What is Diabetic Foot?

Diabetes Mellitus, commonly known as “Diabetes,” is a chronic disease characterized by high blood sugar levels due to a deficiency in insulin or a malfunction in its effects. This disease affects one in every 14 people in our country. It can lead to adverse effects such as eye, kidney, vascular involvement, and loss of sensation. Another problem caused by this disease is “Diabetic Foot,” defined as hard-to-heal wounds on the feet of diabetic patients. Due to the tendency for infection, a minor wound on the foot can easily become inflamed, leading to a “Diabetic Foot Infection.”

One in 7-8 diabetic patients develops diabetic foot. Diabetic foot is responsible for half of all non-trauma-related foot and leg amputations. This fact alone demonstrates the severity of diabetic foot. Below are some examples of foot deformities and wounds seen in diabetic patients.

Who is at Risk for Developing Diabetic Foot?

One in seven diabetic patients will develop a foot ulcer at some point in their life. These ulcers, even if treated well, can lead to the amputation of the foot. With proper care, these negative outcomes can largely be avoided. Therefore, it is crucial to know who is at risk for developing diabetic foot and ensure these patients undergo regular check-ups. Patients at higher risk for developing diabetic foot include:

– Individuals with high blood sugar levels
– Those who have previously had foot ulcers
– Individuals with loss of sensation in the feet
– Those with kidney damage due to diabetes
– Individuals with visual impairment or loss
– Those with vascular blockages
– Individuals with reduced ankle mobility
– Those with foot deformities
– Individuals with dry, cracked feet
– Those with inadequate foot care
– Individuals who do not maintain foot hygiene
– Smokers
– Obese individuals
– Those aged 65 and above
– Individuals with fungal infections on the foot and nails
– Those who wear improper footwear or walk barefoot (as shown in Figure 1).

How is Diabetic Foot Treated?

In diabetic patients, the long-term effects of diabetes on nerves, blood vessels, and the immune system increase the risk of foot deformities and ulcers. Diabetic patients often require hospitalization for foot ulcers. Treating these ulcers can take weeks or even months.

In treating diabetic foot ulcers, the patient should be evaluated by a team comprising Internal Medicine, Orthopedics, Cardiovascular Surgery, Plastic and Reconstructive Surgery, Underwater and Hyperbaric Medicine, and Infectious Diseases clinics. If there is an infection in the foot, appropriate antibiotic treatment should be started. The “dead tissue” around the wound area should be surgically removed. The wound area should be regularly dressed. Patients should be on an appropriate diet and insulin therapy to keep blood sugar levels within normal ranges. Additionally, since pressure on the wound can delay healing, orthopedic measures should be taken to relieve pressure. Figure 2 shows a cast model designed to distribute pressure evenly across the foot, and Figure 3 shows another pressure relief model for the same purpose. More than half of diabetic patients experience vascular blockages or damage. This reduces blood flow to the wound area, hindering healing, so any blockages in the vessels should be treated appropriately. Hyperbaric Oxygen Therapy (HBO) is one of the adjunctive treatment methods used for diabetic foot ulcers. HBO involves administering oxygen at high pressures to alleviate oxygen deficiency in the wound area, enhance the effects of immune cells that kill bacteria, and increase the activity of cells that promote wound healing, thus speeding up recovery.

Another treatment method used in recent years for diabetic foot is growth factors. It is preferred in patients who do not respond to other treatments. Additionally, stem cell therapy is a treatment method being researched for its potential to treat non-healing wounds like diabetic foot ulcers in the future.

How to Prevent Diabetic Foot?

First and foremost, you must keep your blood sugar levels within normal ranges. You should monitor your blood sugar levels daily at home and consult your doctor if you notice any irregularities.

Patients at risk should understand the importance of daily foot inspections, knowing they may lose protective sensation in their feet. Proper foot care primarily involves protecting the skin of the feet, nail care, and selecting appropriate footwear.

Wash your feet daily with warm water and soap. Be sure to dry between your toes with a soft towel. Use a white towel to detect any possible bleeding or infection. Use a softening, moisturizing body lotion or foot cream to keep your skin soft and prevent it from drying out and cracking. Apply the cream to your entire foot, excluding the spaces between your toes, as they need to stay dry.

Carefully trim your toenails with a sharp nail clipper, making sure not to cut them too short, and then file them. If you have vision problems, seek help from someone close to you or, better yet, regularly visit a clinic specializing in foot care that ensures sterilization and cleanliness. Otherwise, using non-sterile tools carries a high risk of infection. Additionally, improper pedicure procedures can put your feet at risk. It is best to use your manicure and pedicure set.

Check your feet daily with a mirror. Look for changes like color changes, redness, cuts, or blisters.

Choose socks without tight bands and change them daily. Ensure that the socks do not squeeze your feet and that they are made of cotton.

Check inside your shoes for any foreign objects before wearing them. Choose comfortable, soft, round-toe shoes with rubber soles. Do not wear shoes without socks. Avoid high heels and open or narrow shoes. Opt for lace-up shoes, which can be loosened if they become tight. Also, worn-out shoes lose their comfort and can cause problems. If you have any deformities in your feet, choose custom-made shoes. Do not wear new shoes for more than 2-3 hours a day until you get used to them.

Do not cut corns or calluses yourself. In cases of cuts, ingrown toenails, fungal infections, or other issues, consult a foot care specialist or a clinic specializing in foot care, or visit an underwater and hyperbaric medicine specialist without intervening.