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Treatment of feet with diabetes

21 Sep 18

Causes and signs of gangrene of the legs in diabetes mellitus

Patients with diabetes experience acute circulatory problems in the extremities, which often leads to a terrible complication - gangrene of the legs.

Necrotic tissue damage at the initial stage goes unnoticed. Treatment not started in a timely manner contributes to the further development of necrosis, and as a result, the patient risks losing his lower limb and even his life.

Causes of gangrene development in diabetes

The main cause of gangrene is high blood sugar, which negatively affects the conduction of nerve impulses and the condition of blood vessels.

The amount of oxygen reaching the affected limbs becomes insufficient, the skin loses sensitivity and tissue begins to die.

Wounds and trophic ulcers appear on the surface, through which infections enter the weakened body.

Factors that provoke gangrene can be:

  • polyneuropathy;
  • decreased vascular patency caused by the formation of atherosclerotic plaques;
  • decreased immunity. The body is unable to cope with the infection;
  • low rate of regenerative processes in tissues;
  • bacterial infection;
  • disruption of blood supply to the brain, heart and lungs;
  • thrombophlebitis.
  • Reasons such as:

  • smoking - nicotine constricts blood vessels and promotes the formation of blood clots;
  • obesity;
  • large blood loss caused by leg injuries;
  • intoxication with toxic substances;
  • thermal damage to the tissues of the extremities;
  • shoes that interfere with blood circulation in the foot.
  • With diabetes mellitus, more than half of patients notice signs of the development of diabetic foot, when the process of necrosis has started and drug treatment is no longer effective.

    There are two types of diabetic foot – dry and wet.

    Dry gangrene (see photo) most often occurs on two limbs at once as a result of insufficient nutrition of muscle fibers. This type of necrosis develops over a long period of time, over several years, and is typical for patients with normal or low body weight.

    A decrease in the volume of blood supply causes the muscles to dry out, which subsequently leads to necrosis, blackening and mummification of the toes and their independent amputation.

    Dry gangrene does not have a toxic effect on the patient’s body and does not pose a threat to life.

    Wet gangrene (see photo) progresses quickly, sometimes several hours are enough for its development. The cause is infection of the affected limb due to acute oxygen starvation of the tissues.

    An introduced infection can lead to the development of dry gangrene into wet necrosis. This occurs in overweight people who are prone to edema.

    Rapid inflammation is accompanied by severe pain and causes swelling and darkening of the leg. The limb begins to rot, which can result in blood poisoning.

    Wet gangrene is a dangerous complication that requires immediate treatment because it can be fatal.

    There are also differences in the types of origin of the necrosis process:

    • osteopathic – damage to bone tissue and the musculoskeletal system occurs;
    • neuropathic – the result of dysfunction of nerve cells;
    • angiopathic – appears against the background of destructive changes in blood vessels;
    • mixed – combines different types of complications.
    • External signs of necrosis at the initial stage

      In order not to miss the development of gangrene, it is necessary to pay attention to such possible manifestations as:

    • loss of sensation in the legs;
    • numbness or tingling sensation;
    • limbs often freeze as a result of poor circulation;
    • pale skin color on the feet, later the leg turns red or blue;
    • legs often get tired;
    • the color and structure of nails changes, their fragility and susceptibility to fungal infections increases;
    • an unsteady gait with pronounced lameness appears;
    • Fever and nausea may occur.
    • Having discovered such signs, you should immediately undergo examination and begin treatment.

      By changing the color of the skin of the legs, you can notice how necrotic damage to the tissues of the extremities begins.

      With dry necrosis, the following changes occur:

    • redness of the fingers is observed;
    • the redness subsides and the skin turns pale;
    • a bluish tint appears;
    • dying fingers turn black;
    • a clear boundary between affected and healthy tissues is visible.
    • Progressive pathology can no longer go unnoticed.

      Signs of dying become pronounced:

    • against the background of normal health, pain in the legs bothers you;
    • limbs become insensitive to external influences;
    • Dying and healthy tissues are more clearly distinguished;
    • the pulse in the leg disappears;
    • deformation of the foot and its drying out occurs.
    • Wet gangrene manifests itself somewhat differently:

    • a venous network becomes noticeable on pale skin;
    • limbs become swollen;
    • at the initial stage there is no difference between diseased and undamaged areas.
    • Advanced wet gangrene manifests itself as clearly noticeable symptoms:

    • intense pain that cannot be relieved;
    • the skin turns black and becomes covered with blisters containing pus;
    • an unpleasant odor appears from ulcers and wounds;
    • high temperature and low pressure are observed, tachycardia increases;
    • vomiting, tremors in the legs, and seizures occur.
    • Video about the stages of development of necrosis in diabetes mellitus:

      Treatment of the complication depends on the type of gangrene and the degree of neglect of necrosis. Dry gangrene in the early stages is more easily amenable to drug therapy. The primary goal of conservative treatment is to reduce blood glucose levels and restore blood circulation in the extremities.

      Wet gangrene can lead to blood poisoning and death, and therefore is an indication for amputation of a limb to save the patient’s life.

      Conservative treatment is aimed at achieving the following results:

    • Normalization and control of blood sugar.
    • Anesthesia. Novocaine injections and antispasmodics can be used.
    • Restoration of blood supply. Actovegin and Trental are prescribed.
    • Heparin will help eliminate blood clots.
    • Antibiotics can block infection.
    • The consequences of poisoning the body with rotting products are eliminated.
    • To eliminate the load on the limbs, bed rest is observed.
    • Vitamin complexes will restore immunity.
    • The complex provides antiseptic treatment for ulcers, relieves swelling, and corrects nutrition.

