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Diabetic foot

Diabetic foot

Diabetic foot is a common complication in patients with prolonged  uncontrolled diabetes. It can affect nearly 6% of patients with Diabetes and can range from infection, ulcer ,destruction of soft tisuues and bone . Between 0.03- 1.5 % of patients require an amputation.

 

The causes of diabetic foot are multifactorial. Poor control of blood sugar, neuropathy, poor blood circulation ,improper foot care , ill fitting shoes ,dry skin are common causes.

 

Foot ulcers are commonly formed in areas of foot prone to repetitive trauma and pressure sensations.

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What causes Diabetic foot?

Neuropathy (nerve damage): High blood sugar levels over time can lead to damage of the nerves, a condition known as diabetic neuropathy. Neuropathy can affect the nerves in the feet, causing loss of sensation or altered sensation. This means that individuals with diabetic neuropathy may not feel pain, heat, or cold in their feet, and may not notice injuries or wounds. Lack of sensation increases the risk of unnoticed injuries that can progress to more severe complications.

Vascular issues (blood circulation problems): Diabetes can also affect blood vessels, leading to poor circulation. Reduced blood flow to the feet means that wounds and infections may take longer to heal. Poor circulation can also contribute to the development of ulcers and increase the risk of complications.

Other contributing factors to diabetic foot complications include:

  • Peripheral arterial disease (PAD):

Diabetes can contribute to the development of PAD, which is characterized by reduced blood flow to the extremities, including the feet.

  • Infections:

Individuals with diabetes may have a weakened immune system, making them more susceptible to infections. Poorly managed blood sugar levels can also impair the body’s ability to fight infections.

  • Foot deformities:

Diabetes can lead to changes in the structure of the foot, such as Charcot foot, which is a condition where the bones in the foot weaken and fracture.

  • Poorly fitting shoes:

Wearing shoes that do not fit properly can contribute to the development of foot problems in individuals with diabetes.

Stages of Diabetic foot ulcer

  • Superficial ulcer
  • Deep ulcer involving tendon bone or joint
  • Deep ulcer with abscess or osteomyelitis
  • Gangrene involving the forefoot
  • Gangrene involving the entire Foot

Treatment of Diabetic foot

The diabetic foot treatment requires multidisciplinary approach to address various challenges associated with disease. 

It typically includes medical management, wound care, and lifestyle adjustments.

  • Blood Sugar Control:

Maintaining tight control of blood glucose levels is essential to prevent and manage diabetic foot complications. This involves adherence to a diabetes management plan that may include medications, insulin, diet, and regular monitoring of blood sugar levels.

  • Wound Care:

Careful and regular inspection of the feet is crucial to identify any wounds, cuts, or infections early. Proper wound care includes cleaning the wound, applying dressings, and, if necessary, using antibiotics to treat infections. Wounds may require debridement to remove dead or infected tissue.

  • Pressure Offloading:

Offloading pressure from affected areas is essential for wound healing and preventing further damage. This can involve the use of specialized footwear, custom orthotic devices, or total contact casting to redistribute pressure away from ulcers or sensitive areas.

  • Vascular Assessment:

Addressing vascular issues is crucial for diabetic foot care. This may involve medications, lifestyle changes, or, in severe cases, surgical interventions to improve blood circulation to the feet.

  • Foot Debridement:

Removal of dead or infected tissue (debridement) is often necessary for wound healing. This can be done through various methods, including surgical debridement, mechanical debridement, or enzymatic debridement.

  • Infection Management:

If an infection is present, prompt and appropriate antibiotic therapy is essential. Severe infections may require hospitalization for intravenous antibiotics.

  • Orthopedic Interventions:

In cases of foot deformities or Charcot foot, orthopedic interventions such as bracing, casting, or surgical procedures may be considered to stabilize the foot and prevent further damage.

Role of Plastic surgeon in diabetic foot

Diabetic foot ulcers are difficult to heal permanently using traditional wound healing methods.

 

Non-surgical approaches may temporarily heal deep wounds, but there’s a high risk of recurrence once the patient resumes normal activities.

Plastic surgeon plays a crucial role in healing by providing wound coverage with the help of grafts, soft tissue flaps and helps in salvage of limb.

 

Different modalities of treatment are as follows:

  • Debridement
  • IV antibiotics
  • Footwear modification
  • Advance dressings like VAC(Vacuum assisted closure) and HBOT ( Hyperbaric oxygen therapy)
  • Platelet rich plasma therapy(PRP)
  • Skin grafting
  • Local flaps
  • Free tissue transfer
  • Dermal regeneration template
  • Amputation of gangrenous part

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Our Goal is Quality Treatment with Satisfaction:

At Sukriti Clinic we believe that quality and customer satisfaction are crucial in any medical practice, including plastic and pediatric surgery clinics. We focus on providing personalized care tailored to each patient's needs. This involves clear communication, empathy, and involving patients in decision-making processes regarding their treatments. We emphasis on:

  • Safety Protocols
  • Quality of Care
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