Diabetic Foot: Causes, Classification, Symptoms, and Treatment

Write a short note on diabetic foot.

Answer. Diabetic foot consists of callosities, ulceration, abscess, cellulitis of the foot, osteomyelitis of different bones, diabetic gangrene, and arthritis of joints.

Meggitt’s Classifiation Of Diabetic Foot

Grade 0: Foot symptoms like pain, only
Grade l: Superficial ulcers
Grade 2: Deep ulcers
Grade 3: Ulcer with bone involvement
Grade 4: Forefoot gangrene
Grade 5: Full foot gangrene.

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Pathogenesis Of Diabetic Foot

High glucose levels in tissues are a good culture medium for bacteria. So infection is common.
Diabetic microangiopathy causes blockade of microcirculation leading to hypoxia.
Diabetic neuropathy: Due to sensory neuropathy, minor injuries are not noticed and so infection occurs.
Due to motor neuropathy, dysfunction of muscles, arches of the foot, and joints occur.
And loss of reflexes of the foot occurs causing more prone to trauma and abscess.
Due to autonomic neuropathy, the skin will be dry causing a defective skin barrier and so more prone to infection.

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Diabetic atherosclerosis: It reduces the blood supply and causes gangrene.
Thrombosis can be precipitated by infection-causing infective gangrene. Blockage occurs at plantar, tibial, and dorsalis pedis vessels.
Increased glycosylated hemoglobin in blood causes defective oxygen dissociation leading to more hypoxia.
At the tissue level, there will be increased glycosylated tissue proteins, which prevents proper oxygen utilization and so aggravates hypoxia.

Diabetic Foot Clinical Features

Pain in the foot
Ulceration
Absence of sensation
Absence of pulsations in the foot (Posterior tibia and dorsalis pedis arteries).
Loss of joint movements.
Abscess formation
Changes in temperature and color when gangrene sets in.
Patients may succumb to ketoacidosis, septicemia, or myocardial infarction.

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Diabetic Foot Investigations

Blood sugar, urine ketone bodies.
Blood urea and serum creatinine.
X-ray of a part to look for osteomyelitis.
Pus for culture and sensitivity.
Doppler study of the lower limb to assess arterial patency.
Angiogram to look for proximal blockage.
Ultrasound of the abdomen to see the status of the abdominal aorta.
Glycosylated hemoglobin estimation.

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Diabetic Foot Treatment

The foot can be saved if only there is a good blood supply:
Antibiotics—decided by pus culture and sensitivity
Regular dressing
Drugs: Vasodilators, pentoxifylline, dipyridamole, low-dose aspirin.
Diabetes is controlled by insulin only.
Diet control, control of obesity.
Surgical debridement of the wound.
Amputations of the gangrenous area. The level of amputation has to be decided by skin changes and temperature changes or Doppler study.
Care of feet in diabetic:

Any injury has to be avoided.
MCR footwear must be used (Microcellular rubber)
Feet has to be kept clean and dry, especially toes and clefts
Hyperkeratosis should be avoided.