Diabetic Foot: One of the most feared complications associated with diabetes

The diabetic foot: what is it and what does it cause?

Diabetic foot is a significant problem, considering that even today, a million people lose a leg due to this condition. Statistics highlight the severity: a diabetic person statistically faces a 40 times higher relative risk of limb amputation compared to a non-diabetic individual.

Timely diagnosis and early treatment are crucial to avoid the worst consequence, namely limb loss.

Understanding Diabetic Foot

Diabetic foot can manifest in various ways, from simple superficial ulcers to extensive foot gangrene. Often, leg and foot injuries can occur without warning and worsen rapidly. Regular preventive check-ups for lower limbs are essential for diabetes patients to prevent the risk of deterioration.

Given the likelihood of vascular complications, screening for vascular diseases in various body areas is also crucial. Key symptoms to monitor include:

  • Increased foot temperature
  • Lack of sensitivity to thermal, tactile, and painful stimuli in the lower limbs
  • Tingling sensation
  • Presence of scratches, cuts, or skin ulcers

The primary issue in diabetic patients is the development of skin lesions, even small ones, which can degenerate into ulcers and infections due to microcirculatory dysfunction related to peripheral artery disease. Essentially, the feet do not receive adequate blood and oxygen supply.

Moreover, the skin of the diabetic foot becomes thinner, fragile, vulnerable, and exposed to infections that pose serious threats. If not evaluated and treated promptly, these infections can lead to the need for amputation of the affected foot.

Diabetic Foot Due to Neuropathy or Arteriopathy

The so-called diabetic foot is a pathological condition that develops as a consequence of neuropathy and arteriopathy, typical pathological conditions of the metabolic disease’s origin.

  • Neuropathy: This is the alteration of the peripheral nervous system, primarily manifesting with tingling, cramps, gait disorders, and sensory disturbances (inability to perceive pain, heat, and cold). Neuropathy is extremely dangerous for the feet of a diabetic patient. In the presence of a foot wound, the patient, who feels minor discomfort compared to the actual extent of the damage or may not feel it at all, continues to bear weight on the foot and walk improperly. This behavior worsens the situation because a small injury (such as a harmless callus) quickly turns into an increasingly larger wound, which, if left untreated, forms bleeding ulcers, infections, or gangrene. Another important element is represented by foot deformities, which can appear even before the onset of characteristic diabetes symptoms. This disorder is a consequence of neuropathy, leading to a reduction in the strength of some muscle groups (usually those in the front of the leg). Consequently, other muscles prevail, resulting in foot retraction.
  • Arteriopathy: This pathological condition refers to problems of blood circulation in the arteries (poor blood circulation). The rapid degeneration into ulcers and infections on the feet from a small lesion in a diabetic patient is explained by poor circulation to the lower extremities. The feet of a diabetic, not receiving adequate blood supply, struggle to repair the damage to the skin. Furthermore, the skin of the diabetic foot becomes extremely delicate (like a child’s skin), making it more prone to traumas and injuries of all kinds. Unlike in healthy individuals, this rapid degeneration of foot lesions does not occur as often, thanks to the blood’s ability to ensure adequate circulation, even at the foot level.

Personalized Treatment Approaches:

In case of infection, the treatment involves:

  • Targeted antibiotic therapy, as directed by the specialist, considering the responsible pathogenic agent of the infection
  • In some cases, surgery

In case of complications affecting the lower limbs, surgical revascularization, known as peripheral revascularization, can be considered. This can be performed with traditional surgery or minimally invasive endovascular procedures.

Today, a better understanding of atherosclerotic disease in the lower extremities has opened new frontiers in peripheral revascularization. In diabetic patients, atherosclerotic lesions have a unique distribution, primarily involving the tibial arteries and the peroneal artery. These are very small arteries, difficult to treat with an open surgical approach, which is why endovascular techniques have found excellent application. However, there are still many cases where traditional surgery is widely indicated, and cases where a hybrid approach is recommended, using both techniques simultaneously.