THE DIABETIC FOOT: ALL YOU NEED TO KNOW ABOUT THIS COMPLICATION OF DIABETES

People with diabetes should regularly monitor the condition and health of their feet. Indeed, when poorly controlled, diabetes can be the cause of several types of complications: the diabetic foot is one of them. The patient must then react as soon as the first signs appear.

What exactly is a diabetic foot? What are the symptoms of this complication? And how to react?

 

What is a diabetic foot?

Diabetes - type I or type II - can cause several complications, affecting different organs or functions of the body. The feet are one of them.
 

A complication of diabetes

Even when the disease is taken care of, hyperglycaemia can be frequent . We then speak of "poorly controlled" diabetes, which is characterized by a level in the blood of glycated hemoglobin (a blood sugar monitoring index over 3 months) greater than 7% .

However, when diabetes is poorly controlled in the long term, these frequent and prolonged hyperglycaemias can alter the nerves and blood vessels, leading to arterial and neurological complications .

Nerve messages are no longer correctly transmitted to the brain and the blood no longer circulates optimally. The cells are damaged and different organs can be affected: the heart, the eyes, the hands, the kidneys, the teeth or even the feet.

Foot damage

Poor control of diabetes induces long-term various complications that can affect the feet:

• arteriopathy : this vascular disorder narrows the blood vessels, which has the effect of reducing the supply of oxygen to the legs and feet. This poor blood circulation promotes the appearance of wounds and ulcers, complicates their healing and slows their healing;

• muscle and bone tissue deformities , which accentuate pressure points in certain areas of the foot;

• progressive loss of nerve function in the lower limbs (peripheral neuropathy): this is one of the most common complications of diabetes. The feet become less sensitive to heat and cold, as well as to pain: pain (or discomfort) caused by minor trauma and minor injuries to the foot (cracks, fungus, ingrown toenails, cuts, blisters, corns or calluses) is no longer perceived immediately. These abnormalities set in gradually, worsen and sometimes end up becoming infected. Without reaction from the patient, they can go as far as gangrene and a risk of amputation of the toe, foot or leg.

While it usually affects the feet first, diabetic neuropathy can also affect the hands .
 

Risk factors

If the appearance of a diabetic foot generally results from a reduction in the blood supply and a loss of nerve sensitivity, other aggravating factors may contribute to the appearance of this complication:

• smoking;

• being overweight;

• poor foot hygiene;

• a high level of triglycerides in the blood.

 

What symptoms?

Signs of an unbalanced diabetes, the complications of the disease are sometimes silent. But they can also be manifested by very characteristic symptoms, especially in the case of diabetic foot.

Symptoms appear gradually, and may intensify over time:

• loss of sensation in the lower limbs (sensory neuropathy): the patient no longer feels heat, cold or pain;

• a burning sensation or small electric shocks in the feet , numbness, tingling or tingling;

• muscle weakness in the lower limbs ;

• a sagging of the arch of the foot (flat foot): diabetic neuropathy disturbs the statics of the foot. It can be responsible for plantar hyperkeratosis (horn develops at the pressure points), which causes deep bleeding and skin ulcerations. This is called “plantar perforating disease”;

• frequent bacterial and fungal infections in the feet : their appearance is favored by the excess of glucose in the blood;

• sores on the feet that do not heal (or heal badly).

 

If these symptoms are ignored, the development of a diabetic foot can lead to more painful and serious complications. Without treatment, this pathology can have the following consequences:

• infections ;

• bleeding ulceration ;

• gangrene (requiring the amputation of part of the foot or the entire foot).

It is therefore essential to contact your doctor as soon as the first symptoms appear .

How to react ?

In France, there are more than 10,000 amputations each year caused by complications of diabetes . However, many of them could be avoided thanks to better prevention, early diagnosis and appropriate care.

 

Indeed, if the appearance of a diabetic neuropathy is often inevitable, the complications of the diabetic foot can be avoided.
 

Adopt certain hygiene measures

Several reflexes and daily habits make it possible to keep feet in good health:

• impeccable follow-up of diabetes treatment , in order to avoid hyperglycaemia as much as possible;

• scrupulous hygiene of the feet (including the nails): the feet must be washed regularly, using a mild soap and lukewarm water. They must then be completely dried (toes, nails and feet). Foot baths should be avoided. Nails should be well groomed, using a nail file (rather than nail clippers). They should not be cut too short, at a slightly rounded right angle. To keep skin supple, a moisturizer or oil can be applied daily to the skin of the feet;

• regular checks of the state of health of the feet : it is recommended to examine your feet every day, even in the absence of pain or numbness. This checks for fungus or wounds that can become infected. Regular visits to the podiatrist (once a year) also make it possible to carry out a complete control. Performed every day, foot stretching movements help keep them in shape;

• appropriate care for the slightest anomaly or injury : the horn (corns, calluses or heel horn) must be removed using a pumice stone. The use of scissors or any other blunt object should be avoided. If in doubt, it is recommended to contact your doctor or pharmacist;

• a choice of comfortable shoes adapted to the morphology of the feet , to avoid injury: preferably with wide toes and laces, the shoes must be worn closed, with clean socks. Before putting them on, you should check that no foreign body (a pebble for example) has accidentally fallen into them. If possible, it is best to change shoes every other day, and to avoid walking barefoot.

Consult a podiatrist

If prevention methods are not enough, it is essential to go to a specialist doctor (or to a specialized center) as soon as a wound or a fungus appears on the feet. How to treat a diabetic foot?

Observation of the foot first allows the doctor to assess the level of risk, according to this classification:

• grade 0: absence of sensory neuropathy;

• grade 1: presence of sensory neuropathy;

• grade 2: the sensory neuropathy is associated with a deformity of the foot and/or a diabetic arteriopathy of the lower limbs;

• grade 3: presence of a history of ulceration or amputation.
   

In case of diabetic foot, the intervention of the pedicure-podiatrist is mandatory from grade 2 . After establishing his diagnosis, he can prescribe:

• nail treatment, especially in the presence of an ingrown nail;

• plantar orthotics: these custom-made insoles aim to evenly distribute the weight on the feet, and relieve pressure points;

• removal of calluses.

When taken care of in time, the wounds usually heal within a few months. Treatment usually involves cleaning the wound, applying a bandage , and prescribing specialized footwear . This is also an opportunity for the doctor to carry out a diabetes check-up. But, in some cases, it is necessary to carry out an amputation (of the toe, of the foot, of the tibia or of the leg).

The podiatrist can also carry out a general examination, during a simple control visit. Thanks to several specific devices, he first determines the level of sensitivity of the foot. He also assesses the overall health of the foot, and checks for abnormalities and minor injuries.