Diabetic Foot — Symptoms, Causes & Treatment

Diabetic foot is a complication of diabetes. People with diabetes over a period may suffer from high blood sugar levels (hyperglycemia), or frequent fluctuations in blood sugar levels that affect the nerves adversely throughout the body and the person starts feeling numbness in the foot because of poor blood flow, this occurs mainly due to nerve damage. Nerve damage can occur in any part of the body, but nerves are mostly affected in the legs and feet.

Diabetic foot occurs in patients suffering from diabetes, which occurs due to:

• Eye disease from diabetes,
• Kidney disease,
• Heart disease,
• Alcohol consumption,
• Obesity,
• Poor quality shoes,
• Poor hygiene,
• Improper trimming of toenails.

The symptoms vary, depending on the severity of the condition. A few of the commonly found symptoms are:

• Numbness,
• Pain,
• Tingling,
• Loss of sense,
• Redness,
• Skin discoloration,
• Changes in skin temperature,
• Swelling,
• Frequent infection,
• Slow healing,
• Weak immunity,
• Changes in toenails,
• Fluid or pus discharge,
• Foul smell,
• Open sores on the feet,
• Corns or calluses,
• Ingrown toenails or infected with fungus,
• Cracks in the skin.

Pathology:

Diabetic foot occurs as a result of the combined effects of diabetes-related vascular disease and neuropathy, which is due to frequent fluctuations in blood sugar levels, affecting the nerves adversely throughout the body. There is a thickening of capillary basement membranes, arteriolar hyalinosis, and endothelial proliferation causing ulceration in severe cases.

Physical examination:

The examiner checks the symptoms, examines the toes, feet, or legs, and checks for the sensation or the feel of touch. Also looks for the signs such as redness, swelling, warmth, skin discoloration, and skin discharge.

X-ray:

X-ray checks the signs of damage to the bones by infection, and foreign bodies in the soft tissues like gangrene - a very serious, life-threatening, or limb-threatening infection.

Doppler Ultrasound:

It is used to check the blood flow through the arteries and veins in the lower extremities, by moving a non-invasive probe over the blood vessels of the lower extremities.

Laboratory test:

Complete blood cell count helps in determining the presence and severity of infection. A very high or very low WBC suggests a serious infection. Kidney function tests, liver enzyme test, and heart enzyme test is used to assess whether other body systems are working properly in the face of serious infection.

Medication: Duloxetine, Pregabalin, Antibiotic, etc.

Note: Medication should not be taken without the doctor's prescription.

Surgical Treatment:

When conservative treatments do not help or do not give the expected results, then in such cases surgical treatment is suggested, which includes:

• Removing dead or decaying or dead tissue.
• Amputating parts.
• Arterial bypass.
• Endovascular surgery.

Bandaging with elevation:

Bandaging helps to decrease the Edema combined with elevation.

Strengthening exercises:

Strengthening exercises improve muscle strength, make the muscles stronger and more injury resistant and help to regain lost strength in the muscles through constant training routines. Strengthening exercises for muscles like the hamstring, quadriceps, calf, and tibialis anterior muscle is recommended.

Therapeutic ultrasound:

Ultrasound is another type of physiotherapy electrical modality that uses very high-frequency sound waves to stimulate the tissue beneath the skin. This can help to regain sensitivity in the feet.

Transcutaneous electrical nerve stimulations (TENS):

TENS helps to reduce the feeling of stiffness and enhances the healing of foot ulcers.

Low-Level Laser Therapy (LLLT):

LLLT is a non-invasive, pain-free method that has been considered an effective treatment option for diabetic feet.

Massage therapy:

Massage can be done regularly. Massage inhibits muscle contraction, spasms, and atrophy due to poor blood supply.

Range of motion exercises:

Exercises should be done regularly, as they may reduce neuropathic pain and can help control blood sugar levels. It should be ensured that exercises for people with diabetic neuropathy do not hurt the feet. Active exercises like hip flexion, extension, abduction, adduction, internal rotation, external rotation, knee flexion, extension, ankle dorsiflexion, plantarflexion, inversion, and eversion. Also, the active assisted exercise of the hip and knee can be recommended.

Stretching exercises:

Stretching exercises can be done manually. Stretching exercises help to keep the joints flexible and reduce the chances of injury during other activities. Gentle stretching for 5 to 10 minutes helps the body warm up and get ready for aerobic activities such as walking or swimming. Calf stretch, seated hamstring stretch, and plantar fascia stretch are examples of stretching exercises.

Balance training:

Keeping the balance system healthy is important for joint pain, weakness, or dizziness. Balance training can help get back to normal, and overcome feelings of stiffness or unsteadiness.

Gait training:

This training involves relearning how to walk and prevent and stabilize foot complications, such as ulcers and injury. This type of physical re-education is crucial for people using prostheses after losing limbs if diabetic neuropathy leads to an amputation.

Aerobic Exercise

Aerobic exercises increase the heart rate, work the muscles, and raise the breathing rate. Usually, the person works for about 30 minutes a day, 3-5 days a week. Initially start with 5 or 10 minutes a day and increase the time, each week. Or split up the activity for the day, try a 10-minute walk after each meal. Other examples of aerobic exercises are brisk walking on a treadmill, stationary bicycle, low-impact aerobics class, swimming, or water aerobic exercises.

The patient is advised not to leave the foot unchecked even for one day. Cuts and injuries should be avoided. Wash the feet every day, using warm water, but never soak the foot, make them completely dry and apply lotion. Trim the toenails and use diabetes-friendly footwear and socks. Never step out barefoot not even when indoors.