Diabetic foot disease

Disease Description (Causes and Symptoms)

Diabetic foot disease is a collective term for neuropathy caused by diabetes, peripheral vascular disease, changes in the skin and nails, calluses and ulcers caused by pressure, secondary infections, and other conditions. Major pathophysiological mechanisms include

• Sensory nerve damage (loss of protective sensation) → failure to recognize wounds, leading to ulcers from continued pressure
• Motor nerve damage → increased localized pressure due to atrophy and deformity of the toe muscles (such as hammer toes)
• Autonomic nerve dysfunction → dry, cracked skin that is vulnerable to infection
• Peripheral artery disease (ischemia) → reduced blood flow and healing capacity, with increased risk of gangrene and amputation
  Major symptoms: tingling, burning, and reduced sensation in the feet; dry, cracked skin; toe deformities; calluses, blisters, and ulcers; changes in skin color (pallor, redness, or black necrosis); swelling; and drainage and foul odor (in cases of infection).

Treatment Methods

• General principles: Optimize blood glucose and use a multidisciplinary approach (including endocrinology, vascular surgery, plastic surgery, orthopedics, and infectious diseases) after evaluating for infection and ischemia.
• Local wound care: Appropriate dressings (moist wound dressings), regular infection monitoring, off-loading (total contact cast, special shoes/insoles), and redistribution of pressure on the foot.
• Infection treatment: Appropriate antibiotics based on bacterial culture; long-term antibiotics, surgical drainage, and excision for severe soft-tissue infection or bone infection (osteomyelitis).
• Necrotic or irreversible tissue: Prompt debridement to promote healthy tissue.
• Ischemia treatment: After evaluating blood flow (ABI, vascular ultrasound, angiography), consider endovascular treatment (percutaneous angioplasty or stent placement) or vascular bypass surgery.
• Reconstructive surgery: Large and deep defects may be treated with skin grafts, local flaps, free flaps, and other procedures to restore function and appearance.
• Adjunctive treatment: Wound-healing treatments such as hyperbaric oxygen therapy and epidermal growth factor (EGF) are used selectively.
• Lifestyle management: Stop smoking; manage weight, blood pressure, and lipids; engage in appropriate exercise (within limits that do not put excessive strain on the feet); check the feet and moisturize them daily; and wear properly fitting shoes.
• Precautions (during treatment and self-care):
  • Do not walk barefoot, and do not directly expose the feet to hot water or heating devices.
  • Do not self-treat wounds (such as removing calluses with small scissors)—consultation with a specialist or foot-care nurse is recommended.
  • If severe ischemia or infection is suspected, immediate emergency evaluation is required (there is a possibility of amputation).

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

Items/records to bring

• A list of currently taken medications (oral medications, insulin, and supplements) and recent doses
• Recent blood glucose and HbA1c test results (bring the test report if possible)
• Results of previous related tests (ABI, ultrasound, X-ray, etc.) or photographs of test records
• Records of wound changes (photographs: take them at regular intervals to compare size and depth)
• The time symptoms began and how they have changed (pain, drainage, odor, color changes, etc.), daily activity level, and type of footwear
  Sample self-check questions before the visit
• Have there recently been any new wounds, blisters, redness, swelling, odor, or pus on the foot?
• Have there been any changes in the color (pale, blue, or black) or temperature of the foot?

General Sample Questions to Ask the Doctor

• What is the cause of this wound, and what is its current stage (infection, ischemia, osteomyelitis, etc.)?
• What is the expected duration of the antibiotic you plan to prescribe, and what are its side effects?
• Are there indications for revascularization (endovascular treatment or bypass surgery) for my wound?
• What dressings or adjunctive treatments (hyperbaric oxygen, EGF, etc.) do you recommend to help the wound heal?
• What shoes or insoles should I use to protect my feet? Is it covered by insurance?

Sample Questions Tailored to the Condition

• How can we determine whether my foot ulcer has spread to the bone (suspected osteomyelitis), and what is the treatment plan?
• Is the current blood flow in my foot poor enough to require reconstruction (endovascular treatment or bypass surgery), and by how much will the risk of amputation decrease after treatment?