Diabetes mellitus is dangerous not only because of its immediate manifestation in the form of deterioration in well-being, but also because of its impact on the functioning of other organs.
Thus, damage to the vascular system in the foot area leads to the development of gangrene and phlegmon.
Phlegmon is an acute inflammation of tissues that develops as a result of pathogenic microorganisms entering them.
The causative agent may be:
Diabetic phlegmon predominantly occurs in the middle cellular layer of the left or right foot and is acute. However, the lesion can affect any part of the limb and manifests itself in different forms (see photo).
According to the nature of the disease, the disease is classified into chronic and acute.
By depth of penetration: subcutaneous and subgaleal.
By location:
As mentioned, the cause of the disease is the penetration of microorganisms into the tissues. This is typical for patients with diabetes, since they have impaired blood circulation in the extremities and reduced local immunity, which allows microbes to develop in favorable conditions.
Pathogens enter soft tissues as a result of:
All these processes lead to disruption of tissue integrity, which allows microorganisms to penetrate and develop. An additional source of pathogens can be a source of chronic infection in the body, which, through the blood or lymph flow, reaches a “weak” area, where it forms phlegmon.
The main symptom that patients pay attention to is severe pain in the limb and a feeling of fullness from the inside. They intensify while walking and applying pressure.
In addition, the patient suffers from:
Fluctuation is detected when trying to squeeze the foot, and there is a feeling that there is liquid under the hand that is moving.
This is due to the absence of a capsule in phlegmon, as a result of which pus accumulates in the tissues. Its only limitation is the fascial cases.
When the chronic form of the disease develops, symptoms may be almost completely absent. And instead of fluctuation, an infiltrate with a hard, woody consistency is found on the foot. The skin over the phlegmon becomes bluish (see photo).
To make a diagnosis, the doctor needs to collect anamnesis, examine the patient and prescribe diagnostic procedures.
The main conclusions are made upon examination and palpation of the affected area, however, to confirm the diagnosis the following is prescribed:
After an accurate diagnosis, therapy with medications or surgery is prescribed.
Treatment of inflammation of the soft tissues of the foot is a long and painful procedure. It includes a set of methods, the main one being surgery. For patients with diabetes, any intervention in the integrity of tissues is dangerous, since the healing process is very slow and poor.
For the operation, it is important to achieve a decrease in sugar levels and maintain them at a low level throughout the recovery period. For this purpose, increased doses of insulin are usually used, including for people suffering from type 2 diabetes.
The operation itself takes place under general anesthesia. The doctor makes a tissue incision at the location of the pus, removes it, and along with it the dead tissue. Then the drainage is installed without sutures.
The wound is restored by secondary intention.
The operation is complex because the foot contains a large number of blood vessels, nerve endings and tendons.
It is important for the surgeon not to damage them, but to completely clean the wound.
During the healing process, the drainage is changed regularly, and the wound is treated with antiseptics and antibiotics to reduce the risk of new infection and eliminate swelling and inflammation.
The leg, as a rule, is fixed for several weeks so that the patient cannot damage the accreting tissues and the process of their restoration proceeds correctly.
In parallel, drug treatment is used, including:
Complete recovery takes several months, during which the wound heals and the tissue is restored. The patient is usually prescribed bed rest, and the leg is placed in an elevated position so that excess fluid drains out.
To accelerate wound healing, methyluracil ointment or Troxevasin gel is used. Iruksol ointment and similar products containing enzymes are used to remove dead tissue.
In case of poor healing of the wound and large defects, dermoplasty is used, with the help of which these defects are hidden.
If necessary, medications can be used to maintain a normal cardiovascular system. Drinking plenty of fluids is also recommended to help with detoxification faster.
After treatment, the patient must wear orthopedic shoes, which will prevent re-entry of infection into the tissue.
In the case when the disease was detected at the initial stage, surgical intervention may not be required if the infiltrate has not formed. Then the patient is prescribed compresses with yellow mercury ointment or thermal procedures.
If left untreated, phlegmon of the foot can lead to:
It is impossible to treat a disease such as phlegmon at home on your own. This can lead to the growth of infection and complete loss of a limb, and in severe cases, death.
