The eternal regret of "sugar" - diabetic foot

Diabetic foot is a unique clinical manifestation of diabetic patients. It is one of the serious vascular complications of diabetes and an important cause of disability and death in diabetic patients.

If combined with lower limb arteriosclerosis, it can cause limb ischemia, intermittent claudication, rest pain, night pain, and in severe cases, weakened or absent dorsalis pedis artery pulsation, leading to tissue ischemic necrosis. If combined with neuropathy, lower limb sensation is reduced or absent, local resistance is weakened, and minor trauma, such as squeezing by ill-fitting shoes, local calluses, improper treatment of corns, and minor skin trauma, can cause infection. Due to the weakening or disappearance of pain, the lesion cannot be discovered in time, causing the wound to expand rapidly, resulting in foot infection, plantar ulcers, and gangrene of the toes and heels. Once the skin of the foot is damaged, the wound is difficult to heal, and the infection spreads rapidly, which can cause suppurative skin infection and even osteomyelitis, which can be life-threatening in severe cases. This shows the importance of foot care for diabetic patients.

Risk factors for diabetic foot

Diabetic peripheral neuropathy is the main risk factor for diabetic foot ulcers, which causes patients to be insensitive or lose sensations such as pain, temperature, vibration, pressure, and touch, and a part of the foot is overly compressed and injured without being felt. Patients experience burning pain, tingling pain, and alternating hot and cold sensations, which often worsen at night. Disuse atrophy of the lower legs, hypohidrosis, and dilatation of the dorsal veins of the feet may occur, which can lead to arteriovenous shunts and produce a warm foot sensation, that is, a warm but insensitive foot, which is an extremely "high-risk" foot. Loss of sensation is the main "alarm symptom" of foot ulcers, and more than 50% of diabetic patients have obvious neuropathy and "high-risk" feet.

Diabetic vascular disease is the main factor affecting prognosis. The skin color of the patient's lower limbs becomes darker, the temperature decreases, the fluctuation of the dorsalis pedis artery weakens or disappears, the blood pressure at the ankle decreases, and arteriosclerosis and thrombosis form, leading to vascular stenosis and blockage. The blood flow is blocked or the blood viscosity increases, which causes microcirculation disorders and obstruction of blood supply to the feet. Reduced blood circulation and malnutrition of the extremities cause ulcers, gangrene and tissue necrosis.

Peripheral vascular disease of the lower extremities is extensive and rapidly progressive, with multiple sites and segments. Chronic severe ischemia may present as persistent, ischemic, static pain. It should be noted that some patients have extensive ischemia but no symptoms because of peripheral neuropathy that causes loss of sensation. Vascular sclerosis occurs at a younger age and is more common.

Diabetic neuropathy and vascular disease weaken the foot's ability to resist infection, making it vulnerable to bacteria and fungi. After infection, it is difficult to heal and osteomyelitis often occurs. In addition, foot trauma, burns, frostbite, etc. induce secondary infection and can also form gangrene.

2. Good blood sugar control is the key to preventing diabetic foot

Adhere to the correct use of medication and monitor blood sugar regularly, adjust the dosage and type of medication in time according to the blood sugar value, maintain a stable mood and good sleep. As long as you pay attention to it subjectively and control blood sugar within the ideal range, you can lay a good foundation for effectively preventing the occurrence of diabetic foot.

3. Foot care knowledge for diabetic patients

1. Wearing shoes:

1. Wear soft leather, cotton or lycra flat shoes that are loose fitting and allow your toes to stretch comfortably. Generally, cloth shoes are better than leather shoes, which are better than plastic shoes.

2. Do not wear "small shoes". Especially female patients, do not follow the fashion and wear pointed high heels, which will cause bone deformation and callus in the long run.

3. Check the inside of the shoes for foreign objects and rough seams before wearing them. The lining of the shoes should preferably be a whole piece of leather or cotton.

4. When wearing new shoes, check whether your feet are squeezed or rubbed within half an hour on the first day.

5. For those with foot deformities, special orthopedic shoes should be customized to correct the load-bearing points of the feet and prevent the feet from being abraded.

6. Do not walk barefoot or wear flip-flops. Do not wear sandals when going out.

2. Wearing socks:

1. Don't wear garter stockings, elastic socks, socks with holes or uneven repairs.

2. Socks should be made of pure cotton or wool, soft and fit well, breathable and absorbent. Socks that are too small or too tight will compress the dorsalis pedis artery and affect blood circulation in the foot.

