Diabetic foot

What is diabetic foot

Diabetic foot is one of the most significant and devastating complications of diabetes, and is defined as a foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes.

Long term unregulated diabetes causes nerve damage and poor blood flow, and as a consequence you may develop serious infections from even a minor cuts, that can even lead to gangrene and amputation.

Common foot problems with diabetes

  • Athlete’s footfungus that causes itching, redness, and cracking. Germs can enter through the cracks in your skin and cause an infection.
  • Fungal infection of nails – Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick, and brittle and may separate from the rest of your nail. In some cases, your nail may crumble.
  • Calluses–  buildup of hard skin, usually on the underside of the foot. Calluses are caused by an uneven distribution of weight.
  • Corns– buildup of hard skin near a bony area of a toe or between toes. Corns may happen because of pressure from shoes that rub against your toes or cause friction between your toes.
  • Diabetic ulcers – A foot ulcer is a break in the skin or a deep sore. They can become infected. Foot ulcers can happen from minor scrapes, cuts that heal slowly, or from the rubbing of shoes that do not fit well.

Signs of a diabetic foot problems

  • Changes in skin colour or temperature
  • Swelling in the foot or ankle
  • Pain in the legs
  • Open sores on the feet that are slow to heal or are draining
  • Ingrown toenails or toenails infected with fungus
  • Corns or calluses
  • Dry cracks in the skin, especially around the heel
  • Foot smell that is unusual or won’t go away


Complications of diabetic foot problems

Skin and bone infections – If you have nerve and blood vessels damage even a small cut or wound can lead to infections. Infections can be treated with antibiotics. Severe cases may require treatment in a hospital.

Abscess – Sometimes infections eat into bones or tissue and create a pocket of pus called an abscess. The common treatment is to drain the abscess. It may require removal of some bone or tissue, but newer methods, like oxygen therapy, are less invasive.

Gangrene – Diabetes affects the blood vessels that supply your fingers and toes. When blood flow is cut off, tissue can die. Treatment is usually oxygen therapy or surgery to remove the affected area.

Deformities – Nerve damage can weaken the muscles in your feet and lead to problems like hammertoes, claw feet, prominent metatarsal heads (ends of the bones below your toes), and pes cavus, or a high arch that won’t flatten when you put weight on it.

Charcot foot – Diabetes can weaken the bones in your foot so much that they break. Nerve damage can lessen sensation and prevent you from realizing it. You keep walking on broken bones and your foot will change shape. It might look like your arch has collapsed into a rocker shape.

Amputation – Problems with blood flow and nerves make it more likely for people with diabetes to get a foot injury and not realize it until infection sets in. When an infection can’t be healed, creates an abscess, or if low blood flow leads to gangrene, amputation is often the best treatment.

Treatment of Diabetic foot

The gold standard for diabetic foot ulcer treatment includes debridement of the wound, management of any infection, revascularization procedures when indicated, and off-loading of the ulcer.

Revasculatization is reopening of the blocked blood vessels via stenting or ballon dilation.

Procedure – Diabetic foot dilation

This procedure is done under the local anesthesia, but you may get a mild sedative. A breathing tube is usually not required, however, some patients may require general anesthesia.

The specialist will make a small incision on site after which he will insert a catheter into the blood vessel. Once the catheter is in place, contrast material will be injected into the artery to perform an angiogram (an x-ray picture of the inside of the blood vessels) which will help identify where the blockage is. As the contrast material passes through your body, you may feel warm. This will quickly pass.

When he identifies where the blockage is he will guide the balloon to the site and inflate it.

Sometimes using just a balloon dilation is not able to sufficiently widens the artery   and he will need to place a stent.

When the procedure is complete, the catheter is removed and pressure is applied to stop any bleeding. Sometimes, your doctor may use a closure device to seal the small hole in the artery. 

When the procedure is done, you will be transferred to a recovery room or to a hospital room and usually you can go home the same day.

How should you prepare for this procedure

It’s important to tell your doctor about any medication you take, especially if you are on any blood thinner. Women should inform the medical staff if they are pregnant or suspect that they might be.

The night before the procedure you should have a light meal. You shouldn’t drink any alcoholic beverages at least 24h before the procedure.

On the morning of procedure, take only the medications that your doctor told you to take with a sip of water.

Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.


Recovering from the procedure

This procedure does not require an overnight hospitalization.  In general, you should be able to go home a few hours after the procedure is completed.

At home, you should rest and drink plenty of fluids. Avoid lifting heavy objects and strenuous exercise for at least 24 hours. 

After the procedure, you may be prescribed aspirin or blood thinners. These drugs can prevent blood clots from forming. Your doctor will monitor the effect of some medicines with frequent blood tests.