Video from an expert:
Prevention of the development of phlegmon of the foot includes simple measures that must be followed by everyone, especially people suffering from diabetes. First of all, they should avoid various injuries to the extremities; if abrasions appear, treat them with disinfectants. And treat any infectious disease until complete recovery. Use comfortable and practical shoes that do not cause blisters or chafing.
At the same time, it is important to control blood sugar levels and prevent their elevated levels. Regular blood sugar testing and adherence to diet therapy play a big role in this.
To normalize blood circulation in the lower extremities, it is recommended to perform a set of exercises, which are developed for each patient individually depending on his physical capabilities.
It is also important to strengthen the immune system by following a healthy lifestyle and taking vitamin supplements. This will help the body independently cope with germs trying to get inside.
At the first appearance of signs of phlegmon, you should immediately consult a doctor who will prescribe therapy. Do not self-medicate under any circumstances.
Diabetes mellitus is a serious chronic disease that is accompanied by a huge number of complications. The most dangerous of them can be considered diabetic foot syndrome (DFS). According to the World Health Organization, this syndrome occurs in 15% of patients with diabetes for 5 years or more.
Diabetic foot syndrome is a pathological change in the nervous system, arterial and capillary beds that can lead to the formation of ulcerative necrotic processes and gangrene.
About 85% of such cases are trophic foot ulcers, the remaining part are abscesses, phlegmon, osteomyelitis, tenosynovitis and purulent arthritis. This also includes non-purulent destructive damage to the bones of the extremities - diabetic osteoarthropathy.
In diabetes, there is insufficient production of the hormone insulin, the function of which is to help glucose (sugar) reach the body's cells from the bloodstream, therefore, with its deficiency, glucose rises in the blood, over time disrupting the blood flow in the vessels, damaging the nerve fibers. Ischemia (lack of blood circulation) leads to impaired wound healing, and nerve damage leads to decreased sensitivity.
These disorders contribute to the development of trophic ulcers, which in turn develop into gangrene. Any cracks or abrasions turn into open ulcers, and hidden ulcers also form under calluses and keratinized layers.
The reason for the late start of treatment and amputation of limbs is that the patient does not notice the changes occurring for a long time, since most often he does not pay attention to his feet. Due to poor blood supply to the legs along with decreased sensitivity, the pain from cuts and abrasions is not felt by the patient and even an ulcer can go unnoticed for a long time.
Typically, damage to the foot occurs in those places that bear the entire load when walking; cracks form under the insensitive layer of skin into which infection enters, creating favorable conditions for the occurrence of a purulent wound. Such ulcers can affect the legs down to the bones and tendons. Therefore, eventually there is a need for amputation.
Globally, 70% of all amputations are related to diabetes, and with timely and consistent treatment, almost 85% could be prevented. Today, when the “Diabetic Foot” offices are open, the number of amputations has decreased by 2 times, the number of deaths has decreased, and conservative treatment is 65%. However, the real number of people with diabetes is 3-4 times higher than statistical data, since many are not aware that they are sick.
So, the reasons for the development of diabetic foot syndrome are:
The main cause of nerve damage is the constant effect of high levels of glucose on nerve cells. This pathology in itself does not cause tissue necrosis. Ulcers occur for other, indirect reasons:
Ulcers that form after micro-abrasions, cuts and abrasions heal very poorly, becoming chronic. Wearing uncomfortable and tight shoes aggravates skin damage. Trophic ulcers, growing and deepening, spread to muscle and bone tissue. According to research, the development of neuropathic ulcers in 13% of cases is caused by excessive thickening of the stratum corneum of the epidermis (hyperkeratosis), in 33% by the use of inadequate shoes, in 16% by treating the foot with sharp objects.
Deterioration of blood flow through the arteries of the legs is associated with atherosclerotic plaques (see how to reduce cholesterol without drugs). Atherosclerosis, which causes damage to large vessels, is severe in diabetes mellitus and has a number of features.
Atherosclerosis in a patient with diabetes can cause tissue death and the formation of trophic ulcers independently, without mechanical impact or injury. An insufficient amount of oxygen enters the skin and other parts of the foot (due to a sharp disruption of blood flow), resulting in the death of the skin. If the patient does not comply with precautions and further injures the skin, the area of damage expands.
