WHAT IS DIABETIC FOOT?

Diabetic foot is a complication that causes wounds in the feet of diabetic patients, leads to prolonged hospital stays, and in advanced cases results in foot loss. It can be prevented with good blood sugar control and foot care.

Diabetes is a chronic metabolic disorder that requires constant medical care, in which the person cannot adequately utilize carbohydrates, fats, and proteins due to insulin deficiency or insulin resistance, causing damage to many organs in the body. Diabetic foot occurs due to the damage caused by diabetes to the blood vessels and nerves.

Diabetes causes a disorder in the nerves called diabetic neuropathy. High blood sugar causes sugar to enter nerve cells at levels far exceeding what the cell can use, leading to cell structure damage. This disrupts nerve transmission in our body. There are three types of nervous systems in our body that enable tissues and organs to function. When one of these, the motor nerves (nerves that activate muscles), is damaged, deformities such as hammer toe, claw toe, foot drop, flat feet, and clubfoot develop in the person's foot.

Another nervous system is the autonomic nervous system (nerves that function involuntarily in the body and stimulate our organs and glands in particular), and when these nerves are impaired, both dryness and cracks form on the skin due to the insufficient functioning of the glands in the skin, and the function of the muscle system surrounding the blood vessels is impaired, making it difficult for blood to reach the extremities. The dryness that develops on the skin can cause cracks in the feet, allowing bacteria that cause infection to penetrate the damaged skin and cause infection in the skin and soft tissue.

Another nervous system is the nerves that provide our sense of touch (the nerves that carry perceptions and stimuli from the outside world to our brain). When these nerves are damaged, loss of sensation develops. Diabetics cannot feel sensations such as pain or burning. Because the patient experiences loss of sensation in their feet, their feet can easily be injured, burned, frostbitten, or cut, and since patients do not feel pain, they are unaware of such traumas.

In addition to the nervous system, high blood sugar levels in diabetic patients cause damage to the walls of blood vessels, leading to blockages. The tissues supplied by the blocked vessels do not receive adequate blood flow.

In summary, due to diabetic neuropathy, the feet become deformed, the skin dries out and cracks, and the loss of sensation combined with impaired blood circulation puts the feet at risk of developing wounds. Unfortunately, any wound that develops does not heal through a normal process as it does in healthy individuals due to the influence of the same factors, and infections in these wounds can lead to serious conditions, including foot loss. In 60% of diabetic patients who lose their feet due to diabetic foot, the cause is infection that develops in the foot and cannot be controlled.

A diabetic patient has a 15-25% risk of developing a foot ulcer during their lifetime. If a foot ulcer develops and is not treated appropriately, it can lead to foot loss. Scientific studies show that diabetic patients who lose their feet have a 3-year life expectancy of 50%. This rate is worse than many types of cancer. In other words, unfortunately, one in every two diabetic patients who have their feet amputated lose their lives within 3 years.

Treatment Methods

The essential steps in treating a patient with a diabetic foot ulcer and associated infection can be summarized under the following main headings:

1. Blood sugar control must be ensured

2. Any vascular problems must be addressed

3. Appropriate antibiotic treatment must be initiated to treat the infection

4. The wound should be cleaned using an appropriate debridement method to remove dead tissue.

5. Once the infection is controlled or completely eliminated, appropriate wound care should be provided to prepare the wound for closure. To this end, the following methods can be applied in accordance with the recommendations of specialists.

a) Wound dressings: When using wound dressings, it is important to select the appropriate dressing according to the needs of the wound. Not every dressing is suitable for every wound.

b) Antiseptic solutions: Antiseptic solutions that eliminate infectious agents on the wound surface and do not harm the cells that promote wound closure should be used. Therefore, iodine solutions (tincture of iodine, rif, etc.) used in the past can cause more harm than good to the wound and should not be used.

c) Negative pressure wound therapy: The wound is covered with a special sponge and sealed with an airtight bandage. A small opening in the bandage is covered with material that connects to a device that provides negative pressure. This method both cleans the tissue and infection debris that prevent wound healing and stimulates the cells that promote tissue healing in the wound area.

d) Growth factors: Studies conducted on diabetic foot patients have revealed that the most important factor causing delayed wound closure in these patients is the deficiency of growth factors that should be present in the tissue. For example, “Epidermal Growth Factor” is a factor that plays a very important role in normal wound healing, and unfortunately, in diabetic patients, it is either not synthesized sufficiently by the cells or the mechanisms through which it exerts its effect are damaged due to diabetes. Scientific studies have also shown that growth factors used in patients with diabetic foot ulcers promote faster wound closure. However, it is important that these products are used in selected, appropriate patients. It is important to select which growth factor, and even which form, should be used in which patient.

e) Pressure relief: In diabetic foot wounds, relieving pressure on the wound is an important factor in the healing process. Healing is nearly impossible in a wound that is under pressure and bearing weight. Therefore, methods that prevent pressure on the wound are used for a certain period during wound treatment. This method is called “Offloading.” Appropriate orthotics (specially made shoes) are used for this purpose, and casts that protect the wound can also be used when necessary.

5. Reconstruction procedures

While some properly treated wounds may close spontaneously during wound treatment, the spontaneous closure process for some wounds may take a long time or may not occur at all. In this case, reconstruction of the wound and foot may be necessary. This procedure is usually surgical and involves methods such as skin grafting or tissue flaps. The goal here is to ensure that the wound closes immediately and to provide the patient with a foot that they can put weight on.