3. Change and wash your socks every day. If you sweat a lot, you can put a little talcum powder in your shoes and socks.

3. Washing feet

1. Soak your feet in warm water for 10 to 15 minutes every night, which can not only keep your feet clean but also promote blood circulation.

2. Ask your family to help test the water temperature before washing your feet. 30℃ ~ 40℃ is enough. Avoid using hot or scalding water.

3. After washing your feet, dry them carefully with a light-colored soft towel (also dry the spaces between the toes) to detect skin damage, bleeding, or exudation in a timely manner.

4. Use hand cream, glycerin or urea ester prepared by the hospital, and apply it evenly on the instep, sole and heel after washing your feet every day, but do not apply it between the toes, and keep the toes dry.

5. Do not take a sauna or hot bath.

Four -legged warmth

1. Do not use a hot water bottle or hot water bag to warm your feet directly. If you must use a hot water bottle, wrap it with a towel. Try not to use an electric blanket.

2. Don't get too close to the fire when you are warming yourself. Diabetics with neuropathy often cannot perceive temperature changes in time and are prone to burns.

3. If your feet feel cold at night, you should wear socks.

4. Prevent foot injuries and frostbite. Check the foot frequently for risk factors, such as lacerations, insect bites, blisters, redness, swelling, discoloration, and temperature changes. Once found, they must be properly handled.

5. Foot Care

1. Toenails should be trimmed frequently, but care should be taken to avoid cutting them too close to the skin to avoid damage and infection; the edge of the nail should be flush with the webbed toes; after trimming the nail, grind the edge into a smooth arc, leaving no sharp corners.

2. Do not go to public bathrooms for pedicure to avoid cross infection.

3. If corns, bone spurs, paronychia, cysts or tinea pedis occur, you should consult a medical professional and avoid using ointments to treat them on your own.

4. Do not trim the thick calluses on the feet by yourself and do not apply corrosive ointments or medicines to avoid skin ulcers.

5. Do not treat blisters or blood blisters on the feet by yourself. Seek medical treatment from a doctor to avoid skin ulcers or gangrene.

6. To prevent chapped skin caused by dry skin, especially around the heels, you can use wet compresses and apply ointment after bathing.

7. Do not use adhesive tape that may damage the skin.

8. To prevent infection, people with tinea pedis and secondary infection should wash their feet with a 0.2 ppm potassium permanganate aqueous solution three times a day and seek early diagnosis and treatment from a dermatologist.

6. Foot examination

1. Hospital check-up: Prevention of diabetic foot ulcers and amputations begins when diabetes is diagnosed and should be continued. Patients should go to the hospital for a check-up once a year, and if there are complications, they should be checked once a quarter. Diabetic patients should ensure that their feet are checked every time they visit the hospital. Patients with ulcers on the soles of their feet should have follow-up visits more frequently, and can have a follow-up visit every 1 to 3 weeks; patients with loss of sensation in the feet can have a follow-up visit every 3 months.

2. Self-examination: Since diabetic patients generally suffer from lower limb neuropathy and have no obvious pain sensation, patients’ self-monitoring mainly relies on vision. The condition of the feet can only be well observed when the distance between the heel and buttocks is less than 15 cm and the distance between the forehead and toes is less than 65 cm.

3. If a diabetic patient has poor eyesight, he or she should ask family members for help.

4. Daily inspection: The patient takes off his shoes and socks and inspects the entire foot (including the skin between the toes). The patient's toes, between the toes and soles should be observed for damage, foot deformities, trauma, calluses or bullae, toenails should be checked for tearing, shoes should be checked for foreign objects, and local pressure areas of the foot should be noted.

5. The “four steps” of self-examination: In addition to going to the hospital for examination, diabetic patients can also conduct self-examination to determine whether they are suffering from diabetic foot.

1) Twist cotton into a pointed shape and gently stroke the instep and foot skin to see if you can feel it. If you can't feel it, it means that the light touch sense has disappeared or decreased;

2) Touch the skin of your feet with a cool metal object to check if the skin feels cool. Soak your feet in warm water at 37 to 37.5 degrees Celsius to check if you feel warmth. If you do not feel any warmth, it means that your feet have obviously lost their temperature sensation.