      In conservative therapy, non-traditional methods of treating wounds are also used:

    • A slightly shocking method is to use flies to tighten ulcers. Larvae placed in a wound eat tissue damaged by rotting and disinfect it, which leads to rapid healing.
    • Use of an oxygen chamber. The affected limb is treated with oxygen in a special apparatus, after which the wounds heal.
    • For wet necrosis, surgical intervention is indicated. In severe cases, it is necessary to remove the affected limb, including a significant part of the healthy area. For example, if a toe rots, the entire foot is amputated. Such radical methods do not exclude the possibility of death after some time, especially in elderly patients.

      If possible, surgeons try to save the leg and remove only the damaged areas, cleaning and restoring the adjacent tissue. After surgery, anti-inflammatory treatment with antibiotics and hormones is carried out.

      If the necrosis process is in the initial stage, less traumatic methods can be used:

      1. Shunting. As a result, the vessel affected by the plaque or thrombus does not interfere with the normal blood circulation process. The tissues receive enough nutrition and the development of gangrene can be stopped.
      2. With the help of hardware, it is possible to remove the formed thrombus from the vessel.
      3. Walling. A wall is installed to widen the narrow lumen of the artery.
      4. These methods will help avoid amputation and maintain leg mobility.

        Traditional medicine - is it worth relying on?

        As an auxiliary measure, you can try turning to traditional medicine. Gangrene is a dangerous complication, so you cannot rely only on healing ointments and drugs.

        The entire complex of therapy must be agreed upon with a doctor, otherwise self-medication may lead to a worsening of the condition.

      5. Sprinkle rye flour bread with salt and chew well. Make a compress from the pulp onto the affected area.
      6. Apply fresh beef liver to sore spots for a long time. Abscesses should form, which should be pierced with a sterilized needle. This compress helps even in the most severe cases.
      7. Finely chop the pink-skinned potato tubers and make compresses every two hours.
      8. Prepare yogurt, preferably from natural fat milk, soak a cloth folded in several layers in it and wrap it around the sore area. Wrap the top with cellophane and a dry cloth. Leave the compress on all night. Repeat the procedure for 4 weeks.
      9. Grind aloe leaves into porridge and combine with salt in a ratio of 1:9. Wash the damaged limb generously with hydrogen peroxide and apply aloe. Leave for two days. Repeat 10 times.
      10. Combine pork fat, sunflower oil, rosin, honey and laundry soap in equal parts and boil. After cooling, mix with chopped garlic cloves, onion and aloe leaves (also in equal proportions). Apply warm to sore spots.
      11. Rinse the affected area with hydrogen peroxide. Lubricate with birch tar. If the gangrene is dry, then replace it with sea buckthorn oil. Mix a bottle of fish oil with 10 tsp. honey and soak a piece of cloth. Place the cloth over the tar-smeared area. Secure the bandage and leave it until the morning. In the morning, remove the bandage and apply a new one after half an hour. The honey mixture should be kept in a cool place.
      12. These remedies will ease the course of the disease and speed up recovery, but only in combination with medication prescribed by a doctor.

        Video material about the treatment of diabetic foot with medicines and folk remedies:

        Patients with diabetes need to carefully monitor the condition of their legs.

        Following simple rules will significantly reduce the likelihood of developing gangrene:

      13. Monitor blood glucose levels.
      14. Move more often. Walking or light jogging helps improve blood flow. You can also imitate movements on the bed.
      15. Give your feet a cold shower every day. Afterwards, rub harshly with a towel.
      16. Warm baths with sea salt or mustard will be helpful.
      17. Taking blood thinning medications regularly will prevent the development of blood clots.
      18. Handle calluses and wounds on your feet carefully, preventing infections from entering them.
      19. Wear shoes that fit properly.
      20. Avoid fungal infections of the feet.
      21. Diabetic gangrene

        According to statistics, gangrene in diabetes mellitus develops in half of patients. The most common gangrene of the lower extremities affects the feet and calves, although the fingers may also be affected. Due to the fact that wounds with diabetes mellitus heal poorly and there is a high probability of infection, foot gangrene becomes a consequence of diabetic foot. Blackening and subsequent rotting of a part of a limb negatively affects the mental and physical state of a person, but the pathology can be prevented.

        Why does gangrene develop?

        Often, due to the negative impact of diabetes on the body, necrosis occurs on the leg, turning into an abscess. If left untreated, the area that festeres gradually enlarges, taking in new tissue and bone. As a result, gangrene occurs.

        The following reasons for the development of gangrene in diabetes mellitus are identified:

      22. Ischemia. Damage to blood vessels by sugar disrupts blood circulation, capillaries and large vessels become clogged due to developed atherosclerosis. Oxygen starvation of tissues leads to the formation of necrosis, which festers.
      23. Infection. Diabetic foot leads to the formation of non-healing ulcers, which can be associated with infection. The proliferation of anaerobic bacteria in wounds leads to gangrene.
      24. Return to contents

        Depending on the cause and characteristics of the course, dry and wet diabetic gangrene of the lower extremities differs. The first type of pathology begins unnoticed, and in an elderly person the development of the disease does not cause suspicion. It is believed that foot problems are natural for older people. If the finger becomes dark or blackened, black spots appear on the skin of the legs, this indicates developing gangrene.

