Diabetic Feet

  • Diabetic Feet

Diabetic patients are prone to ulceration and infection of the foot which may progress to tissue damage requiring amputation. This is due to a combination of vascular disease and neuropathy.

What are Diabetic Feet?

Sensory neuropathy robs the diabetic foot of the protective mechanism of pain allowing ulceration to develop in response to minor trauma or rubbing.

 

Autonomic neuropathy reduces sweating and opens arteriovenous shunts in the foot.  The diabetic foot is typically warm, may have strong pedal pulses and dry, cracked skin.  The skin fissuring allows entry of bacteria causing localised infection.

 

Motor neuropathy causes wasting of the small intrinsic muscles of the foot with collapse of the longitudinal and transverse arches.  Abnormal pressure areas then develop which progress to ulceration.


Diabetic Peripheral Arterial Disease (PAD) restricts bloodflow to the feet and exacerbates infections and impairs wound healing. 

What part of the body do they affect?

Diabetes impairs the function of the nerves and blood vessels supplying the feet.  This makes them prone to small cuts and pressure ulcers which allow infection to enter and spread through the foot.

What are the treatment options?

Good diabetic control and regular assessment by a diabetes podiatrist are the cornerstones of prevention of diabetic foot problems.

 

Diabetic foot ulcers are a serious condition and can lead to amputation of the leg.  For this reason any diabetic patient with a foot ulcer should be assessed by a specialist working as part of a multidisciplinary team.

 

Mr Ian Franklin established the multidisciplinary diabetic foot service at Charing Cross Hospital and works alongside Dr Nick Oliver, Consultant Diabetologist, and a team of specialist diabetes podiatrists to treat patients with diabetic foot problems and prevent amputation.

 

Treatment options for simple ulcers include podiatry and orthotics:

Diabetic foot ulcers caused by restricted blood flow are more serious and may require angioplasty or stenting.  More serious cases may need surgical bypass grafting to improve blood flow to the foot and enhance healing of the ulcer.

 

Is the condition preventable? If so, how?

Management is aimed at prevention by careful foot care.  Good diabetic control helps reduce the severity of foot complications.  There is no specific treatment for neuropathy.  Localised infections should be treated with debridement (surgical removal of infected tissue)  Plain X-rays may show evidence of osteomyelitis (bone infection) and MRI is an accurate way of defining the extent of infection in the foot. 

 

The outcome for patients with diabetic foot problems is greatly improved by multidisciplinary team-working including diabetes specialist, vascular surgeon, radiologist, and microbiologist.  After treatment, ongoing care with a specialist podiatrist and surgical appliance technician to ensure good footwear are beneficial.

What should I do next?

It is crucial to maximise the blood flow into the foot.  Angioplasty works quite well for the larger arteries but is less reliable for the small arteries around the ankle.  Here, bypasses using microsurgical techniques are highly effective at promoting blood flow into the foot to aid healing of wounds.

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