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Diabetic Foot Complications – Gangrene (Types, Causes and Symptoms)

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Diabetes Foot Complications – Gangrene (Causes and Symptoms)

You must be wondering, what is the correlation between diabetes and the foot/foot problems? Read on to know more about how diabetes can commonly cause foot problems and also lead to complications like gangrene.

Uncontrolled sugars in the blood can cause diabetic neuropathy (1) – a condition that results in numbness or a tingly sensation in the limbs (foot/arm) of a person due to lack of blood flow. Lack of blood flow can affect the tissues in the body and lead to more severe diabetic foot problems like gangrene. 

Diabetes is among the most common causes of gangrene (2).

Numbness and not being able to feel pain can cause a diabetic patient to be unaware of any cuts/injuries that may occur in those parts of the body. Lack of blood flow is a real problem in people with diabetes as it takes longer for a wound to heal. Exposure of the open sore/ulcer/wound to dirt and dust may cause it to get infected and if not treated on time can also result in infections and problems like gangrene.

 

What is gangrene?

Gangrene is a condition where the tissues in the body die due to illness, infected wounds or other injuries. It more commonly occurs in the feet, toes, arms and fingers.

Diabetes and gangrene (Types)

Dry gangrene

It is more common in people with diabetes and occurs mainly in the limb areas of the body. It is the result of low blood flow in those parts of the body .It is a common diabetic foot problem. Most of the time, dry gangrene is aseptic. This is because bacteria fail to thrive in dry tissue (3). However, if it gets infected, it can turn into wet gangrene.

Symptoms of dry gangrene:

–          Painful skin

–          Cold/dry skin

–          Darkening of the skin

–          Peeling off of the black skin

Wet gangrene

Wet gangrene occurs when a wound gets severely infected and blood supply gets cut off to allow it to heal (4). It is often caused by infections in the dry gangrene. Once that happens, the wound does not heal or may take too long to heal. Wet gangrene is more dangerous than dry gangrene and if you notice any symptoms, consult a doctor immediately. 

Symptoms of wet gangrene:

–          Fever

–          Swelling/pain

–          Darkening of the skin (change of color wherein the skin may appear red, blue or black)

–          Pus in the blisters

–          Bad odor from the pus

–          Shiny skin without hair

–          Crackling sounds from the affected area if you press on it

 

If you see any of these symptoms, consult a doctor immediately.

More about diabetes and the foot here.

References:

  1. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies 
  2. https://www.nhs.uk/conditions/gangrene/causes/#:~:text=and%20cause%20gangrene.-,Diabetes,to%20injure%20yourself%20without%20realising.
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987754/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987754/
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Charcot Foot with Fracture

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This is a case of diabetic charcot foot with fractured calcaneum. Patient had been to multiple hospitals before coming to us. Patient was asked to walk on the fractured calcaneum. No one bothered to take an x ray and only after we did an X ray we realised the patient had a fracture of the calcaneum. Patient came with a through and through wound on the plantar aspect of the foot, involving the heel. Calcaneum was evident on probing. We did advanced wound management and as the x ray show, the fractured calcaneum healed and patient was mobilised in customised footwear. 
 
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Diabetic Foot – Causes & Symptoms

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Diabetic Foot – Causes, Symptoms and Treatment

What is diabetes?

Diabetes is a disease that occurs when the blood sugar/glucose levels of the body are too high. Glucose is what gives you energy and is distributed to your cells with the help of a hormone called Insulin that is produced by the pancreas.  Sometimes, the body may fail to produce enough insulin or use it well to break down the glucose properly.  This causes the glucose to remain in the body and doesn’t reach your cells. Excess glucose levels in the body can cause diabetes.

Types of Diabetes

Diabetes is usually segregated into Type 1 Diabetes, Type 2 Diabetes and Gestational Diabetes

Type 1 diabetes

  • genetic condition that is usually detected early on in life

Type 2 diabetes

  • usually associated with unhealthy diets and lifestyles and may develop over time

Gestational diabetes

  • Can develop in some women during pregnancy, most likely to be temporary and last only till child birth
  • Women who experience gestational diabetes are prone to developing type 2 diabetes later on in life

 

How does diabetes affect the foot?

 

Diabetes can commonly affect the foot due to nerve damage. A large number of people with diabetes face some sort of nerve damage, that can lead to diabetic foot problems and complications. This is often referred to as ‘diabetic neuropathy” and is common among people with diabetes. Diabetic neuropathy may cause tingling sensations, pain and even loss of feeling in the feet.

Loss of feeling may be dangerous as a person may not realize when they get wounded on the foot. An open cut/blister or wound may lead to infection and inflammation of the foot. If not treated soon enough, it can contribute to complications like gangrene and other diabetic foot problems. The infection may also not heal properly due to loss of blood circulation in the feet.

When should you consult a doctor?

If your wound does not seem to heal within a few days or if you notice it getting worse, consult a doctor as soon as possible.

Common symptoms of diabetic foot problems include:

  • Swelling/inflammation or redness of the foot
  • Cuts/bruises/blisters/ulcers that don’t seem to heal
  • Calluses with dried blood inside
  • Blackening of a wound or foot infection with bad smell
  • Painful skin on the feet

How to prevent foot infections due to diabetes

  • Wash your feet everyday with warm water and soap (avoid soaking as it can dry up the skin)
  • Check your feet once a day for cuts/ulcers/blisters
  • Keep your toenails clean and cut
  • In the case of corns, get them removed safely by your doctor
  • Get your feet checked during your health checkups
  • Wear full-length socks to protect your feet

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The Diabetic Charcot Foot

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The Diabetic Charcot Foot

The Diabetic Charcot foot is commonly unrecognized. Especially in the beginning as it is forming, only a thorough examination of the foot along with radiographs can help in recognizing it. Many times it is recognized after severe foot complications occur.particularly in the acute phase, until severe complications occur. Early diagnosis & recognition, immediate immobilization and lifelong customized footwear can prevent further damage and amputation.

The acute Charcot foot is usually painless and may appear to be cellulitis. Immobilization of the foot at the earliest after detection is the most essential part of Diabetic Charcot Foot management.

Tha charcot foot causes disruption of the bony structure of the foot, resulting in foot deformities, rocker bottom feet and ulcers. These ulcers can lead to infection and in worst case scenarios to amputation. 25% of patients have bilateral charcot foot.

The acute charcot foot can resemble an infection, but usually pain and tenderness are absent. Even if pain is there it is much less severe than the clinical picture would suggest. One differentiating factor is that the blood sugars may be either normal or only marginally raised.

Immediate immobilization and protection of the foot in an off loading device is required for any Charcot foot.

The save legs diabetic foot clinic in Hyderabad routinely treats such patients.

 

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