Diabetes disappears after amputation
Diabetic foot syndrome
The diabetic foot syndrome is a dreaded secondary disease of diabetes mellitus. There is a reason for this: the so-called diabetic foot is the most common cause of non-accidental amputations. It is important to avoid this.
Around 14 percent of all diabetics receive medical treatment for foot complications every year. Those affected often need care after a forefoot amputation, lower leg or thigh amputation. Within 4 years after amputation of the first leg, more than 50 percent of diabetics have to amputate the second leg.
The diabetic foot syndrome is based on damage to the foot nerves (neuropathy) and possibly also damage to the blood vessels (PAD = peripheral arterial occlusive disease). Due to the impairment of the pain-conducting nerve fibers, pain is only perceived to a limited extent or not at all. This means that an important early warning symptom is missing in the event of pressure points (e.g. from tight shoes) or other foot injuries. The result is painless pressure sores (gangrene), which become infected particularly quickly due to the circulatory disturbance that also exists and are then difficult to heal. The combination of diabetic neuropathy with a peripheral arterial circulatory disorder is particularly risky, especially in diabetic patients who also smoke. A special form of diabetic foot syndrome is diabetic neuro-osteoarthropathy (DNOAP, or "Charcot foot"), in which one or more joints or bones of the foot are painlessly destroyed, which often leads to the arch of the foot collapsing. This is usually associated with swelling and reddening of the foot. The diagnosis is made through the clinical examination and then preferably through magnetic resonance imaging (MRI).
Signs of illness
Decreased pain and temperature sensation
The damage to the nerves on the feet means that painful stimuli (e.g. cuts during foot care, foreign bodies entered, unsuitable shoes), which play an important role as warning symptoms for the body, are no longer registered. The affected diabetics therefore often do not notice injuries or small ulcers on the feet for weeks. In addition, the perception of temperature is reduced and the usually sock-shaped loss of sensation is accompanied by a loss of the muscles' own reflexes (Achilles and patellar tendon reflex).
Weakened foot muscles and dry skin
The nervous under-functioning of the muscles in the lower leg and foot changes the rolling process when walking, so that the forefoot is subjected to increased pressure. Muscle breakdown occurs in the small muscles between the toe bones, which results in a misalignment and incorrect strain on the toes. The overall result can ultimately be severe deformation of the feet, which can lead to pressure points in shoes and other injuries. Due to the often reduced sweat production at the same time, the skin is dry, less elastic and therefore even more prone to cracks and injuries.
Disturbed blood supply
Disturbances in the nerve supply to the blood vessels initially cause an increase in blood flow to the skin. Short-circuit connections then form between small arteries and veins (arteriovenous shunts), which lead the blood past the capillary bed without any exchange with the tissue. The shunts make the feet feel warm and pink in color, but they are not adequately supplied with oxygen. This mechanism also favors the development of diabetic foot syndrome: An initially small injury expands into an ulcer and there is a risk of bacterial infections that can penetrate the foot bones. Often an amputation can only be prevented by a lengthy special treatment in a diabetological foot center. The dangerous ulcers occur primarily on pressure points on the foot, in the area of the heel and under the ball of the foot. These areas should therefore be carefully observed during the foot inspection.
Prevent and Treat
Depending on the symptoms, antibiotics, measures to promote blood circulation (including operations), physiotherapeutic exercises or neuroleptics ("nerve suppressants") are used. Often the cooperation of different specialist disciplines is necessary (diabetologists, neurologists, surgeons, specialized foot clinic, foot clinic, orthopedic technician, orthopedic shoemaker).
Diabetics can do a lot themselves to prevent diabetic foot syndrome. Here, too, is the optimal one Adjustment of blood sugar first of all. In addition, anything that additionally burdens the blood vessels should be avoided. This includes lowering high blood pressure values and being overweight as well as largely avoiding nicotine and alcohol.
What is important is the training in which diabetics learn how to examine and properly care for their feet themselves on a daily basis, and what they should pay particular attention to when buying shoes. Regular careful inspections of the feet (at least once a week) and appropriate footwear are important prerequisites for avoiding dangerous pressure points.
Regular inspection of the feet
When examining the feet, the first step is to check the color and temperature of the skin. Increased callus formation, cracks, scars, pressure points or fungal infections must be documented and treated. If the toes or arches of the foot are deformed, special attention should be paid to pressure points. The lack of hair on the toes and deformed nails suggest a lack of oxygen.
The doctor can assess the blood flow to the feet by feeling the foot pulses and an ultrasound Doppler examination. Nerve damage is diagnosed by checking muscle reflexes, sensitivity (tuning fork) and temperature sensation, as well as measuring the nerve conduction velocity. The so-called pedography can be used to check the arch of the foot and the pressure distribution of the foot when walking. Joint damage to the feet, broken bones (fractures) or zones of bone dissolution (osteolysis) can be determined with the help of X-rays.
Medical treatment for diabetic foot syndrome
The treatment must be multidisciplinary, whereby a diabetic foot center should be targeted at least in the presence of a diabetic foot ulcer or Charcot's syndrome. Within such a foot center, general practitioners, diabetologists, internists, vascular surgeons, angiologists, interventional radiologists, general surgeons, orthopedists, diabetes advisors, shoemakers and podiatrists are involved. First of all, it is important to have a good blood sugar control and treatment of underlying internal diseases. The local treatment is carried out by removing dead tissue (debridement), local wound treatment, treatment of a possible Infection and effective pressure relief. A vascular diagnosis must be carried out and in the case of a peripheral arterial circulatory disorder, all options for its treatment including revascularization measures (e.g. expansion of individual arteries, bypass from a femoral artery to a foot artery, etc.) must be exhausted. The most important therapeutic measure for Charcot's foot is complete pressure relief and immobilization for several weeks.
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