        Dry gangrenous type

        Dry gangrene in diabetics occurs due to gradual damage to the lower extremities. The slow deterioration of blood circulation allows the body to adapt and protect itself. The initial stage is accompanied by severe pain, but then sensitivity is lost. Most often, the pathology affects the toes. If the fingers darken, or one of them looks blacker than the rest, this indicates the development of necrosis. The affected area does not rot, but dries out and mummifies. The operation is performed to prevent the development of infection and complications of wet gangrene, as well as from an aesthetic point of view.

        Wet gangrene of the feet occurs quickly in a diabetic patient. The main cause of the pathology? sudden ischemia or infection of existing wounds. This type of gangrene is associated not only with diabetic foot, but also with tissue damage caused by burns, frostbite, cuts, and injuries. Even a minor burn can cause the loss of a leg.

        In wet gangrene, the affected area of ​​tissue is not black, but purple or blue-green. The sore finger rots, but does not dry out. Swelling occurs and an unpleasant smell of rotting appears. When pressing on the sore finger, a specific sound is heard, which provokes accumulated hydrogen sulfide. The patient's general condition worsens due to intoxication. If left untreated, blood poisoning may occur. If wet gangrene of the leg develops due to diabetes mellitus, amputation is necessary.

        The onset of the disease is determined by how the skin looks. At the initial stage, dry gangrene is characterized by the following symptoms:

      25. the skin of the feet and fingers turns red;
      26. redness of the skin turns blue and black;
      27. the diseased area is clearly demarcated from the healthy one.
      28. Wet gangrene develops as follows:

      29. the skin turns pale;
      30. a pattern of dilated vessels appears;
      31. swelling of the legs develops;
      32. there is no clear boundary between the diseased and healthy areas.
      33. In the future, with the dry form of the disease, the following symptoms are observed:

      34. the contrast between the healthy and diseased part of the leg becomes bright;
      35. the leg/finger becomes smaller, deformation appears;
      36. sensitivity is lost;
      37. the pulse disappears in the limb;
      38. there is pain that gets worse at night;
      39. The patient's general health is normal, there is no intoxication.
      40. The following symptoms are characteristic of the late stages of development of the wet type of gangrene:

      41. brown blisters form on the skin and burst on their own;
      42. purulent wounds appear that emit a stench;
      43. the patient's temperature rises and blood pressure decreases;
      44. tachycardia develops;
      45. tremors occur in the limbs and severe pain that cannot be eliminated even with the help of strong painkillers;
      46. The patient’s general condition is serious, convulsions, delirium appear, and vomiting occurs.
      47. Treatment of gangrene in diabetes mellitus

        The first signs of gangrene in diabetes mellitus require immediate treatment. Treatment of gangrene in diabetes mellitus begins with eliminating the first signs of the disease. To prevent a finger or toe from being removed, existing ulcers must be treated. For this, healing ointments are prescribed. You can’t do anything about the problem that has arisen on your own. If a patient has wet gangrene at a late stage of development, amputation is not necessary to save his life.

        Surgery is considered the preferred method of treating gangrene.

        Drug treatment

        Conservative therapy is applied to the dry type of the disease. The wet type can be cured with medication only at the very beginning of development, when ulcers have formed. As part of therapy it is necessary:

      48. Compensate for diabetes. The patient is prescribed antihyperglycemic drugs and a strict diet.
      49. Remove the load from the sore limb. It is recommended to immobilize the affected leg.
      50. Provide the body with oxygen. A series of oxygen inhalations is performed.
      51. Restore blood circulation. The following drugs are prescribed: “Reopoliglyukin”, “Trental”, “Vazaprostan”.
      52. Eliminate blood clots. Drugs such as Streptokinase and Heparin are used.
      53. Heal wounds. Local wound healing agents are prescribed. The healing ointment “Levomekol” is popular.
      54. Eliminate inflammation and infection. Antiseptics and antibiotics are used, for example, Miramistin.
      55. Strengthen your immune system. The patient is prescribed vitamin complexes.
      56. Surgery

        Wet gangrene in diabetes often cannot be eliminated without surgery. If the body is seriously poisoned, it is impossible to help the patient in any other way. During the operation, the affected tissues, fingers, and feet are removed. Depending on the extent of the pathology, high amputation up to the hip is possible. The method allows you to avoid blood poisoning, relieve intoxication and prevent death. In dry cases, amputation is necessary to prevent infection and the development of sepsis.

        Traditional medicine makes it possible to stop decay and cure tissue death that has begun only if traditional methods are used in combination with conservative ones. It is difficult to eliminate the wet type of pathology using traditional methods. The following recipes are popular:

      57. Moisten a natural soft cloth with homemade sour milk and apply to the affected area.
      58. Soak a natural fabric in clove oil and make a compress.
      59. Apply a compress of chewed rye bread and salt to the sore limb.
      60. With the dry type of pathology, which developed against the background of diabetes mellitus, the prognosis is favorable. The affected area may separate on its own. In this case, surgery will not be required. Despite this, if your toe turns black in diabetes, you should definitely consult a doctor. With the wet type of the disease, the prognosis is less optimistic; the likelihood of developing the following complications is high:

        As part of prevention, you should strictly adhere to the diet prescribed by your doctor when diabetes is diagnosed. You need to constantly monitor the level of glucose in the body. It is important to lead a healthy lifestyle, play sports, and move a lot. It is recommended to inspect your feet daily for wounds and cracks, and avoid injuries, cuts, burns, and frostbite. Shoes should be comfortable. With diabetes, even dropsy rubbed by new shoes can cause the loss of a leg.

