Diabetes is the most common cause of lower leg and foot amputations in Germany. To prevent a diabetic foot, regular care and examinations are important in addition to optimal metabolic control. Most of the foot lesions in diabetics come about through unsuitable footwear and wrong foot care. Often, additional visual disturbances are present, so that skin redness and swelling are also not recognized. Basically, the diabetic foot is divided into two forms. This distinction is important because the treatment is appropriate. In circulatory disorders running and exercise are considered as the drug of choice, on the other hand, the neuropathic damaged foot must be quieted.
Peripheral Polyneuropathy (PNP)
Several factors make life difficult for the diabetic. On the one hand, damage to the fine nerve endings of the feet threatens a disturbed perceptive sensation of touch, temperature and pain. Foot injuries can not be noticed in time. For example, those affected do not notice that they walk around the shoe on a pushpin or a bottle cap, often for days. Blowing too tight or badly fitting shoes as well as burns from hot baths or hot water bottles are often detected too late and cause great problems. Therefore, it is important to pay attention to the smallest injuries or changes to the foot and to treat them immediately.
The skin of the diabetic foot has due to the so-called autonomic neuropathy on a reduced sebum and sweat production, so it is very dry and cracked. However, dry skin breaks down faster and provides ideal living conditions for bacteria and fungi - threatening serious infections. The most important rule is therefore a normal blood glucose control.
Improper loading leads to deformations of the foot
Another problem: foot deformity due to nerve damage can lead to deformations or deformations of the foot such. B. hammer toes, claw toes or the known hallux valgus. Due to the incorrect loading, it also leads to an increased corneal formation. These calluses can spread to infections that can lead to serious complications in a very short time. The danger: a wound can look superficially small, but it hides a large infection. It is therefore important to remove the cornea regularly (!) Carefully.
Warning signs for a neuropathic foot include severe dryness, calluses, warm and rosy feet, decreased sensitivity and painless injuries.
Peripheral arterial disease (PAD)
In many cases, there is a peripheral circulatory disorder already when the diabetes is diagnosed. Warning signs of peripheral circulatory disorders are pale, bluish, and cold feet. Injuries are felt to be extremely painful. Feet and legs hurt even at low loads, but these pass away in peace. Since those affected like to stand in front of a shop window until the pain has disappeared, the disease is also referred to as intermittent intermittent claudication. In the case of arterial circulatory disorders, attempts can be made to promote blood circulation and to maintain the limbs with blood circulation-promoting measures or even vascular surgery.
When both forms come together ...
About one-quarter of those affected have a combination of neuropathy and circulatory disorders as the cause of diabetic foot syndrome. If, in addition to the nerve function, the blood circulation is disturbed, the wounds on the diabetic feet are very difficult to treat. Because the typical symptoms of a circulatory disorder can be masked by the combination with neuropathy (reduced pain sensation). It is therefore important that even in the diagnosis of diabetes attention is paid to warning signs.
Diabetic foot: examination at the doctor
Every diabetic should look at his feet daily and feel for bruises and injuries. The doctor should examine the feet of type 1 diabetics after prolonged illness or type 2 diabetics at least once every quarter, at least once a year he should consider the sensation of vibration as a measure of neuropathy. The doctor examines the feet on the texture of the skin (dry, cracked), skin lesions, bruises, calluses and changes in foot aesthetics and motor skills. Furthermore, he will feel the foot pulses of the diabetic to check the blood flow. For non-tactile foot pulses, a Doppler pressure measurement should be performed.
Neurological examination of the diabetic foot
The neurological examination at the doctor is inexpensive, but very effective:
- The most important instrument is the 10 g monofilament according to SEMMES-WEINSTEIN. A nylon thread is pressed onto the examination point. With a base weight of exactly 10 g it bends through. If the patient does not feel this pressure, it can be assumed that his foot is endangered by neuropathy. First, the patient should be demonstrated on the forearm, what he should feel.
- Checking the thermosensitivity with the Tip-Therm. This device has a metal and a plastic end. There is a temperature difference between the two ends. The difference is felt by the patient when he has a true temperature sensation.
- Tuning fork according to RYDELL-SEIFFER: At least once a year, the doctor should check the perception of vibration as a measure of neuropathy. With the 64 Hz damped tuning fork, the sensation of vibration is tested at various points.
For the three studies mentioned, it makes sense for the diabetic to close his eyes in order to be able to fully concentrate on the sensation on the foot. Incidentally, the reflex hammer is also an important instrument for assessing neuropathy, because the Achilles tendon reflex may have died out very early.