It is known that diabetes mellitus seriously threatens foot health. Elevated sugar levels over a number of years can damage the nerve endings and blood vessels of the lower extremities, and neuro- and angiopathy develops. As a result, minor damage to the skin of the feet is not felt by the patient (since diabetic neuropathy reduces sensitivity) and heals slowly (due to high blood sugar levels, infection, and less commonly, angiopathy).
Minor damage to the skin can turn into a non-healing defect – a trophic ulcer. Further progression of the process can lead to more severe complications – deep purulent processes (phlegmon, osteomyelitis), gangrene, amputation. Actually, diabetic foot syndrome refers to trophic ulcers, long-term non-healing wounds of the feet and their above-mentioned consequences.
But patients with diabetes also consult a doctor with other leg problems. One of the common complaints is pain in the legs associated with complications of diabetes – neuropathy and angiopathy. Patients with such problems are at risk for diabetic foot syndrome. There are also so-called “minor problems” of the feet, which also increase the risk of “diabetic foot”. These include:
- Foot deformities (associated not only with diabetes, but also with age-related changes in joints, wearing “wrong” shoes, etc.)
- Hyperkeratosis (excessive callus formation)
- Thickening and changing the shape of nails
- Fungal infection of nails and skin (especially interdigital spaces)
In order to correctly determine the cause of pain, prescribe the necessary treatment, determine the risk of developing diabetic foot syndrome and make efforts to reduce it, there are specialized “Diabetic foot” rooms. It is recommended that all patients with diabetes undergo an examination in such an office at least once a year.
New in the treatment of diabetic foot:
March 30, 2010: International collaboration resulted in a 42% reduction in amputation rates for diabetes at Georgetown Community Hospital, Guyana, South America.
For two years, with support and funding from the Canadian International Development Agency (CIDA), a program to prevent amputations in patients with diabetes was implemented at the Georgetown Community Hospital. This collaboration has been fruitful: it has reduced the number of amputations in this group of patients by 42%.
Currently, with the support of the same organization (CIDA), it is planned to launch a large-scale program to prevent amputations. It will cover 15000 patients with diabetes. As part of the program, it is planned to train 300 specialists at various levels of the healthcare system (doctors, nurses, etc.), as well as open and support the work of 7 diabetic foot centers in regional hospitals. The program also provides training on diabetes and hypertension control, which, along with proper foot care, are priorities for preventing diabetes complications in developing countries.
Source: www.stabroeknews.com
March 12, 2010. Indian surgeons have developed a new technique for reconstructive surgery for severe foot deformities due to diabetes mellitus.
We are talking about the treatment of a not very common, but very dangerous problem that creates a threat of amputation of the lower limb in diabetes mellitus: diabetic osteoarthropathy or Charcot’s foot. This complication is a consequence of diabetic polyneuropathy (damage to nerve fibers), which causes an abnormal increase in blood flow to the bones of the foot. As a result, bones become brittle and can break due to minimal trauma. If Charcot arthropathy is detected at an early stage (when it is manifested by edema and increased temperature of one foot, but the foot skeleton has not yet been destroyed), treatment is carried out with an immobilizing bandage (which was previously made of plaster, but has now been replaced by polymer materials), and destruction of the foot skeleton manages to stop. But when the process is far advanced, fragments of destroyed bones are displaced, and severe deformation of the foot develops, fraught with the development of trophic ulcers in protruding areas. If such ulcers become infected, the patient’s condition may require amputation of the limb.
If severe deformity has developed, to prevent trophic ulcers it is necessary either to wear complex (and not always completely effective) orthopedic shoes for life, or to have surgery on the foot aimed at restoring (reconstructing) its skeleton. The surgical methods here are similar to those used in traumatology (fastening bone fragments with metal plates and screws), but due to the increased risk of complications in diabetes after such an operation, a long period of rest is required (walking is possible only after 4-5 months) or wearing a device Ilizarov until complete fusion of bone fragments.
A new surgical technique was developed by Dr. Varma, who trained in the USA and actively operates in India (Amrita Institute of Medical Sciences, in Kochi). It is called the “Amrita loop” and can significantly speed up the patient’s return to their previous walking pattern.
Source: talk.news-medical.net