Typical clinical symptoms are pain in the foot or ulcer, dryness and thinning of the skin, which is highly susceptible to microtrauma, especially in the toes. According to research, the triggers for neuroischemic lesions are fungal infections of the feet in 39% of cases, treatment of the feet with sharp objects in 14%, and careless removal of ingrown toenails by a surgeon in 14%.
The most dramatic consequence of DFS is amputation of a limb (small - within the foot and high - at the level of the leg and thigh), as well as the death of the patient from complications of the purulent-necrotic process (for example, from sepsis). Therefore, every diabetic patient should know the first symptoms of diabetic foot.
You should examine your feet weekly while sitting on a chair in a mirror placed below - you can simply examine the toes and top of the foot, pay attention to the space between the toes, feel and examine the heels and sole using a mirror. If any changes, cracks, cuts, or non-ulcer pathologies are detected, you should contact a podiatrist (foot specialist).
Patients with diabetes should visit a specialist at least once a year and have the condition of their lower extremities checked. If changes are detected, the podiatrist prescribes medicinal treatment to treat the feet, the angiologist performs operations on the vessels of the legs, if special insoles are required, then an angiosurgeon is required, and special shoes - an orthopedist.
Depending on the predominance of a particular cause, the syndrome is divided into neuropathic and neuroischemic forms.
Comfortable, high-quality shoes, made taking into account the requirements for the prevention of injuries and corns, help to avoid foot deformation and significantly reduce the risk of developing diabetic foot syndrome in diabetes mellitus.
Important requirements for shoes for diabetics:
If possible, a custom pair of insoles is made.
Shoes for diabetic feet should be stable and comfortable. The leg fit is adjustable for maximum comfort.
To prevent the development of diabetic foot syndrome, it is important to treat diabetes mellitus and ensure that the sugar level is close to normal. The patient is required to regularly visit the doctor and monitor his feet - it is important to notice changes in time.
It is also important to monitor the condition of blood vessels and control blood pressure. Foot hygiene is carried out regularly; every day the patient should examine the skin for changes and damage.
Massage with moisturizing cream or oil prevents roughness and cracks in the skin, improves blood flow and reduces congestion in tissues.
Ankle exercises improve circulation and blood supply and prevent swelling.
Foot care includes:
If the patient is not lazy and follows all recommended measures, this can significantly reduce the risk of developing diabetic foot. It is easier to prevent a disease than to treat it.
If ulcers are detected early, this allows them to be cured. Contact your doctor right away to prevent infection and avoid complications or amputation.
Diet and unloading of the limb are necessary to heal foot ulcers. After wound healing, it is necessary to strictly adhere to preventive measures to prevent the formation of ulcers in the future.
Maximizing a person's ability to fight infections is possible by strengthening the immune system. Controlling your blood sugar, moderate exercise, good nutrition, and nutritional supplements can help improve your health and well-being.
— Diabetes mellitus (E10-E14)
Diabetic foot according to ICD 10: E10.5 - E10.6 - E13.5 - E14.5 - depending on the form of diabetes mellitus
A person’s foot is a mirror that reflects the state in which his body is. Its static and dynamic functions, as well as its shape, largely depend on the structure and relative position of the bone, articular, ligamentous and muscular apparatus. If minor changes in the appearance, temperature or color of the feet indicate disturbances in the functioning of internal organs, then foot deformity is a serious reason to sound the alarm.
In the field of orthopedics, diseases associated with deformation of the bone structures of the foot are divided into:
Among the reasons that contribute to deformities are:
Flat feet are usually called deformities that manifest themselves due to a decrease in the height of the arch of the foot, pronation of the rear and flattening of the forefoot. This deformation occurs accompanied by a violation of the relative position of bones and a violation of trophism.
Flat feet are also divided into the following types:
Valgus and varus deformities of the big toes (also called bunions or bunions on the foot) are the most common (especially among ballerinas) complex diseases. Symptoms include the formation and enlargement of a dense growth at the base of the first toe. This bump is only an external manifestation of a number of changes in the structure of the foot. Includes:
Congenital weakness in the ligamentous apparatus and prolonged exposure to stress in the forefoot, in particular, wearing tight shoes and high heels, contribute to the development of this disease.
