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Diabetic Foot – Causes & Symptoms

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

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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Charcot foot with Osteomyelitis

This is a Charcot foot in a diabetic. Patient had a long standing draining wound on the foot. Xray showed a fracture of the base of the fifth metatarsal along with osteomyelitis.

Two months after surgery the wound had closed completely

An Xray taken six months after treatment was started, showed complete resolution of the osteomyelitis and the fracture of the base of the fifth metatarsal had healed.

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Cellulitis of the Leg in Diabetics

Cellulitis Leg in Diabetics Cellulitis of the leg

Cellulitis of the lower limb. Many cases of cellulitis do not require surgery unless necrosis has set in, when the patient needs debridement, or then there is a compartment syndrome(Swelling in the leg which is not settling with conservative means leading to gangrene etc), when a fasciotomy may be needed. This and similar cases are usually treated with medicines and other supportive therapy to heal the wounds. The patient however usually needs to be admitted for a few days to undergo the treatment. After this is done and the cellulitis has settled down, we usually investigate to know the cause, especially in cases of recurrent cellulitis and might suggest a surgery or medicine or supportive treatment to try and prevent future recurrences.