Diabetic Foot and its treatment

As you are aware, November is devoted to raising awareness of diabetes and those who have the condition. Knowing this pathology and the processes that go along with it will help you identify the disease at an early stage and protect yourself from unforeseen repercussions. The National Center of Surgery's vascular surgeon and angiologist Levan Gogliashvili will discuss diabetes and related illnesses.

What is diabetic foot?

In simpler terms, diabetic foot is a diabetes mellitus complication that is characterized by neuropathy, which is characterized by loss of sensation in the limb, microangiopathy, which is characterized by toughening and closing of small blood vessels, which results in ischemia, which is a disruption of blood flow, ulceration, and infection. It might eventually result in amputation and diabetic gangrene.

In 1956, the term ,,diabetic foot” was first used to characterize the condition. Since then, medical developments in pharmacology and technology have helped to control diabetes mellitus and associated complications. The disease's side effect, diabetic gangrene, continues to be a significant obstacle.

Diabetes and Georgia

• Approximately 232,000 (163,500-368,500) Georgians (163,500-368,500) have diabetes, according to the 8th edition atlas published by the International Diabetes Federation in 2017.
• This disease ranks seventh among Georgia's leading causes of death;
• The global cost of health care for people with diabetes was estimated at 850 billion USD in 2018;
• Around 500 million people worldwide have diabetes;
• 100,000 leg amputations occur annually in the United States; 50–76% of these cases involve diabetes;
• The risk of amputation increases four times if the patient also has chronic arterial disease;
• Gangrene of the lower extremities is 20 times more common in diabetic patients than in the general population; and mortality after amputation is roughly 50–65% in five years.

Diabetic angiopathy: What is it?

One could argue that the most crucial connection in the development of a diabetic foot is diabetic angiopathy. Diabetes causes damage to capillaries as well as tiny and medium-sized blood vessels. The disease also causes atherosclerosis, which eventually causes blood vessels to constrict and close. In turn, this results in tissue ischemia, which impairs nerve function, lowers local immunity, and leads to skin damage, infection, and gangrene.

Diabetic neuropathy: what is it?

One of the main causes of diabetic foot development is diabetic neuropathy. Nerves that are delicate and active are now harmed. When a sensitive nerve is damaged, the patient loses their ability to feel touch, pain, and temperature, as described - ,,as if marbles were thrown in shoes'', this condition is known as Morton's neuroma, or intermetatarsal neuroma. It can produce symptoms of pain, burning, tingling, or numbness in the ball of the foot that develops over time, and some people might have the sensation of a bunched-up sock or pebble in their shoe. They can experience profound burns without even being aware of it. When the motor nerve is damaged, the biomechanics of the foot is disturbed.

Identifying a diabetic foot

The patient must be examined, anamnesis must be collected accurately and completely, the limb must be well examined, and physical examination of pulsation must be performed. After that, tests in the lab and with devices are advised.

Diagnosing limb blood circulation

1. The Ankle Brachial Index (ABI) Study and duplex scanning of the lower leg arteries are performed in the first stage. High-tech tests including computer tomography, magnetic resonance imaging, and digital angiography are performed if damage is found;
2. Computed angiography offers greater details on the location of blood vessel damage, the severity of enlargement, and the underlying cause. But if the patient has chronic kidney disease (CKD), which is common in diabetic patients because of diabetic neuropathy, CT angiography cannot be done. Correct diagnosis, therapy, and surgical intervention are complicated by this;
3. The National Center of Surgery has a cutting-edge 3-Tesla magnetic resonance imaging device that may be employed with no contrast or only a little contrast to offer the information a vascular surgeon needs for future patient care. In addition, the patient won't be exposed to radiation, hence the kidney function won't be harmed;
4. If an ulcer is present, a smear must be taken in order to determine the Bacteriogram and provide the correct antibiotic. Evaluation of the ankle's bone-joint structure, radiography, and podography (FBM angle analysis). As was already noted, diabetes damages the bones and joints in the feet as well as the biomechanics of the foot, which causes deformation and an inappropriate distribution of force on the foot, which in turn leads to a number of issues (occurrence of bunions, joint pain, back pain, etc.), in order to properly distribute the load, customized shoes and insoles should be chosen based on the biomechanics of the foot of a particular patient. In order for the damaged tissue to heal, continual pressure must be removed;
5. Assessing neuropathy includes - measuring touch force, motility, vibration, and the temperature perception.

Treatment of Diabetic Foot

Modern medicine has made great strides in teaching people how to prevent disease rather than treat it. It is crucial to increase the patient's and their loved ones' understanding of what diabetes is and the fundamental knowledge they need to possess.
The patient must follow the following rules:

• Check the ankle every day, do not miss: swelling, abrasion, scratching; redness;
• Wash your ankles every day, gently rub them between your toes to dry them, and apply moisturizing lotions to dry areas;
• Do not remove or cut a callus or any other sort of injury on your ankle.
• Clip your nails carefully. If you're having trouble, get assistance.
• Avoid going barefoot, even at home;
• Wear clean, dry socks made of cotton; avoid wearing elastic material (bandages).
• Purchase soft, comfy shoes with orthopedic insoles. It would be advisable to put on the patient's proper footwear. Avoid wearing high heels or tight, squeezing shoes on your toes;
• See your family doctor, endocrinologist, and angiologist frequently.

The following are the main risk factors for diabetes and its complications:

1. There is a psychiatric treatment called nicotine replacement therapy for smokers;
2. Hypertension - frequent medication use under a cardiologist's guidance;
3. Hyperlipidemia - correct diet, statin use, under cardiologist or endocrinologist care;
4. Controlling blood sugar is important because 1% more glycated hemoglobin raises the risk of peripheral vascular disease by 25–28%, which causes tissue ischemia, starvation, and gangrene. It is important to keep blood sugar levels as close to normal as possible.

First and foremost, the vascular network should be assessed using the above-described instrumental examinations if the patient has already developed an ulcer on the foot or necrosis of one of the fingers, gangrene. Performing reconstructive surgery, such as recanalization—drilling a blood artery—balloon angioplasty—balloon expansion—and stenting—a specific device that stays in the blood vessel and prevents constriction of the blood vessel—should be done in the event of his inadequacy.
A smear is collected from the wound after a successful operation, a bacteriogram is conducted, and antibiotic therapy is then provided based on sensitivity. Necrotic tissue is also removed from within the living tissue.
Following surgery, anticoagulants, often known as blood thinners, must be used for a considerable amount of time. You should never discontinue without first talking to your doctor.

Diabetes control and treatment are achievable at the National Center of Surgery with the aid of cutting-edge methods and trained specialists.
With the use of local anesthetic and a sophisticated angiograph with a wide variety of consumables, including stents, balloons, and guiding wires, which allows to avoid amputation with one stroke, practically without blood, with local anesthesia.

Do not wait for the disease to worsen if you have diabetes and have numbness, cold limbs, trouble walking, an ulcer on the foot or fingers, or discolored fingers. Visit the National Center of Surgery, where limb preservation is practiced. All vascular pathologies, including diabetic foot, are treatable by us.

Wish you health!