Early symptoms and treatment methods, what patients with diabetic foot need to know!

Author: Cui Lei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

Reviewer: Wu Xueyan, Chief Physician, Peking Union Medical College Hospital

According to statistics, there are currently 120 million to 150 million diabetic patients in my country, and the incidence of diabetic foot accounts for about 10%-15% of the entire diabetic population, so there are also a large number of diabetic foot patients in my country.

1. Why does diabetes lead to diabetic foot?

The most basic change of diabetes is high blood sugar, which can cause blood vessels in the limbs to become blocked or narrowed. After blood vessels are blocked or narrowed, the blood supply to the tissues will be interrupted or reduced. In this case, if wounds appear in the limbs, it will be difficult to heal.

In addition, its pathological changes not only involve blood vessels, but also peripheral nerves. Peripheral nerves include motor nerves and sensory nerves. When motor nerves are damaged, muscle movement will be damaged.

Many diabetic patients suffer from minor injuries to their feet, which lead to small wounds that gradually expand and eventually develop to the point of amputation. Many friends may wonder why these small wounds cannot be controlled in diabetic patients?

The main reason is that diabetes not only affects motor nerves, but also damages sensory nerves. For example, if there is a stone in the shoe, we will quickly find and throw it away if we feel good. But when the sensory nerves are damaged, we can no longer feel the existence of the stone, and it will break the skin if we keep hitting it, causing wounds.

In addition, when the sensory nerves are damaged, the sense of water temperature will become dull. When washing feet in relatively hot water, diabetic patients will not feel that the water temperature is very high and will easily get scalded. This minor burn will also lead to the further development of diabetic foot.

Therefore, the onset of diabetic foot is usually caused by the combined effects of damaged blood vessels and nerves.

Figure 1 Original copyright image, no permission to reprint

2. What are the early symptoms before diabetic foot occurs?

The early symptoms of diabetic foot are based on the basic damage that diabetes causes to tissues, namely damage to nerves and blood vessels.

If the nerves are damaged, the patient will feel numb; if the sympathetic nerves are damaged, the patient's skin will not sweat, because the secretion of sweat glands and sebaceous glands is controlled by the sympathetic nerves. After the sympathetic nerves are damaged, the patient's sweating function is affected, causing the skin to become dry and prone to chapped.

Therefore, the early symptoms are determined by the different manifestations of tissue damage. Numbness and dry skin are manifestations of nerve damage.

If the hands and feet are relatively warm, it means that the damage to the blood vessels is relatively small. If the patient feels that the hands and feet are cold, especially the feet are cold, it is certain that the blood vessel damage is more serious.

Figure 2 Original copyright image, no permission to reprint

In terms of physical signs, people with some professional knowledge can take a dorsalis pedis artery to see its pulse. Compared with a normal foot, it will be found that the pulse of the dorsalis pedis artery is weakened, which means that the blood vessels above are partially blocked or narrowed.

As diabetic foot slowly progresses, patients may feel as if their entire foot is covered with socks, with severe numbness, and walking feels like walking on cotton.

In addition, pigmentation may also occur. Due to insufficient local blood supply and hypoxia, it may even cause local blackening, ulceration, and necrosis, which is a more serious situation.

3. How to treat diabetic foot?

First, control blood sugar and various complications, especially for patients with poor renal function, the renal function must be adjusted, because poor renal function will affect the healing of diabetic foot wounds.

Second, many diabetic patients have a series of problems besides high blood sugar, high blood lipids, high blood pressure, high uric acid, etc., which we call metabolic syndrome. These diseases will also affect wound healing, so we need to adjust the whole metabolic status and the whole body condition.

Third, as for the wound itself, its pathological basis is insufficient blood supply to the blood vessels, so we need to find ways to restore blood supply. For example, if the main blood vessels are blocked, can we use a stent to prop it open? If it is completely blocked, can we make a bypass or a vascular anastomosis to open another pathway so that blood can flow continuously to the tissue and ensure blood supply.

Fourth, nerve damage is also a key issue in the pathological changes of diabetic foot, so it is necessary to protect the damaged nerves through measures such as oral vitamin B.

Fifth, when a diabetic foot wound appears, it is necessary to clean the wound in time. Because a large amount of necrotic tissue and pus accumulate in the wound, it will enter the blood and affect distant organs. Therefore, it is necessary to clean the wound in time, remove the pus and necrotic tissue from the wound, and then use some methods to accelerate the healing of the wound.

In addition, some diabetic patients have poor overall condition, such as malnutrition, so they need to strengthen nutrition so that the functions of the whole body can adapt to the growth of the wound and accelerate the healing of the wound.

Therefore, the treatment of diabetic foot should be comprehensive, all-round, and multidisciplinary, so that the wound can heal as quickly as possible.