Diabetes mellitus (DM) very often leads to the development of such dangerous complications as impaired renal function, vision, diseases of the cardiovascular system. The target organs of diabetes also include the lower extremities.
How to treat a diabetic foot and prevent the development of this complication?
The main mechanisms of leg damage in diabetes mellitus include: diabetic neuropathy (damage to the nerve endings in the lower extremities, as a result of which all types of sensitivity decrease), as well as diabetic angiopathy (violation of vascular patency). Angiopathy occurs 2-3 times less often than neuropathy, therefore, the opinion that all problems in diabetes are caused by vascular pathology is erroneous.
Neuropathy leads to a violation of sensitivity, which means that the patient can injure his leg (injure with shoes, burn, etc.) and not even feel it. Any, even the smallest wound, with diabetes mellitus may not heal for a long time due to high blood sugar. Practice shows that in diabetic foot syndrome, trophic ulcers in 85-90% of cases lead to disability: more than 50% of all amputations that are not associated with injuries occur in people with foot diabetes.
What to do to prevent this from happening?
- Treat diabetes mellitus, maintaining normal blood glucose levels (up to 5.5-6.0 mmol / L and up to 8-9 mmol / L on an empty stomach and after meals, respectively). For diabetic foot treatment to be effective, sugar levels need to be normalized!
- Proper foot care for diabetes is essential . Any damage to the feet must be excluded. For this, the patient does not have to walk on the floor without shoes. In addition, he needs to regularly check the condition of his shoes (they should not chafe and be tight). Feet should be checked every day for damage, which may not show up in any way due to impaired sensitivity.
- Always use high quality and effective DiaLineStep socks ( Dialine Step), which were developed by Dialine specialists specifically for people with type 1 and 2 diabetes. In the process of making these socks, innovative ways of processing fabrics are used. Their use is indicated for diabetic patients for the prevention of diabetic foot.
- An equally important point is the timely implementation of pharmacotherapy for diabetic angiopathy and neuropathy. Medicines for diabetes mellitus should be prescribed exclusively by specialists from the Diabetic Foot offices, as well as neurologists, endocrinologists, etc.
- Timely eliminate such foot problems as moisture in the skin of the interdigital spaces, dry skin, calluses, since all of them are risk factors for diabetic foot syndrome. The most susceptible to dryness is the skin of the heel area, where cracks often occur, which, against the background of diabetes, eventually turn into trophic ulcers. To eliminate dry skin on the legs, it is necessary to apply the Dialine Active emollient cream and treat the thickened skin of the feet with a special Dayline pumice . In the presence of pronounced roughness of the skin, which is difficult to eliminate with the help of a cream, the patient is recommended to wear home slippers with a heel (in such shoes, when walking, the shock load on the heel will be minimal). In case of severe dryness of the skin of the feet, the cream should be applied 2-3 times a day. To soften the skin, use creams, sprays, balms, which contain vegetable oils or waxes. But today, the most effective means in eliminating dryness are recognized creams that contain urea, which increases the water content in the stratum corneum.
With extensive mycosis of the plantar surface of the feet, the use of fatty creams is not recommended. The fact is that under the cream, which forms a greasy film on the skin, the phenomena of mycosis can be aggravated. For these purposes, it is necessary to use special creams with antifungal components. But it is better to start using them after consulting a dermatologist and prescribing suitable therapy for them.
The moisture of the skin of the interdigital spaces often causes the appearance of skin cracks and diaper rash in this area. The reason may be a cheesy plaque on the skin, called mycosis, or improper foot care (excessive moisture inside the shoes, application of cream in the interdigital zones). Remember! Do not apply creams between your fingers!
If there are no reliable signs of mycosis, it is enough just to reduce the humidity (first – with the help of a gauze pad, then for these purposes you can use talcum powder or special socks with compartments for fingers).
In the presence of fungal infections, it is recommended to use antifungal drugs. It is worth giving preference to drugs in solutions, not creams ( Clotrimazole solution 1%, Lamisil spray , Nit-rofungin ). With mycosis of the nail plates, the course of treatment should be prescribed by a dermatologist! Recently, such a procedure as the removal of the nail plate is no longer practiced, since it is ineffective and traumatic.
The most effective means of treating onychomycosis are antifungal drugs for oral administration, which, as a rule, do not have pronounced side effects. As for antifungal varnishes or creams, they have only a prophylactic effect with onychomycosis and are an adjunct to the main treatment. If the patient is wary of systemic antimycotic therapy or has contraindications for such treatment, he is prescribed topical agents that dissolve the nail plate. The most effective of these drugs is Mycospor (cream + patch), which must be used within 2-3 weeks. After that, for several months, a special antifungal cream ( Mikospor , etc.) must be applied to the nail . Hyperkeratosis (calluses), arising under the influence of excessive pressure, often cause hemorrhages with further suppuration and the formation of a diabetic ulcer. The causes of such overloading of the feet are orthopedic problems, deformities of the feet, and improper selection of shoes. It is important that patients with diabetes mellitus promptly remove corns with a pumice stone, a special apparatus in the offices of the “Diabetic Foot” or pedicure salons.
In diabetes mellitus, the use of special fluids and plasters to remove corns is contraindicated, since their use can often cause the formation of diabetic ulcers.
If the overload of the skin area is not eliminated, the callus will certainly form again. To reduce the load, it is recommended to wear special prophylactic or orthopedic shoes, to use the means of “small orthopedics” (correctors of the beak-shaped fingers, gel pads, insoles, instep supports, etc.). However, these funds can only be used after they have been prescribed by an orthopedic doctor or a specialist in the Diabetic Foot. The patient should know all the precautions and the rules for their use, since against the background of impaired sensitivity there is a high risk of damage to the skin.
In case of diabetes mellitus, the use of magnetic massage insoles (with protrusions) is contraindicated – this can lead to skin damage and the development of a diabetic ulcer.
Features of the treatment of the resulting foot injuries
A patient with diabetes can provide first aid to himself. First you need to rinse the wound. To do this, you can use a solution of hydrogen peroxide, chlorhexidine , miramistin or acerbine .
Acerbin is a versatile antiseptic and anti- inflammatory drug . It also stimulates the regeneration of damaged tissues, which means that its use will be advisable at all stages of the wound process.
Then a sterile bandage should be applied to the wound (you can also use a special napkin, for example, Koletex ) and fix it well with a bandage. If the wound does not heal within 2-3 days, the patient should urgently visit an endocrinologist or the Diabetic Foot office.
Remember that the treatment of feet with diabetes should be carried out exclusively by specialists. It is important to know that more than 90% of patients with diabetic foot syndrome are cured without amputation if the necessary measures are taken in a timely manner.