        Treatment of leg trophic disorders in type 2 diabetes mellitus

        Everyone knows that failure to comply with doctor's instructions leads to complications of diabetes. However, almost every patient hopes that this fate will bypass him and the extra candy or bun will not affect his health in any way. Unfortunately, the course of diabetes is very unpredictable and the slightest deviation from the given treatment and lifestyle can throw you out of the regime, and recovery will take time, during which complications can develop, and legs with diabetes suffer in most cases. In addition, only a complete laboratory examination can reveal the progression of pathological processes, so even good numbers on a glucometer are not a 100% guarantee that diabetes is not progressing. The most common problems are foot problems. In the most severe cases, amputation is possible, so treatment of legs for type 2 diabetes should be prescribed as early as possible.

        With diabetes mellitus, especially if the second type, atherosclerosis develops. Moreover, the older the age, the more severe the narrowing of blood vessels. With stenosis, a sufficient amount of oxygen and nutrients is not delivered to the lower extremities, so pain occurs, which proportionally depends on the size of the lumen of the vessels. It is important to perform stenting in case of stenosis of 50%. This will not only help get rid of pain, but will also allow the vessel to maintain the necessary lumen for many years.

        There are two courses of development of complications.

      61. Damage to the nerves of the legs due to constant high sugar. As a result, it is impossible to conduct a nerve impulse, which leads to loss of sensitivity, so nothing may hurt, but the process still progresses. This disease is called neuropathy.
      62. Progressive atherosclerosis, clogging blood vessels, contributes to the development of oxygen starvation. With this outcome, the pain syndrome is very pronounced. My legs hurt almost constantly.
      63. The first course is dangerous because even the slightest microtrauma will go unnoticed, and weak immunity will lead to the development of an ulcer, the treatment of which will take a very long time.

        Edema of the lower extremities

        Edema is a symptom of nephrotic syndrome and atherosclerosis. The syndrome disrupts metabolic processes in the body, and sclerosis impedes blood flow. Therefore, if your legs hurt and swell, you should immediately consult a doctor, since diabetes mellitus in its decompensated form progresses very quickly. Especially if you have type 2 diabetes, in which patients monitor their sugar levels once a week.

        For edema, it is important to carefully follow a diet, do special exercises that will help alleviate the condition, and follow the prescribed treatment that will combat both the symptoms and the cause.

        Ulcers of the lower extremities

        Causes of ulcer formation in patients with diabetes:

      64. disruption of tissue nutrition;
      65. nerve conduction disorder
      66. pathological processes in blood vessels;
      67. mixed type.
      68. Prerequisites include:

        Pharmacies once again want to make money from diabetics. There is a smart modern European drug, but they keep quiet about it. This.

        The second most serious complication after a trophic ulcer. This disease is dangerous because it is detected in more than 80% of patients with diabetes mellitus who ignored the initial symptoms of the disease - swelling and pain. The result of severe and moderate cases is amputation. The level of amputation depends on the severity of the process and the depth of the lesion.

      69. long experience of diabetes mellitus;
      70. constant jumps in blood glucose concentration;
      71. skin trauma.
      72. loss of sensation;
      73. thickening of the skin;
      74. pale skin;
      75. swelling;
      76. pain syndrome (legs hurt almost constantly, but the condition worsens during physical activity).
      77. Treatment of feet for diabetes mellitus has no standards. The approach to each patient is individual, which means that the treatment and recommendations will differ, since the severity of the disease and concomitant diseases are different for everyone.

        There are three areas that are considered basic:

      78. treatment of atherosclerosis;
      79. elimination of diabetic foot syndrome;
      80. surgery to restore blood flow.
      81. Treatment of diabetic foot

        If conservative treatment does not produce positive results or is no longer advisable, then the surgical method is used.

      82. diabetes compensation, that is, keeping glucose levels within normal limits;
      83. antibiotics to prevent the development of bacterial inflammation;
      84. the use of pain relief, mainly in the form of tablets;
      85. prescribing medications that improve blood circulation and thin the blood;
      86. the use of antiseptics in the form of ointments or patches.
      87. necroectomy only if the area of ​​necrosis is small;
      88. plastic surgery of blood vessels or their removal if restoration of patency is impossible;
      89. removal of fingers (a type of amputation);
      90. leg amputation, the level depends on the degree of damage.
      91. Unfortunately, patients seek help in the later stages, and therefore about 80% of ulcers develop into an inflammatory process that cannot be treated for a long time. Just like the treatment of diabetic foot, the treatment of ulcers can be conservative or surgical.

        Conservative is the most strict, therefore it is often carried out in a hospital under the supervision of medical personnel, because diabetes mellitus is not a disease that can be stabilized on its own.

