Diabetes mellitus (DM) is a metabolic disorder in which the body can not produce or effectively use the hormone insulin. Insulin is a hormone that is responsible for enabling the conversion of sugar into energy in the cells of the body, and if this function is impaired, blood sugar (glucose) levels can become abnormally high.
A prolonged period of time with high glucose levels in the blood can lead to damage of various body parts, including the feet. Besides diabetic neuropathy, diabetic foot is one of the major complications of diabetes. Moreover, the abnormally high glucose level in blood can cause some changes in blood vessels, including arteries.
So, in peripheral vascular disease, fat deposits are leading to an obstruction of blood vessels that supply the brain and heart, while diabetes tends to affect the blood vessels going to and from the extremities also, reducing the blood flow to the arms and feet.
Reduced blood flow can cause pain, slow wound healing, and infections that may progress to a state where amputation is needed.
Risk factors for diabetic foot
There are various risk factors that increase the chance for the development of diabetic foot and leg infections in people with diabetes. Some of the most important ones are:
Unsuitable shoes are a common cause of problems with feet in people with diabetes. If a patient has dry and red skin, rash or constant pain associated with footwear, it is necessary to get appropriate shoes as soon as possible.
If a patient has common abnormalities in the legs, such as flat feet, bunions or clinodactyly, special shoes or appropriate inserts may be necessary.
People with long-term or poorly controlled diabetes are at risk of nerve damage in legs, and this phenomenon is known as peripheral neuropathy.
Due to damage to the nerves, the patient may have a reduced ability to feel the pain in legs. Moreover, they may not be able to feel the position of their feet and fingers while walking and balancing. With fully functional nerves, a person can usually feel that their shoes are rubbing with their feet or if one part of the foot is pushed to the ground while walking.
People with diabetes may not be able to properly experience minor injuries such as cuts, scratches or calluses. Usually, people can feel the presence of stones in shoes, and then they can immediately remove them. A person with diabetes may not be able to spot a stone, and this constant rubbing can easily create an injury.
Diabetes can lead to hardening of arterial walls or atherosclerosis, especially if it‘s not under control. When blood flow to damaged tissue is inadequate, the healing process can not be done properly.
Athlete‘s foot, fungal skin or nail infection, can lead to more serious bacterial infections that need to be treated immediately. If a toenail gets ingrown, it should be immediately reported to a doctor.
Smoking of any form of tobacco causes damage in small blood vessels of the feet and legs. These damages can disrupt the healing process and they represent the main risk factor for infections and amputations. The importance of quitting smoking can never be overemphasized.
Treatment of diabetic feet
You need to avoid walking to prevent pain and ulcers. This is recommended for all forms of diabetic foot problems because the pressure done by walking can aggravate the infection and the spread of the ulcer.
A doctor may sometimes recommend you some orthopedic appliances such as diabetic shoes, a compression bandage or footwear inserts or they can treat diabetic foot by debridement, removal of the dead skin, foreign objects, or infected tissue that are possible causative agents of the ulcer.
A doctor may prescribe you some antibiotics, antiplatelet or anticoagulant drug to treat ulcer if the infection progresses. The most common bacteria that cause infections of diabetic foot are Gram-positive bacteria, such as Staphylococcus aureus or beta-hemolytic streptococci. Severe conditions are usually infected with different types of bacteria.