optimization

Achieving and maintaining optimal blood glucose levels (target HbA1c tailored to individual risk) is the most important measure to prevent further complications and support healing.

Amputation

In severe cases -- particularly with extensive tissue death or life-threatening infection -- amputation may be unavoidable. Surgeons aim to preserve as much tissue as possible and perform the amputation at the most distal level feasible.

Prevention

In many cases, diabetic foot can be prevented or its progression slowed through consistent preventive care:

Daily foot inspection (using a mirror to check the soles)
Careful foot hygiene: trimming nails straight, moisturizing the skin
Wearing well-fitting, soft footwear at all times
Never walking barefoot
Regular check-ups with a physician and trained diabetes care specialist
Optimal control of blood sugar, blood pressure, and blood lipids
Smoking cessation (smoking significantly impairs circulation)

References

International Working Group on the Diabetic Foot (IWGDF): IWGDF Guidelines on the Prevention and Management of Diabetic Foot Disease, 2023. Available at: https://iwgdfguidelines.org
Armstrong DG, Boulton AJM, Bus SA - Diabetic Foot Ulcers and Their Recurrence. New England Journal of Medicine, 2017; 376(24): 2367-2375.
World Health Organization (WHO): Global Report on Diabetes, 2016. Available at: https://www.who.int

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