      92. maintaining sugar concentration within normal limits;
      93. treatment of diseases of other organs and systems;
      94. anesthesia;
      95. unloading of the lower extremities;
      96. drugs to restore nerves in the legs;
      97. blood thinners;
      98. use of antibiotics and antifungal drugs.
      99. use of sterile bandages and dressings with preliminary antiseptic and antibacterial treatment;
      100. necroectomy and cleaning tissue from pus;
      101. vascular plasticity;
      102. amputation (if all previous measures did not give the desired positive effect).
      103. Complications of diabetes mellitus that result from the absence or improper treatment of the legs:

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        • acute, recurrent inflammatory process caused by streptococci;
        • regional and then generalized inflammation of the lymph nodes and blood vessels;
        • sepsis, which is almost impossible to treat.
        • It is important to know that no treatment can replace a correct lifestyle. Even amputation of a limb is not the final stage if the patient does not comply with the doctor’s instructions. Another problem is that patients ignore the initial symptoms and come to the doctor with already advanced complications that require a radical solution.

          In the initial stages, you can get by with self-massage and physical therapy, which will improve blood circulation and relieve pain. However, if you have existing symptoms (such as swelling or numbness), it is important to discuss any exercise and massage with your doctor, as this can only complicate the course of diabetes. In the absence of any prerequisites, it is still worth taking preventive measures; this will help not only improve the current condition, but also avoid serious problems in the future.

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          Diabetic foot is a syndrome that combines vascular changes, disruption of the conduction of nerve impulses, deterioration of recovery processes in the area of ​​the lower extremities (feet) and reduced body resistance to infections due to diabetes mellitus.

          Diabetic foot syndrome is various diseases of the feet in the form of purulent-necrotic processes that develop against the background of pathological changes in the skin, blood vessels, nerves, soft tissues, joints and bones.

          Prevalence of diabetic foot syndrome

          Leg diseases are one of the most common complications of diabetes. 4-10% of people with diabetes have foot ulcers, one of the most common manifestations of diabetic foot.

          Diabetic foot syndrome develops 10 times more often in patients with type 2 diabetes mellitus than in patients with type 1 diabetes.

          Amputations of the lower extremities in patients with diabetes are performed 15 times more often than in all other people.

          Causes and mechanism of development of diabetic foot syndrome

          The main changes causing diabetic foot syndrome are:

          • polyneuropathy – due to damage to nerve cells and fibers, the conduction of impulses along nerve fibers is disrupted, which leads to malnutrition of the feet;
          • micro- and macroangiopathy – damage to small vessels (capillaries) and medium-diameter vessels (various arteries) due to the deposition of lipids in the walls of vessels, vascular calcification, and the development of atherosclerosis;
          • changes in bone tissue - with diabetes mellitus osteoporosis develops, bone tissue is gradually destroyed;
          • reduced resistance to infections - patients with diabetes are prone to infectious kidney diseases, tuberculosis, fungal infections, anaerobic infections (develops in conditions of lack of oxygen).
          • Certain conditions and diseases associated with diabetes mellitus predispose to the development of diabetic foot syndrome. These diseases include:

            • foot deformity;
            • lack of pulse in the arteries of the feet;
            • increased keratinization of the skin in the foot area;
            • peripheral neuropathy in the feet.
            • Depending on the severity of these symptoms, 3 risk groups are distinguished among patients with diabetes.

              I – In the area of ​​the feet, pulsation in the arteries is normal, sensitivity is preserved at all points on the legs. Such patients require a detailed examination of the lower extremities once a year.

              II – If there is reduced sensitivity in the feet, the presence of deformities, or the absence of a distal pulse, patients should be examined once every six months.

              III – In the presence of severe neuropathy, ulcers, or a history of amputations, a detailed examination of the lower extremities is necessary once a quarter.

              Classification of diabetic foot syndrome

              There are 3 main forms:

              • neuropathic – 60-70%;
              • ischemic – 3-7%;
              • mixed (neuroischemic) – 15-20%.
              • Complaints of patients with diabetic foot syndrome

                In the early stages of the disease, patients are concerned about increased fatigue of the legs when walking, paresthesia (feeling of goosebumps, tingling), and chilliness in the feet.

                As the disease progresses, deformation of the feet develops, and selection of shoes becomes problematic.

                When walking, pain may appear in the calf muscles, which goes away after a short rest (intermittent claudication).

                Clinic of diabetic foot syndrome, main symptoms

                The neuropathic form is characterized by decreased sensitivity of the skin in the area of ​​the feet and deformation of the feet.

                Due to the reduced sensitivity of the skin in the area of ​​the feet, patients do not promptly pay attention to small wounds and cracks into which bacteria enter, and against the background of reduced body resistance, purulent complications often develop.

                The main manifestations of the neuropathic form are neuropathic ulcers and osteoarthropathy. The typical location of neuropathic ulcers is the interdigital spaces and the sole area.

                Diabetic osteoarthropathy manifests itself in the form of changes in the osseous-ligamentous apparatus and deformation of the feet.

                In the ischemic form, the skin on the feet is cold, pale, and sometimes may have a pinkish tint. Sores may be located on the tips of the fingers and the edges of the heels.

                This form is characterized by a weakening or complete absence of pulse in the arteries of the foot, popliteal and femoral arteries. Intermittent claudication is a characteristic symptom of the ischemic form of diabetic foot syndrome.

                Diagnosis of diabetic foot syndrome

                It is necessary to conduct a thorough examination of the lower extremities of a patient with diabetes mellitus. You need to pay attention to the color of the limbs, the condition of the nails, the presence of areas of increased keratinization (hyperkeratosis), and ulcerative defects.

                Then it is necessary to assess the temperature of the lower extremities and check the pulsation in the main arteries.

