Diabetic foot
Diabetes mellitus, a disease characterized by high blood sugar, is a major health problem and a frequent cause of hospitalization.
Most foot problems in diabetic patients occur due to damage to the blood vessels. This damage leads to two main problems:
- Poor blood supply to the nerves impairs the sensitivity of the feet;
- Poor blood supply to the skin and the foot in general makes it difficult for wounds to heal. Therefore, diabetic patients have problems with wound healing. Non-healing wounds create an opportunity for bacteria to enter the foot, leading to the development of diabetic foot infections.
The nerve damage that occurs with diabetes is called diabetic neuropathy. One of the most serious foot conditions resulting from diabetic neuropathy is Charcot's arthropathy (also known as Charcot's neuroarthropathy or simply Charcot's foot). This condition results from undetected damage to the bones of the foot that can lead to significant deformity and disability.
Charcot arthropathy is a condition of the foot and ankle caused by the inability to feel injuries, which can lead to significant deformities.
Patients with diabetes and neuropathy may suffer fractures or dislocations of the foot without realizing it.
The injuries occur as a result of obvious traumatic events such as falls or ankle sprains.
The disease develops slowly over time due to changes in weight distribution on the diabetic foot. Unevenly distributed forces on the foot cause pain, causing the patient to automatically adjust their position and redistribute weight before injury or damage to the foot occurs. However, a diabetic patient does not feel pain and cannot properly distribute the load on the foot, so these forces can cause fractures and other injuries.
Without feeling pain, a diabetic patient may continue to walk with an injured foot, aggravating the injury and leading to significant deformity. Only about 25-50% of patients with Charcot foot note the specific injury.
As previously mentioned, neuropathy contributes to the development of Charcot foot. However, there are other risk factors as well:
- Obesity is the most significant risk factor;
- The risk of developing Charcot in diabetic patients also increases with age.
The resulting Charcot foot deformities can lead to a number of problems:
- They can make it difficult or even impossible to wear shoes normally;
- Ulcers or sores can form due to excessive pressure on the skin. Once the skin is damaged, the risk of developing an infection in the foot is very high, and the damage to blood vessels makes it difficult for diabetics to heal wounds and fight infections.
Symptoms
Although patients with Charcot arthropathy usually do not experience severe pain, they may have other symptoms.
The earliest sign of Charcot disease is swelling of the foot, which can occur without obvious trauma.
The redness that occurs in the foot in the early stages is a normal inflammatory response to injury.
Swelling, redness and warmth can be confused with infection. However, infection is very unlikely if there is no wound on the skin. In a diabetic patient whose foot is swollen in the absence of a wound, the likely diagnosis is Charcot's disease.
Diabetic foot - prevention
There are many treatment options for diabetic foot. However, the best treatment is prevention. Strict control of blood glucose levels and daily foot examinations in diabetic patients are essential for both overall health and prevention of complications.
The best prevention of diabetic complications is compensation of carbohydrate metabolism, which is expressed by the glycohemoglobin index. A visit to an endocrinologist will help to manage diabetes, after which a neurologist and angiologist may need to be consulted.