This question is one of the most pressing today. Some may resolve on their own as the child grows, while others require prevention and treatment.
Foot deformity - clubfoot is recognized as a far from rare pathology that manifests itself in newborns. In this case, the foot is turned inward, brought toward the knee, and all the emphasis falls on the outer edge of the foot. The foot itself takes on a crescent shape. You can also find another type of deformation in which the foot is lifted up and brought to the shin - the so-called heel foot. It is believed to be formed inside the womb.
Horse's foot (foot equinus) is a foot deformity that often occurs with spastic paralysis and in most cases it is accompanied by varus of the anterior or posterior sections. There is a congenital (very rare) and acquired equinus foot. The causes of cauda equina foot include damage to the muscles in the front of the leg and their tendons, some types of myopathies, and inflammation in soft tissues (cellulitis, as an example).
Diabetic foot (diabetic foot syndrome) is a disease that combines a complex of functional changes in the anatomy of the foot. It is caused by metabolic disorders in the endocrine system that develop with diabetes mellitus.
The syndrome increases the possibility of injury and infection of the soft tissue of the foot, the course of purulent-necrotic processes, which in advanced cases leads to amputation. It is a collective concept that unites groups of complications that have arisen in diabetes. As a result, pathological changes in the foot rapidly develop in the form of:
In some cases, the concept is not used as an independent nosological form, but only the components of foot disease in diabetes mellitus (gangrene, abscess, etc.) are indicated.
According to its forms, the syndrome is classified into:
The syndrome is the main reason for limb amputation in diabetes. It affects approximately 8-10% of people suffering from diabetes, and 40-50% of whom can be classified as at risk according to the following criteria:
It is surprising that over the course of many centuries, and even today, there are often cases where the foot is deliberately subjected to deformation. This phenomenon has become widespread among professional ballerinas and, until recently, in Chinese culture. For a ballerina this is a surplus of the profession, but for Chinese women it is a custom that provides great opportunities.
Foot binding is a custom among Chinese girls that has been practiced for a long period (particularly among the aristocracy). It consisted of tying all the toes, except the big one, to the foot. Afterwards, they were forced to wear small shoes, which caused significant deformation in the anterior region. In some cases, disability occurred, and the girl was completely unable to walk. The traditional name for such legs is “golden lotuses”. The process itself was divided into four stages, the purpose of which was to form a high arch of the foot. As a result, many unpleasant consequences arose:
Ballet has been delighting and captivating the minds of audiences for a very long time. But not many people know that for ballerinas, legs are the most painful topic in backstage life. In medicine, a separate specialization has even been created that deals exclusively with injuries to dancers.
The ballerina’s legs, despite the fact that they are unusually strong, strong and resilient, are considered a very vulnerable place. Often, professional injuries in ballet are associated with fractures, dislocations and sprains, as well as joint injuries.
Ballerinas also have the concept of “breaking the rise.” It consists of deliberately stretching the ligaments of the upper and forefoot. With such an unnatural bending, the tensile ligaments are stretched and partially torn, as a result of which the ligamentous apparatus weakens and becomes very loose. In addition, ballet dancers are also prone to other foot problems that were mentioned earlier.
During dance, ballerinas' feet experience stresses that go beyond nature and are considered unnatural. Over time, the front of the foot becomes flattened. The result of the movements is the formation of transverse flat feet, divergence to the sides of the extreme metatarsal bones and expansion of the anterior section.
In ballerinas, the appearance of hallux valgus is associated with the tightening of pointe shoes across the legs, moving on the tips of the toes, while experiencing simply colossal loads. During a performance, movements are made around the axis of the foot. Twisting and untwisting of the foot in ballerinas occurs in the opposite direction regarding the anterior and posterior sections. A professional ballerina's feet do not always look attractive without pointe shoes and therefore require a high degree of care and attention.
There are many methods that help assess the condition of the internal organs: magnetic resonance imaging (MRI), ultrasound examinations (US), X-rays. In diagnosing injuries, in our case with foot deformities, all of them can be used, where the most accurate method is MRI. However, it does not always allow you to see everything.