                An examination of the lower extremities of a patient with diabetes mellitus must necessarily include an examination of the neurological status. It is necessary to evaluate pain, temperature, vibration, tactile sensitivity, and determine tendon reflexes in the legs.

                The main instrumental research methods used to diagnose diabetic foot syndrome include Doppler ultrasound, Doppler ultrasound, angiography and radiography of the feet and ankle joints.

                In addition to the mandatory determination of blood sugar levels and daily glycemic profile, in the presence of ulcerative defects, a bacteriological examination of the discharged wound defect is carried out to determine the causative agent, its sensitivity to antibiotics and the selection of the optimal drug for treatment.

                Treatment of diabetic foot syndrome

                Treatment of leg problems must begin with the treatment of diabetes itself. It is necessary to achieve normal blood sugar levels by selecting optimal doses of insulin.

                If a patient has type 2 diabetes mellitus and was taking tablet medications, it is necessary to switch him to insulin.

                If you have ulcers, you need to choose an effective antibiotic.

                The legs need to be given rest. This is achieved by observing bed rest, wearing special orthopedic shoes, using a wheelchair, and crutches.

                Local treatment of ulcers includes excision of dead tissue, areas of hyperkeratosis, removal of purulent contents, and washing of wounds with an antiseptic solution (chlorhexidine).

                B vitamins, antispasmodics (no-spa, papaverine), and prostaglandin preparations will help improve the condition of blood vessels.

                In case of pronounced necrotic changes, the question of amputation may arise.

                Prevention of diabetic foot syndrome

                Regular examination by an endocrinologist, selection of the optimal dose of insulin, timely treatment of minor wounds and abrasions will help prevent the development of severe complications.

                If your feet are deformed, you must wear special orthopedic shoes.

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                What is diabetic foot: description, photos, symptoms and treatment

                Diabetic foot is one of the late complications of diabetes mellitus, characterized by pathological changes in the tissues of the foot. According to statistics, 8-10% of patients with diabetes suffer from this syndrome, and 50% of such patients are at risk.

                When blood sugar is elevated for a long time, dysfunction of the large and small vessels of the legs occurs. In the future, this leads to disruption of the functioning of all tissues of the lower extremities - bone, muscle, as well as changes in the structure of the skin.

                All this is the basis for rapid infection, resulting in the formation of ulcers, phlegmon and even gangrene. The latter leads to indications for amputation of a limb, after which the person becomes disabled.

                There are three types of diabetic foot:

              • Neuropathic – damage to the nervous tissue predominates;
              • Ischemic – circulatory disorders;
              • Mixed - both previous types are combined.
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                From here you can learn everything about the trigeminal nerve and its treatment.

                The main causes of complications

              • Peripheral neuropathy.
              • In simple words - damage to the nerves of the lower extremities; people who have had diabetes for more than 10 years are at risk of such complications. With damaged leg nerves, the patient does not fully feel his limbs. Therefore, if the shoes are uncomfortable or rub, the diabetic simply will not pay attention to it, he does not feel it. Therefore, scratches, calluses and corns are discovered late.

                Poorly controlled diabetes mellitus, as mentioned above, disrupts the functions of small and large vessels of the legs (veins, arteries). This leads to atherosclerosis, in which rapid healing and recovery take longer.

                Any damage or injury to the foot is very dangerous in case of diabetes; even a small cut or scratch should not be ignored.

                They can lead to serious complications in the form of bacterial infections, so the fungus must be treated.

                This most often occurs when wearing tight shoes. If you do not notice the ingrowth process in time, the soft tissues of the finger and then the entire foot may become infected.

                What are the symptoms?

                At the very beginning of the development of a diabetic foot, the patient does not experience any painful sensations, since most of the nerve endings of the leg no longer produce pain impulses, since they have already died.

                This is precisely the danger of this disease - the invisible onset of the disease, which does not give rise to a reason to consult a specialist. The following symptoms are observed:

              • Swelling of the foot;
              • Redness;
              • Feeling of tingling and crawling;
              • Cold feet;
              • Cramps.
              • At the stage of manifestation of all these signs, treatment can be carried out, most often it is reversible. But if these symptoms are missed, the process develops further, starting with the appearance of superficial ulcers, which then penetrate deeper into the subcutaneous fat space.

                Stages of diabetic foot

                Stage 0 – the foot is deformed, calluses and corns form, the skin is pale and cold to the touch. Ulcers have not yet formed.

                Stage 1 – superficial ulcers occur, the underlying tissue is not affected.

                Stage 2 - the ulcer affects not only the skin, but also subcutaneous fat, muscle tissue and tendons.

                Stage 3 – the ulcer penetrates further and reaches the bone.

                Stage 4 – a limited area of ​​the foot turns dark blue or black – this is gangrene. At this stage it is small and has clearly defined contours.

                Stage 5 - Gangrene spreads to the entire surface of the foot and spreads higher - to the lower leg.

                Diagnosis of diabetic foot is carried out by such specialists as: endocrinologist, neurologist, surgeon.

              • X-ray of the feet – to assess the condition of the bones;
              • Ultrasound of blood vessels of the lower extremities;
              • Ultrasound Dopplerography (Doppler ultrasound) of the lower extremities - for a detailed examination of the condition of the veins and arteries.
              • Treatment of diabetic foot

                Treatment of this disease can be either conservative (drugs) or surgical. The approach depends on the stage of the developing syndrome.

