Diabetic feet: symptoms, complications, treatment
A formidable complication of diabetes, diabetic feet are the cause of one amputation every 30 seconds around the world. Meeting with Dr. Ha Van, author of the book Diabetic foot syndrome and co-founder of the Multidisciplinary Podiatry Unit.
What are diabetic feet?
Diabetic foot is one of the most dreaded complications of diabetes. Indeed, when the latter is not balanced, chronic hyperglycemia can induce neuropathy, that is to say, damage to the peripheral nervous system. “This neuropathy of the lower limbs significantly disrupts pain sensitivity, especially in the feet, said Dr. Ha Van, a specialist in Physical Medicine and Rehabilitation, co-founder of the Multidisciplinary Unit of Podiatry. Patients are less perceive small wounds: blister, badly cut nail, horn at the points of support. However, these skin lesions, if we are not careful, can become infected and degenerate into gangrene if the foot is poorly vascularized. Amputations related to the diabetic foot often find their origin in a small wound that could have been avoided … “
What are the symptoms?
Diabetic neuropathy is often a silent pathology. The hyperglycemia chronic eventually alters the nerves. Symptoms vary from patient to patient and may initially be tingling or painful. The patient may also present with cold and heat sensitivity disorders as well as a reduction in the sensation of pain: he then no longer perceives the traumas that may occur on the foot and injure himself without noticing it. “The neuropathy will insidiously cause disturbances in the walking pattern and the morphology of the foot who will become at high risk for superficial injuries confirms Dr. Ha Van.
“The occurrence of a wound on a completely insensitive foot and more or less well vascularized is the number 1 enemy”
” These can give way to ulcerations of the skin. The foot also often suffers from dry skin causing cracks, real wounds sources of infection. Calluses next to the deformities can also cause subsequent injuries. of a wound on a completely insensitive foot and more or less well vascularized is the enemy number 1! “.
What are the causes?
When diabetes is not well controlled, chronic hyperglycemia (high blood sugar) affects the functioning of the nerves. To this neuropathy of the lower limbs can be added arteritis, that is to say, an alteration of the arteries which will reduce the supply of oxygen to the feet. “This poor tissue vascularization causes wounds to spread and not heal,” says Dr. Ha Van. The risk of arthritis is estimated to be 2 to 5 times higher in diabetics compared to non-diabetic patients …
What are the complications?
In the event of a wound (blister, improperly cut, ingrown nail, etc.) that goes unnoticed or is slow to be treated, the wound can become infected and degenerate into gangrene in the event of associated diabetic arteritis. “Nearly 10% of diabetics are at risk of amputation, confirms the Federation of Diabetics. It is little and a lot at the same time because there is every year around the world, it is estimated that every 30 seconds a leg is amputated due to complications of diabetes.” In France, between 2008 and 2014, the hospitalization rate for diabetic foot wounds fell from 508 to 701 per 100,000 diabetics, but at the same time, the amputation rate fell from 301 to 262 per 100,000 diabetics. ” PIt is true that with optimal care, we are hospitalized more often for a foot wound but that we are less amputated “adds the specialist.
When and who to consult?
As a first-line treatment, a general practitioner should be consulted who will then refer the patient to a specialist if necessary. “You can also go to a center specializing in diabetic feet which, thanks to its multidisciplinary care (diabetologist, podiatrist, orthopedic surgeon, vascular surgeon, angiologist, infectious disease specialist, etc.). It will allow you to receive appropriate care and prevent recurrences ” confides Dr. Ha Van.
What exams to do?
It is advisable to have the sensitivity (monofilament test) and vascularization of his feet checked every year to detect possible complications of diabetes (neuropathy, arterial disease) or wounds.
→ For information, the classification described by Wagner in 5 stages has not been used by real specialists for more than 25 years. We no longer rely on a classification to amputate or not.
What are the treatments for diabetic feet?
The treatment of a chronic wound of the diabetic foot requires a multidisciplinary approach. “The first step is to re-establish the conditions for good healing through strict relief of the foot, to which antibiotic therapy, tissue revascularization, or surgical debridement will be added if necessary,” explains Dr. Ha Van. Quick treatment in a referral center increases the chances of recovery and avoids amputation.
“It is essential to abolish all bathroom self-pedicures”
Diabetes foot amputation: at what grade?
Amputation takes place as a last resort, when all the treatments are undertaken have been too late or when the foot can technically no longer be revascularized.
What prevention to avoid recurrence?
Patients must be regularly monitored, treat their wounds early, and prevent the risk of recurrence through pedicure care and the wearing of suitable shoes. “When there has been a chronic wound of the diabetic foot, after healing, the recurrence rate is 40% the first year, recalls the specialist. This is why it is essential to educate the patients. Health professionals – chiropodists, nurses, and doctors – must ensure regular monitoring of these high-risk feet. Because the patient, since he feels few symptoms, has difficulty taking care of himself and himself. is often surprised by the appearance of painless wounds and infections … potentially very serious! ”
→ Health insurance covers pedicure care at the rate of 6 sessions per year for diabetic patients who have already had a wound lasting more than 1 month and 4 times per year for those with neuropathy with arteritis or deformity feet. ” It is essential to abolish all self-pedicure in the bathroom, insists
→ Shoes: “The shoe should have an anterior chamber that is wide and high enough for the patient’s foot” advises Dr. Han Van. But no need to take shoes that are too big for more comfort. The foot being loose in a shoe that is too large rubs more on the upper of the shoe and injures itself more.