Diabetes Aims the Feet

Nerve damage and vascular occlusions caused by diabetes can cause wounds and infections in the feet that carry the entire load of the body. In patients who do not receive appropriate treatment on time, undesirable consequences can be encountered from limb loss to the risk of ending life.

In the picture of diabetes, which increases in parallel with poor nutrition and sedentary life, there are sudden increases and decreases in blood sugar, as well as serious complications in the eyes, kidneys, and feet. We know that patients with diabetes have nerve damage called neuropathy and occlusions with narrowing of the arteries, and various traumas occur in the presence of these. If the wounds are infected, a diabetic foot infection can occur, which can have very important consequences. Since this problem is seen in the majority of neuropathy patients, it is necessary to think as if all diabetics have neuropathy and take precautions accordingly.

Patients Consult Late To the Doctor

Diabetics do not feel pain due to sensory neuropathy, which is present in most of them, so they are late to apply to the doctor and hospital. Due to this delay, the open wound can be easily infected by contact with microbes. Difficulty in feeding and blood supply due to capillary problems also complicates infection control. Immunodeficiency/impairment can also be seen in diabetic patients, especially those with uncontrolled diabetes. Since the white blood cells that need to fight infection are much harder and immobile than normal, they cannot do enough to provide immunity. As a result, wounds can be inflicted on the feet, which are open to trauma due to neuropathy and vascular problems, even with the slightest impact. If timely and inadequate precautions are not taken, these wounds become infected. This can lead to a cut on the foot or even loss of life.

The Patient Does Not Feel The Pain

Although patients with neuropathy have very painful periods from time to time, the main problem is painlessness. Because pain refers to an important, protective sense that protects the person from all kinds of trauma. People with reduced or completely lost sensation of pain are easily injured because they do not feel traumas such as hot cold, impact, hitting, or crushing, and they are delayed in taking the necessary precautions and treatments for them. With the most frequent shoe strikes, scalding and burning are encountered due to reasons such as boiling water, stove, and heater. When these injuries and injuries occur, patients continue to live as if nothing happened.

The Risk of Falling in Diabetes Patients Is Also High

Diabetic patients are at least 20 times more likely to fall than normal people. One of the reasons for this is a weakness due to excessive melting in the muscles. Patients have difficulty standing or walking. The main reason is the loss of the sense of "proprioception", that is, the sense of being able to perceive where the feet are in space due to neuropathy. When the feet are stuck somewhere, when they hit, the patients do not feel it and fall. This can lead to serious injuries.

The First Step in the Treatment is To Clean the Wound!

It is of great importance that diabetic foot treatment is performed by experts in their field. In the treatment of the wound on the foot, the approach "What should we put on the wound?" is not right, but the “What should we clean over the wound?” approach is correct. All ointments applied on the wound are often both harmful and can cause allergies. Instead of applying something to the injured area, it is of great importance to remove all dead, bad, dirty tissues on the wound. Hard, thick nails shaped like horns with calluses need to be cut and cleaned. It is important to eliminate everything that causes pressure and pressure and to ensure that the patient does not step on his/her feet until the wound heals. Specialist physicians can decide to use a double crutch or wheelchair by placing the foot in a special plaster if necessary. It is recommended to use only barrier creams that can absorb the secretion inside the wound and protect its surroundings. Afterward, if shoes are to be allowed to be worn, the patient's foot should be molded, the places of pressure should be determined, and shoes should be prepared accordingly. Multidisciplinary committees consisting of many physicians must decide to use auxiliary methods such as hyperbaric oxygen, negative pressure wound closure, and larval treatment used in the treatment of diabetic foot wounds and other chronic wounds. Unfortunately, these and similar auxiliary methods are used too much in our country. It should not be forgotten that these can facilitate treatment only in appropriate patients and when applied correctly.”

How Should Diabetics Protect Their Feet?

It should not be forgotten that people who pay attention to diet and lifestyle and whose diabetes is under control can live much healthier and longer than the normal population. Measures that can be taken to protect the feet are as follows: First of all, patients should be trained in terms of neuropathy and vascular disease and kept under follow-up. It is also important to check the feet naked during the examination. Diabetics should wear soft socks made of cotton or mercerize, not wool or nylon. Since the feet are extremely dry due to neuropathy, it is also very important to apply softening cream several times a day. One of the precautions that can be taken is that the shoes are soft, do not squeeze the foot, and provide comfortable walking.