What are the other Names for this Condition? (Also known as/Synonyms)

• Diabetic Foot due to Diabetic Neuropathy
• Diabetic Foot owing to Diabetic Peripheral Neuropathy
• Foot Ulcer due to Diabetes

What is Diabetic Foot? (Definition/Background Information)

• Diabetic Foot occurs in individuals having diabetes for a prolonged period. Uncontrolled blood sugar levels can result in diabetic neuropathy, frequently leading to Diabetic Foot
• Diabetic neuropathy is a type of nerve damage that affects individuals with diabetes. The term neuropathy indicates nerve dysfunction that causes symptoms such as weakness and loss of sensation
• Elevated levels of blood sugar cause injury to nerve fibers throughout the body, and a diabetic neuropathy particularly damages the nerves present in the hands and feet, potentially resulting in Diabetic Foot. Poor blood circulation in diabetes may also lead to Diabetic Foot
• The symptoms of Diabetic Foot include tingling, numbness, burning/stabbing pain, sensitivity to touch, lack of coordination, muscle weakness, ulcers, and other deformities affecting the feet
• The early symptoms of Diabetic Foot may get better when blood sugar is brought and maintained under control
• In many developed countries, Diabetic Foot results in foot ulceration in about 2% of the people diagnosed with diabetes. It is the most common cause of non-trauma related amputations. In developing nations though, foot ulcers and consequent amputations are much more common

Who gets Diabetic Foot? (Age and Sex Distribution)

Diabetic Foot is a condition that develops as a result of prolonged poor glycemic control and resultant diabetic neuropathy. Thus, individuals of any age and gender may be affected.

• Individuals with non-insulin dependent diabetes mellitus (NIDDM) appear to have an earlier onset of neuropathy symptoms than those with insulin-dependent diabetes mellitus (IDDM), which can lead to Diabetic Foot
• The symptoms of neuropathy and Diabetic Foot are more prevalent in those with type 2 diabetes
• Prevalence of Diabetic Foot as a result of diabetic neuropathy is reported to increase the longer an individual has uncontrolled diabetes
• Symptoms of Diabetic Foot, as part of lower extremity amputations in diabetes, appear more prevalent in men across all ethnic groups
• Diabetic African-American and Hispanic men are reported to develop Diabetic Foot at a higher rate than non-Hispanic whites

What are the Risk Factors for Diabetic Foot? (Predisposing Factors)

Any individual with diabetes may develop diabetic neuropathy, and therefore, Diabetic Foot. However, the following factors could make one more susceptible to nerve damage that leads to the condition:

• Poor glycemic control
• The time period one has had diabetes (usually several years)
• Poor body weight management and obesity
• Race: African-American and Hispanics are reported to be more susceptible to diabetic neuropathy
• Hypertension
• Smoking
• Excessive alcohol consumption
• Loss of sensation in feet as a result of neuropathy may cause small cuts, blisters, etc. to go unnoticed, causing infections and ulceration

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Diabetic Foot? (Etiology)

Diabetic Foot is caused by either damage to nerves or blood vessels in diabetic individuals, such that the feet do not get enough oxygen. Such damage could be caused by:

• Poor glycemic control
• Longstanding diabetes
• Being diabetic and not maintaining a healthy body weight
• Poor foot hygiene
• Lack of regular physical activity
• Smoking and alcohol consumption, which are both known to contribute to diabetic nerve damage and blood vessels constriction

What are the Signs and Symptoms of Diabetic Foot?

An individual with Diabetic Foot may show one or more of the following signs and symptoms (in the feet):

• Foot pain
• Sensitivity to touch
• Numbness in the foot
• Tingling sensation
• Burning and stabbing pain
• Muscle weakness
• Calluses on feet
• Wounds that take a long time to heal
• Chronic foot ulcers 
• Frequent infections in wounds on the feet marked by redness, increased pain, pus formation, odor, fever etc.

How is Diabetic Foot Diagnosed?

A physician may employ one or more of the following tests and procedures to diagnose Diabetic Foot:

• An examination of the feet, to check for sores, scratches, and ulcers
• Blood tests that include fasting plasma glucose, hemoglobin A1c, and complete blood count (CBC)
• Tests for sensation such as temperature, touch, and vibration, to assess how well an individual feels or responds to stimuli
• Nerve conduction velocity (NCV) test to determine how fast nerve impulses travel
• An electromyography (EMG) test in conjunction with NCV test to see how well the muscles receive signals from the nerves
• If an individual has an infected wound in the foot, sending samples of the wound for microbiological assessment
• If the physician suspects that the infection has spread to the bone, imaging tests such as X-rays, to confirm or rule out the same

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Diabetic Foot?

Diabetic Foot occurs as a result of nerve damage and/or poor circulation that could potentially result in serious complications, such as:

• Chronic ulcers
• Infections that do not heal completely
• Infection spreading to the bone
• Bone deformities, such as Charcot foot
• Gangrene
• Foot and/or lower extremity amputations

How is Diabetic Foot Treated?

Treatments for Diabetic Foot vary, depending on the severity of the condition:

• The most important treatment available is good glycemic control
• If there is a wound, debridement by a healthcare professional, which involves:
• Cleaning and disinfecting the skin and surrounding area
• Cutting away the dead tissue and washing the ulcer
• If the wound is infected, then:
• Determining the kind of microbe causing the infection by culturing the wound
• Antibiotic treatment to cure the infection
• If there is an ulcer or infection, the physician may advise rest, since walking with an ulcer or infected wound could push it deeper into the tissues
• Enzyme treatments to dissolve dead tissue around ulcers, as recommended by the doctor
• Dressing of the wound by a healthcare professional following treatment
• If the physician determines that the infection has spread to the bone, surgical removal (amputation) of infected area, including the entire foot or lower limb, as required

How can Diabetic Foot be Prevented?

Since Diabetic Foot occurs as a result of complications of diabetes, the following steps may help prevent the condition:

• Keeping blood sugar regularly under control
• Examining the feet daily
• Cutting toenails regularly
• Getting the feet examined by a healthcare professional periodically, more so if diabetic peripheral neuropathy and peripheral arterial disease are noted
• Keeping the feet clean and soft 
• Wearing shoes and socks at all times, thus protecting the feet from hot and cold, as well as avoiding cuts, wounds, etc.
• Wearing special shoes as recommended by a healthcare professional
• Wearing comfortable, adjustable shoes that allow airflow
• Helping blood flow to the feet by routine physical activity

What is the Prognosis of Diabetic Foot? (Outcomes/Resolutions)

• Diabetic Foot, if diagnosed early, is reportedly treatable and reversible in a majority of cases
• However, if an infection becomes chronic and spreads deep within the tissue or to the bone, it could result in amputation of the foot or lower limb

Additional and Relevant Useful Information for Diabetic Foot:

• Type 2 diabetes is a chronic disease in which the blood contains high levels of glucose (sugar), the body’s main source of fuel

The following article links will help you understand type 2 diabetes and diabetic peripheral neuropathy:

https://www.dovemed.com/diseases-conditions/type-2-diabetes/

http://www.dovemed.com/diseases-conditions/diabetic-peripheral-neuropathy/