Diabetic foot symptoms, causes, and how to avoid this common diabetes mellitus complication
Diabetic foot is a common complication of uncontrolled diabetes, caused by neuropathy, infection, and poor blood flow. It leads to ulcers, loss of sensation, and delayed healing, often progressing to gangrene if untreated. Proper foot care, infection control, blood sugar monitoring, and timely medical intervention are vital to prevent severe complications.
Increasing prevalence of diabetes worldwide Diabetes has been becoming increasingly common worldwide. While a person with diabetes may not notice a lot of difference, the physiology of the body is certainly altered, and the increased blood sugar levels can lead to deleterious effects if not timely checked. (Images: Canva)
Common complication of uncontrolled diabetes Diabetic foot is one of the most common complications of uncontrolled diabetes mellitus. It refers to an infection or ulceration of the foot, along with destruction of the tissues in the affected area. It can often be associated with a neuropathy as well.
Underlying mechanisms of disease The etiopathogenesis underlines the simultaneous effect of neuropathy, raised blood glucose leading to infection, and involvement of the blood vessels. Neuropathy causes a loss of sensation, whereas ischemia from peripheral vascular disease leads to delayed healing.
Role of infection and necrosis Concurrent infection works to worsen the necrosis of the underlying tissues. The three mechanisms result in the formation of ulcers that do not easily heal. Such infected ulcers, when left untreated, can serve as predisposing factors to the formation of gangrene.
Effect of nerve involvement The involvement of nerves causes a loss of pain sensation and deformities. More often than not, the affected individual fails to realise the presence of an ulcer, as there is no associated pain. Alongside, the skin becomes dry and develops fissures, contributing to the development of infection.
Impact of peripheral arterial disease Peripheral arterial disease is a common occurrence in people with diabetes, as there is development of atherosclerosis. The arteries are unable to provide enough blood/oxygen to the foot, which impairs wound healing. This can subsequently cause necrosis of the foot and absent pulsations distally.
Increased risk of infection As a consequence of reduced immunity and increased blood glucose levels, the incidence of infections increases. They are frequent and severe, and must be managed timely to avoid further complications. Common organisms responsible include Staphylococcus, Streptococcus, and Gram negative organisms.
Typical presentation and symptoms A person with diabetic foot may present with ulcers that seem to not be healing, and are accompanied by a foul discharge. There are also complaints of swelling and pain. Pain may not be a primary complaint, and may even be absent in a number of cases because of concurrent nerve damage.
Clinical examination findings On examination, it may be found that the person has callosities and deformities, along with a loss of sensation. The peripheral pulses may be reduced or absent, and secondary infection becomes common. Ultimately, the ulcer can become gangrenous.
Investigations and preventive care Investigations like blood sugar levels, HbA1C, and a urine analysis may be advised by the healthcare provider. A Doppler ultrasound aids in identifying any issues with the arterial flow in the lower limbs. A wound swab culture can help identify the causative organism. It is necessary to care for the foot and maintain all aseptic precautions to avoid further damage. (Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis)
