Diabetic foot is a serious complication of diabetes, which can occur in poorly balanced patients.
The severity of the diabetic foot can lead to hospitalization or even amputation. This dramatic outcome is not, however, inevitable. Effective means of prevention exist.
The presence of diabetic foot ulceration is the main leading risk for amputation in patients with diabetes. Proper assessment and classification of a diabetic foot ulcer is an essential part for the management of the diabetic foot. A prompt and adequate ulcer treatment may lead to foot amputation prevention, preserving the life quality of the patient.
Several classifications have been proposed for the categorization of diabetic foot ulcers. The most used one is:
Wagner-Meggitt classification
It is one of the earliest and most widely used classifications. It classifies the diabetic foot ulceration depending on how deep the wound is, includes 6 grades:
- Grade 0: The skin is intact;
- Grade 1: Presence of ulcer which is superficial;
- Grade 2: Presence of ulcer which is deep;
- Grade 3: Deep ulcer with abscess, bone involvement or osteomyelitis;
- Grade 4: Gangrene in the forefoot;
- and (6) Grade 5: Whole foot gangrene.
Wagner-Meggitt classification has shown several disadvantages:
- cannot address all patterns of diabetic foot ulcerations and infections;
- the presence of infection is addressed in only one stage, thus, the superficial ulcers if infected or ischemic are not properly categorized in this system;
- this system does not properly assess the presence of peripheral ischemia in categorization of foot ulcers.
Neuropathy, the disease-causing diabetic foot
These foot wounds are lesions, often benign, caused by trauma, but which heal poorly due to diabetes and the neurological and vascular complications of this disease.
“The diabetic foot is indeed a complication of diabetes, itself linked to another complication of this disease, neuropathy “
In other words damage to the peripheral nerves. This results in a loss of sensitivity of the feet, a decrease in the natural hydration of the foot causing dryness, cracks and calluses, and bone deformations of the foot.
Characteristics of the diabetic foot
” The diabetic foot does not occur overnight. It is a gradual phenomenon ”
The main characteristics are:
- Plantar perforating disease: neuropathy seriously disturbs the statics and dynamics of the foot. This can cause the stratum corneum of the epidermis to thicken and create a horn on the feet (plantar hyperkeratosis). And, if it doesn’t heal normally, it can develop deeply, causing bleeding and leading to skin ulceration.
- Imperceptible pain in feet
- Difficult healing: diabetics generally suffer from arteritis, reducing the oxygen supply to the feet. This complicates the process of healing.
For example, take the case of static disorders, deformities of the foot, such as hallux valgus or bunions.
These are very common and do not have a particular impact because they are generally taken care of when they interfere. However, a diabetic patient, whose disease has been unbalanced for several years and who has developed neuropathy, will not be sensitive to repeated rubbing of his deformed feet in his shoes; in the long run, this friction will cause lesions that he will not feel anymore and to which he will not provide the necessary care. The risk is then that these wounds become infected, explains the specialist. An early diagnosis is essential to prevent the development of complications. “The problem is that many patients and non-specialist health professionals have little knowledge of the gradation of podiatry risk, even though it is part of the annual diabetes assessment “.
The main risk: amputation
Taken care of quickly, most wounds heal within 3 to 6 months. But in 15 % of cases, the diabetic foot results in amputation. For example, 7 749 diabetics amputation in 2013. It is limited in half of the cases to a toe, but it can affect the entire foot (19 %), the leg (17 %) and the tibia ( 12 %).
Where to consult for a diabetic foot?
The treatment of a diabetic foot should be as early as possible.
” It is imperative that the patient immediately shows the slightest wound to the foot to his doctor ” .
It is also necessary to unload the wound as much as possible as soon as it appears. This means that one should never press on it, let alone to walk.
Patients who suffer from a diabetic foot can go to specialized “diabetic foot” centers within the diabetology departments or in healing centers , which offer multidisciplinary care with vascular surgeons, pedicures, diabetologists. , nurses …
Diabetic foot treatments
Sent to a specialized service, the patient will then benefit from appropriate care, including cleaning the wound, fitting a bandage, prescribing specialized shoes as well as an assessment of his diabetes, his arteries, its risk of infection and its treatment .
” A patient must absolutely avoid walking on his wound. Custom-made shoes are the main treatment for diabetic feet “, insists the specialist, who deplores that ” this treatment is not always prescribed nor always worn” .
Means of prevention
There are three main ways to prevent diabetic feet : good footwear, good hygiene and no heat.
- A good boot requires comfortable shoes that do not hurt, seamless inside, not too tight at the front, with heels that are not too high.
- Good hygiene means washing and drying the feet thoroughly, in order to avoid yeast infections which are a gateway to infections. To these basic hygiene measures, we must add pedicure care to prevent the development of horns. (Note: since 2008, patients with a grade 2 and grade 3 podiatry risk may benefit from health insurance coverage of 4 and 6 podiatry treatments per year, respectively). These treatments should not be aggressive, at the risk of causing the opposite effect. Electric pumice should be avoided, it is better to prefer cardboard pumice, recommends the specialist.
- Finally, diabetic patients with neuropathy are insensitive to pain and burning in the feet. They should therefore avoid soaking them in too hot baths, exposing them to the sun or walking barefoot on hot sand …
Precautionary measures to avoid a diabetic foot:
- Choose comfortable shoes and always put on natural fiber socks, even in summer
- Do not walk ever bare feet
- Moisturize your feet with cream to prevent the appearance of horns, and sand it using non-aggressive instruments
- Avoid cutting your toenails too short
- Dry your feet well, especially between your toes, to prevent the development of yeast infection
- Test the temperature of the bath or shower water with your hand, never your foot
- Examine your feet every day
” All of these tips are part of the therapeutic education enjoyed by patients in diabetes services or networks of care “
Annual monitoring is required
The risk of suffering from a diabetic foot should be assessed annually in a patient with diabetes. This risk is established by a sensitivity test under the foot determined by a score ranging from 0 to 3.
- Score of 1 : there is a loss of sensitivity linked to neuropathy, which increases the risk of diabetic feet by 5.
- Score of 2 : an arterial disease (circulatory disorders) or static disorders in addition to neuropathy. The risk is then multiplied by 10.
- Score of 3 : existence of foot wounds or a history of amputation, in addition to neuropathy and / or arterial disease, which increases the risk of diabetic foot by 30.