Arthroscopy is a type of special surgical procedure that minimizes damage to healthy tissue. Arthroscopy has opened up opportunities that were previously unavailable: it allows for a most accurate diagnosis and literally immediate surgery on the damaged area, and the patient can be discharged on the same day.
This is one of the few low-traumatic methods that allow you to directly see joint damage. Thanks to the use of this method, about 5-10% of information is lost, which is very little compared to other methods that allow observing the joint from the inside. Significant magnification makes it possible to see many small details.
Unlike arthrotomy (opening the joint cavity), arthroscopy creates a clearer picture, allowing the surgeon to most accurately see and evaluate the real interaction of the elements of the organ that is being examined. At the moment when tissue is dissected and joints are exposed, this opportunity is usually lost.
Diagnostic arthroscopy is suitable for use on any type of joint (this also includes the joints of the foot).
We can boast of a list of disorders for which arthroscopy is used. It is quite impressive, covering various types of pathologies: traumatic and organic in nature. Arthroscopy is practiced in case of rupture, damage to the ligament, cartilage (other elements), in correcting overgrowth, in diagnosing diseases of various types (arthritis, arthrosis, osteoarthritis, etc.).
Actually, like all surgical interventions, arthroscopy has its adverse consequences. But their frequency is negligible compared to standard operations, and complications can be quickly and easily treated.
As a result of arthroscopy, the following may be observed:
This procedure allows you to quickly rehabilitate and return to everyday life. At the same time, excessive loads should be avoided.
And in conclusion, I would like to say that timely reaction and action in case of foot problems will allow you, if not to completely avoid the harmful consequences, then at least reduce them to a minimum. Don't be afraid to see a doctor! Take care of your feet!
If a patient with diabetes does not take the necessary measures to prevent complications of this disease, then problems cannot be avoided. One of the most severe pathologies is Charcot's foot in diabetes mellitus. This complication is also known as diabetic osteoarthropathy or Charcot joint. The disease is characterized by changes in bone tissue.
Diabetic osteoarthropathy occurs in only 1% of patients with impaired carbohydrate metabolism. The disease appears in cases where diabetes cannot be compensated for and a person has a constantly high concentration of sugar in the blood.
It is almost impossible to prevent the development of this pathology. The only method of prevention is compensation for diabetes. As carbohydrate metabolism disorders progress, the nervous system is damaged and sensitivity decreases.
In diabetes, the process of demineralization of bone tissue begins. As a result, any injuries cause joint deformation and damage. Disturbances in the functioning of the nervous system can lead to the patient not even feeling bone injuries. His gait simply changes, the body itself redistributes the load.
With Charcot foot, the following changes in bone tissue can progress:
Bones are broken repeatedly and do not heal properly. As a result, the foot becomes deformed. Over time, the situation worsens and neuropathic complications appear. Along with fractures and deformities of the legs, ulcerative lesions develop. And this causes blood flow to problem areas and increases the process of leaching calcium from the bones.
Charcot foot is not the only form of manifestation of diabetic foot.
Neuroischemic pathology develops against the background of diabetic angiopathy. It manifests itself as a deterioration in blood flow: the sensitivity and shape of the foot are preserved. But swelling is observed, the surface of the skin becomes cold, and the pulse weakens.
It is also possible for a mixed form of damage to occur: symptoms of Charcot foot and neuroischemic pathology develop simultaneously.
Experts distinguish 4 stages of this disease. Initially, patients' joints are destroyed, acute bone fractures appear, and joint capsules are stretched. All this together leads to the appearance of dislocations. The skin turns red, swelling appears, and local hyperthermia is observed.
If treatment is refused, the leg will eventually have to be amputated.
Diabetics need to know what leads to the onset and progression of the disease. The main cause is high blood glucose levels. As a result of persistent hyperglycemia:
Any damage to the legs in diabetic patients requires close attention.
If you notice foot deformation, cuts, calluses, or sores, you should immediately consult a doctor. You should pay attention to the following complications:
With these pathologies, the intensity of disease progression increases. Diabetics should pay attention that DOAP (diabetic osteoarthropathy) appears when the feet are overloaded, stretched, or deformed. The wrong choice of shoes and injury to certain areas of the feet also lead to the development of problems.
