Effective and Definitive Treatment of Diabetic Foot

Diabetic foot treatment

Diabetic foot is a common complication of chronic diabetes, which is formed as a result of narrowing and occlusion of the peripheral arteries that supply the limbs, or as a result of malfunctions of the nervous system; Which leads to the loss of some of the basic functions entrusted with maintaining the integrity of the feet.

Diabetic foot causes:
Diabetic foot is not considered a specific disease, but it is a specific group of pathological conditions that lead to the description of the diabetic foot, in which damage to the foot occurs as a result of various factors, namely:

1- Peripheral Neuropathy:
Sensory nerves are damaged and thus the feeling of the hands and feet disappears, including the feeling of heat, cold or pain, and therefore the patient may not feel obstacles while walking like a healthy person, which exposes him to multiple wounds that become an entry point for infection.
The sympathetic nerves also malfunction, resulting in a lack of sweat secretion; Therefore, the skin of a diabetic patient becomes dry and has cracks, which allows the entry of germs and bacteria and infections.

2- Vasculopathy:
The development of wounds occurs in a negative direction due to the lack of blood flow; This takes longer to heal, can cause bacteria to multiply, and the patient is at risk of gangrene and tissue death from lack of blood.

3- Osteopathy, joints and ligaments:
Due to sensory neuropathy and its imbalance in pressure and vibration, a diabetic patient becomes unaware of his feet and according to Newton's third law "for every action there is an equal and opposite reaction"; So every unstable step results in pressure in the patient's body and causing microscopic fractures around the joint, but the patient will not feel it; So he continues to walk this way on the affected foot and ends up with Charcot's foot due to a bone protruding from the bottom of the foot. Charcot foot is a disorder of the foot in terms of form, function and progresses to dislocation of the joint and the patient may go for amputating his leg from below the knee.

High level of glucose in the blood for long period of time affect the arteries of the body and cause the presence of these factors that threaten the feet of diabetics to develop diabetic foot.

Diabetic foot treatment methods:
Treatment depends on the speed of diagnosis after the appearance of some of the initial symptoms, including:
- Feeling pain.
- Changes in skin color and skin temperature.
- Cracks in the skin.
- Sunken or fungus-infected nails.
- Foot ulcers that are slow to be healed.
- Unusual swelling, irritation and redness.
- An unusual smell in one or both feet.
- The black tissue surrounding the ulcer, which is the most obvious sign of the diabetic foot, due to the lack of proper blood flow to the area surrounding the ulcer, causing partial or complete diabetic foot gangrene, which indicates the rotting and death of tissues due to infection.

The treatment for diabetic foot varies according to the degree and severity of the case. There are many treatment options available, and here are some of the treatment details:

Non-surgical treatment:
Usually, a doctor will first try to treat diabetic foot problems without using surgery. Some non-surgical methods which include:
- Keeping the wounds clean.
- Constant monitoring of the foot in anticipation of gangrene in the toes, due to the interruption of blood flow to it.
- Wearing supportive shoes to protect the feet for 6 months, especially in cases of Charcot's foot, to avoid fractures and dislocation of joints.
- Avoid walking because the pressure of walking on the foot may increase ulcers and persistent pain in the foot.
- The doctor prescribes medical treatments.
- Patients with mild infections can be treated with antibiotics.
- Regulating blood glucose level, either by taking medication or by injecting insulin.
- Remove dead skin to prevent infection of the ulcer.
- Pharmacotherapy to control peripheral neuropathy may be followed by the use of pressurized oxygen.

Dealing with diabetic foot infection:
Infection is a serious complication of diabetic foot ulcers and requires immediate treatment. Not all infections are treated the same way or given the same antibiotic, but the tissue around the ulcer may be sent to a laboratory to determine the type of antibiotic most appropriate to control and eliminate the infection. If the doctor suspects a serious infection, the patient may need an X-ray to look for signs of a bone infection.

Other treatments:
In some patients, the condition of the diabetic foot may reach advanced stages, requiring various interventions to treat the ulcers and reduce pressure on them by removing the deformities in them, to prevent the ulcers from becoming worse, and their only treatment is amputation. The doctor may also consider surgery for gangrene of the foot. Options include:
- In cases of vasculopathy, non-surgical intervention is recommended through the therapeutic catheter, which is done by inserting a simple needle into the upper thigh artery, under the influence of local anesthesia, until the occlusion is reached and photographed. A peripheral catheter is used to open closed blood vessels through the balloon that is opened. In some cases, Prof. Dr. Hossam El-Mahdy places stents to keep the blood vessels open and to ensure that the leg receives important substances and oxygen through a healthy blood circulation. It is also possible to deal with impaired blood circulation by undergoing interventional radiology.
- Blood flow diversion surgery to restore blood flow to the peripheral blood vessels.
- If the gangrene is very advanced, the appropriate solution is amputation. The degree of amputation varies according to the progression of the gangrene, from amputation of the affected fingers to the amputation of the leg below the knee.

Dealing with Chronic Wounds:
- Surgical cleaning to remove decaying and dead tissue.
- Use a passive air suction device.
- Discharge the pressure under the ulcer.
- The application of modern dry dressings, which vary in the materials used, whereby the choice is made among them according to the condition of the ulcer; Therefore, it is necessary to consult the best vascular surgeon, Prof. Dr. Hossam El-Mahdy, who has sufficient experience to choose the most appropriate type of treatment for each ulcer.

Diabetic patient care:
There are some tips that reduce the chance of diabetic foot ulcers, including the following:
1- Controlling blood glucose level.
2- Washing the feet daily with warm water and take care of drying them well.
3- Accurate examination for the foot daily.
4- Cutting the nails in a transverse way and stay away from cutting them in a circular way, which means, avoic cutting the corners or sides of the nails, so as not to cause any side wound during the cut.
5- Using moisturizing creams to prevent cracks.
6- Making sure to wear closed-toed shoes or slippers, even indoors.
7- Maintaining blood flow to the foot by raising it when sitting and moving the toes several times a day.
8- Stop smoking to avoid exacerbating blood flow problems.

In the clinics of Dr. Hossam El-Mahdy, Professor of Vascular Surgery and Diabetic Foot Treatment at Kasr El-Ainy Medicine and a Fellow of the Royal College of Surgeons of England, you can get the best ways to treat diabetic foot instead of exposing its unlimited risks, as the treatment includes cleaning the wounds and removing dead tissues in the feet, in addition to reducing the pressure on the feet and improving blood circulation through peripheral catheterization and other methods that aim to improve the quality of life for diabetic foot patients.