3) Use the blunt end of a pin (or sewing needle) to touch the skin of the foot to see if there is any feeling. If there is no feeling, it means that the sense of touch is reduced;

4) Use your fingers to touch the skin of the instep near the ankle to check for the presence of the instep artery pulsation and the strength of the pulsation. You can compare it with the instep artery pulsation of a normal person. If you cannot feel the pulse or the pulse is very weak, it means that the instep artery is not receiving enough blood. This often indicates that there is a stenosis or obstruction of the large artery at the upper end of the instep artery.

Seven sports and massage

1. Do not exercise if the foot skin is already damaged. If there are open lesions such as skin ulcers, pus, inflammation, gangrene, etc., you should stay in bed and rest.

2. Walk briskly or jog for half an hour after a meal to speed up blood circulation, improve blood supply to the feet, and promote nutrition of the skin of the feet.

3. Do not rub too hard during local massage to avoid damaging the skin.

4. Avoid strenuous exercises such as hiking and running.

5. Try to avoid standing for long periods of time: Because the foot is the end of the lower limbs, the blood and oxygen supply are less than other tissues. Especially when the patient's blood sugar is not well controlled, the microcirculation of the foot will be disturbed, the blood and oxygen supply will be significantly reduced, and the hidden danger of diabetic foot will occur. Especially in the cold winter, the capillaries in the lower limbs will contract significantly, and the blood circulation of the skin will be affected to a certain extent. Therefore, patients should choose suitable cotton shoes and comfortable and warm pants.

6. Eight Exercise Methods

1) Dry leg massage: Hold one thigh tightly with both hands, and massage from the top of the thigh to the ankle with a little force, and then massage from the ankle back to the thigh. Use the same method to massage the other leg, and repeat 10-20 times to promote blood flow.

2) Leg swinging: Hold the wall or tree with one hand, swing the calf forward first, lift the toes upward and forward, then swing it backward, straighten the feet and legs, and swing the legs alternately, 80-100 times each time, to increase muscle strength and promote blood circulation.

3) Rub the calf: Hold the calf tightly with both palms and rotate and rub it, 20-30 times on each side, alternating between the two legs 6 times, to clear the blood vessels and increase the strength of the leg muscles.

4) Twist the knees: Place your feet parallel and close together, bend your knees and squat slightly. Place your hands on your knees and rub them clockwise for dozens of times. Then switch to rubbing in the other direction. This can treat lower limb weakness, knee joint pain and unblock blood vessels.

5) Toe bend: Sit upright with legs straight, head down, body bent forward, and bend toes with both hands 20-30 times. This can exercise the waist and legs, increase foot strength, and prevent foot weakness.

6) Rub your feet: Rub your palms together to warm them up, then rub the soles of your feet 100 times each. This can prevent foot pain, fatigue, and numbness, and promote blood circulation in your feet.

7) Leg kicking: Before going to sleep, lie flat on the bed, hold the back of your head with both hands, and do leg kicking exercises from slow to fast, 3 minutes each time, then switch to the other leg, and repeat 8 times. This can make the blood flow smoothly in the legs.

8) Rolling a paper ball: Put two pieces of waste newspaper (or other paper) in an empty large basin, step into the basin with one foot, roll the newspaper into a paper ball with one foot, then change the paper and repeat the rolling with the other foot. This method is not only suitable for diabetic patients, but also very suitable for the elderly with poor foot sensation and movement. It can improve the flexibility and sensory function of each joint of the foot and promote blood circulation in the foot.

Eight minor wound treatments

1. When there is a small wound on the skin, do not use sticky tape to bandage it to prevent the skin from being torn during removal, causing the wound to become larger, bleeding, or new damage.

2. Carefully handle wounds: Even small wounds on the feet of diabetics take a long time to heal, so they must be treated with extreme care. If there is nerve damage, you may not feel the irritation and pain of the wound. Any injured skin is very susceptible to infection, which can lead to serious consequences.

3. For minor wounds:

* You should first clean the injured area thoroughly with a disinfectant (such as alcohol) and then cover it with sterile gauze.

* Avoid using strong disinfectants such as iodine.

* Do not use dark-colored disinfectants such as gentian violet, as the color of the drug will cover up signs of wound infection.

* Do not use plasters, corn ointments or corrosive acidic drugs to avoid skin ulcers.

* If the wound does not heal within 2-3 days, seek medical attention as soon as possible. Do not treat the wound without medical advice.

9. Other matters needing attention

1. Since smoking can cause limb blood vessel spasms and aggravate tissue ischemia, you must quit smoking.

2. Once you get sick, seek treatment early. Don’t neglect the disease and end up having to undergo amputation.

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