Signs of this rare disease include:
Diabetics should be aware of all the symptoms in order to begin treatment in a timely manner.
Even with careful monitoring of changes in the body, it is often impossible to detect the development of Charcot foot in diabetes mellitus in a timely manner. Because of this, treatment is sometimes started late. Indeed, in the early stages it is not possible to notice changes even during an X-ray examination.
The disease can only be detected by MRI and bone scintigraphy. Characteristic symptoms appear in later stages of the disease.
For an accurate diagnosis, patients are referred to special centers dedicated to the identification and treatment of diabetic foot. Clinic doctors rarely encounter the pathology, also known as Charcot's joint, so they may make an incorrect diagnosis. Sometimes patients are mistakenly diagnosed with thrombophlebitis, lymphostasis, and phlegmon.
It is important to determine whether the foot lesion was caused by an infectious or non-infectious disease. Depending on this, an accurate diagnosis is established and treatment is prescribed. Therefore, if DOAP is suspected, MRI and bone scintigraphy are indispensable. With the help of these examinations, it is possible to identify microfractures, inflammatory processes even in the initial forms, and increased blood flow in problem areas.
If the disease was detected in the acute stage, then all efforts should be directed toward preventing the occurrence of further fractures and stopping the process of osteolysis. The main method of treating neurogenic foot damage is complete unloading of the limb. It continues until the symptoms of inflammation completely disappear: swelling, hyperthermia.
Providing adequate unloading is more important than prescribing drug therapy. If you continue to put stress on the problematic leg, the likelihood of bone fragments shifting and the progression of the deformity increases.
In the first weeks, strict bed rest is mandatory. If signs of improvement appear, walking is allowed using a special orthosis that transfers the load from the foot to the lower leg.
The swelling usually goes away 4 months after the start of treatment. After this, the doctor should allow you to begin gradually removing the orthosis. It will be possible to walk only in specially made shoes.
Medicines are also prescribed to treat arthropathy. They recommend medications that affect the metabolic process in bone tissue. The hormonal drug Calcitonin and bisphosphonates (Xidifon, Fosamax) stop the process of bone destruction.
The use of vitamin D3 metabolites, for example Alpha D3-Teva, as well as anabolic steroids, can stimulate the process of bone tissue formation . But there is no point in taking calcium supplements; they do not have any effect on the metabolism in bone tissue. After all, the inclusion of calcium in bones is regulated by hormones. But they are necessary in the treatment of severe pathologies of bone tissue: they ensure the supply of calcium to the body in the required quantity.
To eliminate swelling, it is recommended to prescribe non-steroidal anti-inflammatory drugs, some diuretics and tight bandaging. To quickly stop inflammation, radiotherapy is prescribed. But without adequate unloading of the limbs, this method will be ineffective.
A control x-ray is taken 4-6 months from the start of the treatment process. Even if the condition improves, patients should take care of themselves and wear specially designed orthopedic shoes. With its help you can prevent:
It is better to abandon attempts to correct the resulting deformities using orthopedic shoes. This can cause ulcers to develop quickly.
In some cases, diabetic foot syndrome can only be cured through surgery. It is necessary to correct the shape of the foot. But surgical treatment methods are possible only after the inflammatory process has completely stopped and the process of osteolysis has stopped.
Patients with diabetes should closely monitor their sugar levels. If diabetes cannot be compensated for, pathologies may develop. One of the most severe complications is Charcot's foot. With this disease, bone tissue is destroyed, due to multiple fractures, the foot is deformed, and ulcers appear.
On the other hand, the disease affects the processes of fat and nitrogen metabolism in the body, provoking vasospasm. An increase in the level of low and very low density lipoproteins in the blood leads to the deposition of cholesterol crystals on the vascular walls and the development of atherosclerosis.
Obviously, under the influence of such changes, normal blood circulation throughout the body and the supply of tissues with oxygen and nutrients are disrupted. Decomposition products are also not removed in a timely manner. Increased fragility of blood vessels increases the likelihood of their rupture and local hemorrhages.