                Conservative treatment includes:

              • Normalize blood glucose levels as much as possible.
              • Antibiotics that are prescribed based on bacteriological examination of the contents of an ulcer or wound.
              • Analgesics to reduce pain (Ibuprofen, Ketorol, Analgin)
              • Drugs that improve microcirculation (Trental, Agapurin).
              • Antiseptic and antibacterial drugs for topical use (hydrogen peroxide 3%, chlorhexidine 0.05%).
              • For severe lesions of the lower extremities that are not amenable to conservative therapy, surgical intervention is indicated. It comes in several types:

              • Angioplasty and stenting. This method is used in severe gangrene as a way to save a limb.
              • Vascular bypass. Carried out to improve blood circulation in blood vessels
              • Skin plastic surgery. After excision of dead tissue of the foot, the wound surface is closed with a healthy flap of skin.
              • Amputation of a limb. The amputation site depends on the extent of the pathological process.
    • First of all, it is necessary to control blood sugar levels, follow a diet and take medications in a timely manner.
    • Only comfortable, closed shoes. If it’s summer time, then be sure to be breathable. Heels are no higher than four centimeters.
    • Under no circumstances should you use traumatic devices such as pumice stones or all kinds of scrubs when caring for the skin of your feet.
    • You need to take care of your foot hygiene.
    • It is advisable to do a pedicure at home to avoid the risk of infection.
    • Trim your toenails straight, do not round the corners.
    • Every day, do foot massage and gymnastics yourself.
    • If the skin of the feet is dry, then with the help of a doctor you can choose special moisturizing creams.
    • Treat fungal infections of the feet promptly.
    • Active lifestyle.

    Diabetic foot syndrome is extremely dangerous for humans. If signs of this syndrome are detected and treatment is started on time, the risk of progression is minimal. If the form is advanced and untreated, the patient faces disability.

    More information about diabetic feet from a doctor is in the next video.

    Manifestations and treatment of leg swelling in diabetes mellitus

    Disturbances in the blood circulation of the legs can be caused by a number of reasons, among which hormonal imbalances occupy one of the first places. The occurrence of swelling is accompanied by changes in the condition of the skin, stagnation in the tissues, and an increase in blood pressure. Swelling of the legs, which occurs with diabetes, has characteristic manifestations that make it possible to identify the initial stages of the disease and begin the necessary therapeutic intervention to prevent the worsening of the disease.

    The first symptoms that should alert you

    The manifestations that are noted with the development of any type of edema in the legs are accompanied by significant swelling of the tissues of the legs and a decrease in the degree of sensitivity. In the absence of treatment, a rapid increase in the degree of discomfort in the patient is likely; due to disturbances in the processes of removing fluid from the body, a change in the consistency of the subcutaneous tissue and an increase in the volume of the affected limb may appear.

    Swelling of the legs, which is observed in diabetes mellitus, is accompanied by the following primary signs, which make it possible to promptly detect the pathology, consult a doctor and begin the necessary treatment:

  • the appearance of areas with swollen and enlarged tissues that have reduced sensitivity to mechanical stress;
  • when you press on such modified tissues for some time (several seconds), a dent remains on the skin;
  • with a longer course of the disease, pain may appear in the swollen area;
  • When type diabetes mellitus manifests itself, many people swell not only the lower extremities, but also the lower abdomen.
  • Even in the initial stages of a polysymptomatic disease such as diabetes, the legs may become swollen in the ankle, shin, or sole area. In some cases, they also swell in the thigh area, but this symptomatology is especially common in the lower legs. Any change in the tissues of the legs should alert you: the appearance of edema of any localization indicates a progressive pathology, which is accompanied by renal failure, extensive congestion in the body, and deterioration in the process of fluid administration.

    Causes of swelling in diabetes

    Since diabetes mellitus is accompanied by significant changes in the body, which are caused by disruption of the hormonal system, disruptions in the process of removing excess fluid from the body can be caused by various reasons. Edema of the legs, which develops in the tissues of the lower extremities with diabetes, can be caused by the following reasons and provoking factors:

  • Heart failure, as a result of which, even in the initial stages of diabetes, a significant decrease in the quality of the heart and blood vessels develops.
  • Hormonal imbalances, which most often cause swelling in the legs.
  • Renal failure, in which the kidneys cannot cope with removing the required volume of fluid from the body, its stagnation occurs, which can provoke the development of infectious processes in the tissues.
  • Pregnancy, which is accompanied by significant hormonal changes and a gradual increase in body weight, which negatively affects the general condition of the lower extremities.
  • Wearing tight and narrow shoes can also provoke stagnation of fluid in the legs.
  • Damage to the blood vessels can cause the development of this disorder in the process of removing fluid from the body, however, in some cases, changes in them become a consequence of edema. At the same time, increased fragility of the walls of veins and blood vessels and changes in the process of blood circulation are noted. In order to find out why swelling occurs, the doctor, when a patient comes in with complaints about the appearance of areas of swelling and a change in the shape of the legs, prescribes a general condition of the body. Analyzes show both changes in hormonal levels, which makes it possible to diagnose diabetes mellitus in a timely manner, and also reveal the stage and degree of swelling in the legs.

    Diagnosis of pathology

    The process of identifying current pathology requires careful diagnosis. Diagnostic methods are standard, with their help you can detect even minor deviations from the norm in the functioning of the hormonal system, and identify other current diseases in the body.

