What are the Stages of Diabetic Foot?
The most commonly affected organs in diabetes are the feet. Diabetes, if not kept under control, leads to many problems with the feet over the years. This condition, also called ”diabetic foot", can go up to gangrene and amputation of the foot in later periods. Prolonged high sugar levels in the blood can lead to nerve damage and blockage of the vessels of the feet, causing circulatory problems.
Stages of Diabetic Foot
Dryness in the foot, caused by disruption of the sweating mechanism due to autonomic neuropathy in diabetic patients, causes the formation of cracks, crevices and calluses on the skin. These cracks and crevices are the entry point for fungi and other infectious agents. Infection leads to the growth and deepening of cracks. As a result of the destruction of the sensory nerves due to diabetes (diabetic sensory neuropathy), the patient does not feel the infected wound and pain in his foot. When the wound grows and the infection increases, along with the discharge from the outside, when the patient becomes aware of the wound, the wound has already become threatening to the foot and leg. As a result of vascular destruction due to diabetes, wound healing is delayed due to insufficient blood supply to the foot.
The diabetic wound has stages. The stages of diabetic foot are listed as follows according to the Wagner Classification:
• Stage 0: Healthy skin
• Stage 1: Superficial ulcer
• Stage 2: Deep ulcer
* Stage 3: Ulcer with bone involvement
* Stage 4: Gangrene of the forefoot (fingers/tip of the foot)
• Stage 5: Gangrene of the whole foot
According to studies, about 10-15 percent of diabetics face a diabetic foot wound at some time in their lives. In our country, where it is estimated that there are about 10 million diabetics, 1-1.5 million patients are faced with diabetic foot wounds.
Diabetic foot problem is more common in the following people:
* Those with nerve damage or poor blood flow in the feet
• Those who have been suffering from diabetes for a long time and cannot maintain blood sugar balance (those who have frequent episodes of hyperglycemia)
* Those with weight problems (obesity)
* those over the age of 60
* Those with high blood pressure and high cholesterol problems
Symptoms of Diabetic Foot
Diabetic foot can cause serious wounds to open on the feet of patients, infection to develop, and wounds to grow, causing the development of conditions such as finger, foot and leg losses. As a result of the involvement of small vessels in the area below the knee, in patients with blocked all the vessels feeding the foot, walking a very short distance or at rest can cause a picture called critical leg ischemia, in which severe ischemic pain develops that cannot be passed with painkillers. Their quality of life decreases significantly due to infected wounds on the feet of patients that cause severe pain. When a small wound is neglected, it can become a very large and problematic wound.
Symptoms that may occur as a result of the progression of a diabetic foot infection disease, as well as splashing into the bloodstream and causing a condition called sepsis, which can be life-threatening:
* Pain and redness in and around the standing wound
* Very high blood sugar levels that cannot be controlled
* Shock at an advanced stage when the intervention is delayed
Diabetes is a disease that requires regular doctor control. What changes should I go to the doctor for in this disease that causes wounds on the feet? Here are the reasons:
* Skin color changes on the feet (bruising and blackening)
* Swelling of the foot or ankle
* Temperature changes in the feet (cooling)
* Pain in the feet or ankles when walking or at rest
* Permanent wounds on the feet
* Ingrown toenails
* Foot fungi
* Dry and cracked skin on the heels
* Signs of infection
Diabetic Foot Treatment
• In patients who develop diabetic foot wounds, first of all, the wound-developing areas should be freed from the burden of the body, insoles and shoes should be used to reduce the load on the wound.
* In cases where a serious infection is detected during blood tests and outpatient, antibiotic treatment should definitely be given orally or intravenously.
* The vessels supplying the leg and foot should be examined and examined quickly for obstruction and stenosis, endovascular or surgical interventions to be performed in the presence of stenosis or obstruction, and the foot should be re-blooded (revascularization).
• After the foot and leg nutrition is provided, after the dead and infected tissues are cleaned in a protective way, wound healing can be achieved with appropriate wound care treatment.
Treatment of Vascular Occlusion
The treatment of stenosis and blockages in the leg veins due to diabetes can be performed closed (endovascular) and open (surgical).