In macroangiopathy , the targets are large arteries and veins, mainly the coronary system of the heart and the vessels of the lower extremities. This form is expressed in the rapid progression of atherosclerotic changes.
In the case of the heart, this eventually results in coronary disease with the risk of myocardial infarction, in the case of the legs - in thrombosis and impaired functionality.
The best prevention for angiopathy is compliance with the diabetic regimen and all doctor’s instructions. When diagnosed with diabetes, regular annual (or more frequent) examinations by an ophthalmologist, cardiologist and nephrologist or urologist should be the norm. It is necessary to completely stop smoking and preferably from drinking alcohol, since they put a high strain on blood vessels. A low-salt and low-protein diet is good for preventive purposes.
Patients need to develop self-control, closely monitor their health, and focus on any little things that could develop into serious problems in the future. Often the further path of development of the disease depends only on them. With a responsible approach, the prognosis is favorable in most cases.
Fungal infection, as a result of phlegmon of the foot in diabetes mellitus, is often encountered in medical practice. In the absence of adequate treatment, an infection gets into the affected areas of the skin, forming a purulent abscess. This often provokes blood poisoning and leads to inevitable amputation of the limb. In diabetes, the disease is difficult to treat; due to high sugar levels, even a minor wound takes a long time to heal. In this case, medication and surgical intervention cannot be avoided.
There are a sufficient number of causes of phlegmon in diabetes mellitus. This is due to the fact that pathogenic microorganisms penetrate the soft tissues, which begin to multiply and infect new areas. The inflammatory process begins, followed by suppuration. First of all, the disease develops in people with diabetes and immunodeficiency, as the body's resistance sharply decreases. The most common causes of soft tissue damage:
Cellulitis occurs in the deep layers of the dermis, so when it is closed, it is not contagious.
Symptoms of phlegmon in diabetes are clearly expressed by painful sensations in the foot area. With pressure, the pain intensifies, the person is constrained in movement and cannot walk in usual shoes. It can be open or closed, purulent, serous, putrefactive, or develop into a necrotic form. This type of formation is characterized by:
It is very easy to determine the presence of fluctuations at home; just feel with your hand; you will feel the free movement of liquid under your fingers. In the chronic form of phlegmon caused by streptococci, there may be no symptom at all. Sometimes cyanosis appears in the affected areas.
To confirm the diagnosis of phlegmon, the attending doctor collects information about the patient. First, an examination is carried out; if the phlegmon in a diabetic is located on the surface and is open, then a sample is taken, and if it is located internally, an ultrasound or x-ray examination is prescribed. A survey is conducted to determine whether there were any bruises on the limb, diabetic foot, open wounds, or fungal diseases. All this will be required when drawing up an individual treatment plan.
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In this case, treatment requires surgery. Surgery can be avoided in rare cases when the purulent sac has not yet formed. Then heat compresses and mercury ointment are prescribed. The operation is performed under general anesthesia, a deep incision is made and the wound is cleaned, after the manipulation a drainage is installed. In this case, stitches are not applied, the wound heals by secondary intention to avoid relapse. The patient remains in the hospital for several days under the constant supervision of a doctor, the drainage is changed daily, and treated with antiseptic and antibacterial agents. Concomitant medications are prescribed to improve the patient’s condition and speed up healing.
Self-medication is strictly prohibited for this disease. In this case, cellulitis can lead to gangrene and loss of limb.
After surgery, the disease may be complicated by osteomyelitis.
The rehabilitation process is difficult and the possibility of complications cannot be ruled out. This is due to the fact that the wound has no boundaries in the form of compactions, so new areas are quickly affected. If the infection spreads to the bone tissue, osteomyelitis will develop and the vascular system will also suffer, which leads to the formation of thrombophlebitis and complicates treatment.
To protect yourself from phlegmon, you need to strengthen the immune system and promptly treat tumors on the legs, especially with diabetes. It is recommended to establish metabolic processes in the body and eliminate bacterial irritants that provoke the development of the disease. Choose comfortable shoes made from natural materials; if corns, calluses or wounds appear, carefully treat and isolate the area until complete healing.