    An external examination allows us to establish the presence of deviations in the condition of the skin and subcutaneous tissue, which, with stagnant processes in the lower extremities, acquire an unhealthy shade and irregular shape: thickened and swollen, the legs at the site of localization of edema become pale, sometimes bluish in color. The doctor also examines the condition of the skin: the presence of wounds on the legs, which are caused by excessive thinness and fragility of the capillary walls, a tendency to form bruises and hematomas, often becomes a symptom of the initial stage of diabetes.

    The diabetic component in detecting swelling of the legs is detected using blood tests, which make it possible to determine the level of glucose in the blood. It is a blood test that allows us to detect current pathological processes in the tissues of the body, the presence of inflammatory processes in them, existing chronic pathologies, which can significantly complicate the process of treating diabetes and have a negative impact on the general health of the patient.

    What is the danger of edema

    The appearance of edema is accompanied by serious disruptions in the functioning of the entire body. In diabetes mellitus, the general health of the patient gradually deteriorates in the absence or insufficiency of treatment, therefore timely diagnosis of the underlying disease, accompanied by edema, will allow stopping the disease at the initial stage and preventing its worsening. With significant stagnation of the process in the tissues of the lower extremities, a negative effect on the blood vessels and veins is noted: the nerve endings are subjected to mechanical stress due to their compression under the influence of enlarged tissues saturated with excess fluid, and the blood vessels become more and more permeable due to the appearance of fragility of their walls .

    Often it is edema that provokes complications that occur when diabetes mellitus becomes the cause of their occurrence. If there is insufficient treatment of the underlying disease or the accompanying edema, there is a high probability of deterioration in the functioning of internal organs such as the kidneys, cardiovascular system, and heart problems may arise. If the listed internal organs are weak, there is a high probability that complications from diabetes will affect them.

    Methods for treating edema

    After diagnosis using an external examination of the affected areas if they are deformed, carrying out the necessary tests, the doctor prescribes treatment. The use of physiotherapy methods, medications and classical therapy for diabetes mellitus can significantly improve overall health and eliminate the main symptoms of the disease.

    Since the elimination of high blood sugar is the main direction of treatment when identifying edema in the presence of diabetes mellitus, first of all the treatment is based on eliminating this characteristic symptom and stabilizing the patient’s condition. And although diabetes mellitus is considered an incurable disease, timely initiation of treatment according to a scheme drawn up by a doctor will help to quickly eliminate the most unpleasant manifestations of the disease and, first of all, swelling of the lower extremities.

    The most effective treatment regimen is one based on the following types of therapy:

  • traditional therapy, including insulin and medicinal effects;
  • traditional medicine methods that have a good supporting and stimulating effect;
  • the use of physical therapy aimed at activating the circulatory system and removing excess fluid from the tissues of the lower extremities.
  • The listed treatment options make it possible to stabilize the general condition of the circulatory, cardiac and hormonal systems, eliminate swelling of the legs, and prevent a possible worsening of the current pathological process.

    Traditional therapy

    Treatment of swelling of the leg tissues, which is carried out using medications, is based on the use of the following drugs that have diuretic, anti-inflammatory and restorative properties:

  • diuretics - their action is based on activating the excretory system and restoring renal function;
  • blockers of antigensin converting enzymes, eliminating congestion and preventing inflammation;
  • ACE inhibitors, with the help of which the occurrence and development of fluid stagnation in tissues is prevented and kidney function is activated.
  • The regimen for using the listed medications is prescribed by the attending physician, who, based on an examination of the affected area and tests performed, will receive a complete picture of health, the degree and stage of development of the pathological process, and its localization.

    Traditional medicine methods are most often used as an additional intervention, since its action is aimed primarily at stimulating the functioning of the immune system, eliminating the consequences of inflammatory processes in the body, and ensuring faster healing of areas of skin damage.

    A technique that explains how to treat swelling of the legs caused by diabetes mellitus includes the following rules:

  • prevention of worsening of the current disease;
  • elimination of inflammation in places of stagnant processes;
  • stimulation of immunity.
  • Treatment with herbal infusions with an anti-inflammatory effect, essential oils, which ensure the cessation of the pathological process in tissues, prevent inflammation of mechanical damage to the skin due to increased fragility of blood vessels, has a good effect.

    Health-improving physical education

    With the help of exercise therapy, you can achieve a significant improvement in the general condition of the patient’s body: activation of blood circulation due to exercises chosen by the doctor, anti-inflammatory effect and stimulation of all systems allows you to guarantee a stable and long-term positive effect from the use of physical therapy.

    However, to prevent a possible deterioration of the condition, the amount of load should be normalized and the body should not be overtrained.

    Prevention of edema: how a diabetic should care for his feet

    Since diabetes mellitus is accompanied by the manifestation of a large number of characteristic symptoms, it is necessary, first of all, if you have a diagnosis of diabetes mellitus, to monitor the condition of the skin of your legs; if any symptoms of swelling begin to appear, consult a doctor for a general examination of the body. Since the walls of blood vessels become very fragile, even minor mechanical damage can provoke bleeding. Treatment of the skin in damaged areas is carried out using a solution of hydrogen peroxide.

    Prevention of leg swelling in diabetes includes dietary correction with a predominance of fresh vegetables and herbs, lactic acid products and vitamin preparations to strengthen the walls of blood vessels. Constant drug therapy with the use of diuretics and exercise therapy is also required.

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