Although almost all patients with diabetic foot wounds may also have problems with larger vessels, they are necessarily faced with stenosis and blockages in small veins under the knee and foot. The vein that feeds the leg in the area below the knee is divided into three and progresses to the foot, and two of these veins merge on the foot, forming a belt and network that feeds the entire foot and fingers. For wound healing, blood supply of at least one vein supplying the foot and fingers should be ensured with the treatments to be performed.
Foot nutrition can be provided in the angiography room without any incision as a result of interventions made through needle holes in the groin and / or foot veins with closed methods called endovascular.
* Balloon Angioplasty Method: With the balloon angioplasty procedure, which is the most common treatment performed closed to blocked vessels, a balloon catheter sent through the vein can be inflated in the stenosis and obstruction area to relieve the stenosis. But especially in diabetic patients, because the vessel walls are blocked with hard and petrified plaques, about half of the patients who are treated with balloons rupture these plaques, and stents of various sizes and lengths are placed in the vein after the balloon procedure to prevent re-blockage.
* Vascular Shaving Method: When stents are placed in the veins below the knee, which are very small and thin, these stents narrow and block in a short time, and it becomes difficult to re-open the veins and feed the leg. For this reason, when these hard and petrified plaques in the vein are cut and removed by a vein shaving method called atherectomy before the balloon procedure, the vein wall softens. After the balloon procedure, the risk of rupture in the vessel wall decreases significantly. Thus, the drug can penetrate the vessel wall better when medicated balloons are used, which are drugs that prolong the opening time of the vessel. For this reason, the use of vascular shaving – atherectomy in order to ensure better results by reducing the use of stents, especially in the treatment of vascular blockages located on the lower side of the groin and below the knee, provides benefits.
* Carbon Dioxide (CO2) Angiography: Contrast agents used for tomography and imaging during endovascular procedure in diabetic foot patients with impaired renal function may cause further deterioration of functions and the need for dialysis. In this case, kidney function is almost never affected as a result of angiography and endovascular interventions using carbon dioxide (CO2) gas, which is excreted not from the kidney, but from the lung.
• Surgery (Bypass) Method: Also, in patients with diabetic foot is a foot that nourish a healthy and open the target vessel in the case of the patient's own leg with the camera system on or off (endoscopic) veins pass by made by using the extracted as (bridging) surgery open surgical procedures can be fed to the leg and foot. Surgical by-pass surgery in patients whose veins cannot be opened by the endovascular method is also of vital importance for saving the foot and should not be ignored Decisively.
What Should Be Considered in Diabetic Foot Care?
For a diabetic foot wound, first of all, attention should be paid to personal hygiene and foot care. For diabetic foot care, you can pay attention to:
* A person with diabetes should wash their feet every day with warm water and soap, dry thoroughly and wear cotton socks. Since the foot with diabetes does not feel the heat, it can easily burn. The temperature of the water in which the foot is washed should also be controlled with the help of a thermometer or elbow. After washing the feet, they should be thoroughly dried with a soft towel and Decanted with cream, excluding the between the fingers. Cream should not be applied between the fingers Decently.
* One should not walk around the house barefoot, a cotton sock and closed-toe slippers should be used.
• Instead of pointed-toed, hard-soled, narrow shoes against diabetic foot problems, soft, leather, closed-toed shoes with soft insoles should be preferred.
* Great care should be taken when cutting nails, fingers should not be injured. Nails should be cut straight, the tip of the scissors should not be pointed, pedicure should not be done. The treatment of ingrown toenails should definitely be continued by a surgeon who specializes in this matter.
• A person with diabetes should thoroughly examine his feet every evening, immediately consult a doctor if he suspects a diabetic foot in the presence of the slightest discoloration or injury.
* In order to evaluate blockages in the veins of the legs and feet, a vascular surgery specialist should be monitored.
* Smoking negatively affects circulation. If smoking is present, it should be stopped.
• Regular exercise by diabetics every day to improve leg blood circulation can reduce the development of diabetic feet.
• If a person with diabetes has calluses on his feet, he should not try to clean them with cutting tools such as knives, razors, scissors, and callus medication should not be used. It is necessary that the treatment of calluses is carried out by specialists in diabetic foot outpatient clinics and using special devices. With these methods, the risk of wound formation can be reduced by about 50 percent on the feet whose calluses are cleaned regularly.