How to prevent the development of diabetic foot syndrome | What to do | How to treat foot injuries
Diabetes mellitus (DM) often leads to such dangerous complications as diseases of the cardiovascular system, visual impairment and kidney function. The legs are among the target organs for diabetes.
How to prevent the development of diabetic foot syndrome (SDS)
The main mechanisms of leg damage in diabetes are diabetic neuropathy (damage to nerve endings in the extremities, leading to a decrease in all types of sensitivity) and diabetic angiopathy (impaired vascular patency). Neuropathy occurs 2-3 times more often than angiopathy, so the widespread belief that all problems in diabetes are caused by vascular disease is incorrect.
Due to neuropathy, sensitivity is impaired, and the patient may injure his leg (burn, injure with shoes, etc.) and not feel it. Any diabetes wound may not heal for a long time due to elevated blood sugar. The occurrence of trophic ulcers in SDS (85-90% of cases) can ultimately lead to disability: more than half of all amputations (not related to injuries) are in patients with foot diabetes.
What to do to prevent this from happening
Firstly, to treat diabetes, maintaining blood sugar levels within acceptable limits (up to 5.5-6.0 mmol / L on an empty stomach and up to 8-9 mmol / L after meals). Without normalizing sugar levels, treating foot injuries will never be effective!
Secondly, follow special rules for foot care. It is necessary to exclude any damage to the feet: do not walk without shoes on the floor, check the condition of the shoe (it should not be tight or rub), wear special socks with silver ions. You should also inspect the legs daily in order to detect injuries that, due to impaired sensitivity, may not be manifested by soreness.
Thirdly, timely pharmacotherapy of diabetic neuropathy and angiopathy. Medications should be prescribed by specialists of the Diabetic Foot offices, as well as endocrinologists, neurologists, etc.
Without normalizing sugar levels, treating foot injuries will never be effective!
Fourthly, to eliminate the so-called “small problems of the feet” (dry skin, skin moisture of the interdigital spaces, calluses), which are risk factors for diabetic foot. Dryness is primarily affected by the skin of the calcaneal region, where cracks can form, turning into trophic ulcers due to diabetes mellitus. To eliminate dryness, apply cream and treat thickened skin with a special pumice stone. With severe coarsening of the skin, poorly eliminated with a cream, the patient is recommended to wear slippers with a back (they have minimal impact on the heel when walking). With severe dryness, the ointment should be applied 2-3 times a day. To soften the skin using creams, balms, sprays containing vegetable oils or waxes. But the most effective in eliminating dryness are urea-containing products, which increase the water content in the stratum corneum.
Fatty creams are contraindicated in case of extensive mycosis of the plantar surface of the feet due to the risk of exacerbating the phenomena of mycosis under the cream, which forms a greasy film on the skin. For this purpose, there are creams with antifungal components, but it is better to start using them after visiting a dermatologist and prescribing appropriate therapy.
No creams should be applied between the toes!
The moisture content of the skin of the interdigital spaces leads to the formation of diaper rash and skin cracks in this zone. The cause may be mycosis (cheesy plaque on the skin) or improper foot care (applying cream between the toes, excessive moisture inside the shoe). No creams should be applied between the toes!
In the absence of reliable signs of mycosis, a decrease in humidity is enough (temporarily a gauze pad, then talcum powder or socks with separate toe holes).
In case of fungal infection, antifungal drugs are prescribed, preferably in solutions rather than creams (Lamisil spray, Clotrimazole 1% solution or Nitrofungin). If there is mycosis of the nail plates, the treatment should be prescribed by a dermatologist! Removal of the nail plate is not practiced in recent years due to low efficiency and trauma.
If there is mycosis of the nail plates, the treatment should be prescribed by a dermatologist!
Only antifungal agents for oral administration can cure onychomycosis. There are various drugs for this without pronounced side effects. With onychomycosis, antifungal varnishes or creams have only a prophylactic or auxiliary (with respect to the main treatment) effect. In case of contraindications or fears of the patient regarding systemic antimycotic therapy, the most effective topical agents are drugs that dissolve the nail plate, for example, Mikospor (cream + patch) for 2-3 weeks. After that, for several months, an antifungal cream (Mikospor, etc.) should be applied to the nail.
Hyperkeratosis (corns) are formed as a result of excessive pressure, leading to hemorrhage, followed by suppuration and the formation of a diabetic ulcer. Overloading occurs due to orthopedic problems, deformation of the feet, improper selection of shoes. Patients with diabetes should promptly remove corns with pumice stone (or with a special device in the Diabetic Foot office or pedicure salon).
Special plasters and fluids for removing calluses are contraindicated in diabetes mellitus, since their use often leads to diabetic ulcers.
Special plasters and fluids for removing calluses are contraindicated in diabetes mellitus!
If the problem in the skin area persists, the corn will inevitably form again. Reducing the load allows the use of special preventive or orthopedic shoes, the use of “small orthopedics” (gel pads, beak corrector, insoles, arch supports, etc.). However, an orthopedic surgeon or a specialist in the Diabetic Foot Cabinet should prescribe these treatments. The patient should be trained in their proper use and precautions (due to the risk of skin damage due to impaired sensitivity).
Massage magnetic insoles (with protrusions) are contraindicated in diabetes mellitus, because there is a high risk of skin damage and the development of diabetic ulcers.
How to treat foot injuries
The patient can provide first aid to himself. He should first rinse the wound with a solution of hydrogen peroxide, miramistin, or chlorhexidine.
Chlorhexidine is a universal drug and not only has an antiseptic effect, but also relieves inflammation, stimulates the regeneration of damaged tissues, so it can be used at all stages of the wound healing process (treatment and prevention of diabetic foot and domestic injuries).
Then put on a wound a sterile dressing and fix it with a bandage. If the wound does not heal for 2-3 days, you must urgently consult an endocrinologist or visit the Diabetic Foot office. Most amputations occur in patients who did not seek the help of specialists in time. Remember that more than 90% of people with diabetic foot syndrome can be cured without amputation if the necessary measures are taken at the time.