Diabetic foot swelling around the legs
Diabetic foot - these are problems with the legs,which arise due to elevated blood sugar. Diabetes, which is poorly controlled, breaks the sensitivity of the nerves (neuropathy), and also worsens the blood flow in the vessels of the legs. This increases the risk of injury and infection. Syndrome diabetic foot - the patient on his feet appear ulcers, joints and even bones. Wounds do not heal well, the pathogenic microbes multiply in them. In neglected cases this causes gangrene and amputation. Below, we describe what causes, symptoms, prevention and treatment of diabetic foot. Learn how to properly treat ulcers on the legs of the house and in a medical facility. Gangrene, amputation and subsequent disability - this is a real threat in diabetes. But you can prevent it if you follow the rules of foot care.
Diabetic foot syndrome is a common cause of lower limb amputation
Diabetic foot: the content of the article
If you have diabetes for several years, andespecially if all this time you had poor control, then there is a significant risk of injuring your leg. As you know, any wounds and injuries in diabetic patients heal badly. Even a small injury can become festering, gangrene will develop, and it will be necessary to amputate the foot. This is a common scenario. To avoid it, study and carefully follow the rules of foot care, which are given below. If your legs are aching because of neuropathy, then read the article "Sore feet with diabetes - how to be treated". Below is described what to do if the sensitivity in the legs is lowered on the contrary. This happens more often. A diabetic does not feel pain in his legs, changes in temperature, load, cuts, blisters, a stone caught in shoes, etc. With this problem one can live carelessly, and then suddenly it will be discovered that the foot has started to rot and it is necessary to lay down on the table to the surgeon. Follow the recommendations below to keep the opportunity to "walk on your own two".
The number of people with diabetes who have problems withlegs, all the time increases, because the incidence of type 2 diabetes is increasing. In the territory of the Russian Federation and the CIS countries, more than 200 specialized departments of the diabetic foot operate in regional centers. With the help of new modern methods, doctors are increasingly able to prevent amputations.
Treatment of diabetic foot in Moscow - public medical institutions
To find specialists who areclose to you, type in the search engine "the center of the diabetic foot [your city, the regional center]" or "the office of the diabetic foot [your city, the regional center]." After that, you will immediately see what state medical institutions and private clinics are.
Let's examine what causes problems withfeet with diabetes. Diabetics often have a disrupted blood circulation in the vessels that nourish the legs. Not getting enough nutrition, the skin on the legs becomes especially vulnerable to damage, and they heal slowly. Also, the skin of a person with diabetes has a negative effect of frost, although healthy people tolerate winter cold without problems.
Because of chronically elevated blood sugarconduction of nerves in the feet is impaired. This is called sensory neuropathy. Its symptoms - a diabetic feels bad or generally ceases to feel pain, pressure, heat, cold and any effects on the skin. Healthy people, these sensations help to quickly take measures to protect themselves from leg injuries. And patients with diabetes under the same conditions are injured.
Since blisters, burns and abrasions in diabetics are painless, they can not pay attention to their leg problems until gangrene begins.
Another manifestation of diabetic neuropathy -the skin on the legs loses the ability to sweat and remains dry all the time. A dry skin, as is known, often crack. Cracks in the skin on the heels can turn into ulcers. Since these ulcers do not hurt, the diabetic does not take medical measures, and the process moves to gangrene. Another form of diabetic neuropathy is one that blocks the work of the muscles in the feet. There is an imbalance of muscles, which leads to deformation of the foot bones. This type of deformation includes bent toes or fingers in the form of claws, as well as a high arch and a curved foot.
If diabetes has impaired vision, the development of problems withlegs becomes even more likely. Because a person does not see well where he goes when walking. Also, the risk of a diabetic foot is increased if the patient swollen legs due to kidney problems. Because edema increases the amount of feet. The shoes become tight, squeezes and traumatises feet when walking.
What to do? The main means is to bring sugar in the blood back to normal with a low-carbohydrate diet. This is the most important tool to control type 1 and type 2 diabetes. Normalize your sugar - and the manifestations of diabetic neuropathy will pass. You will get rid of them for several months, in severe cases - for 2-3 years. Study and implement a type 2 diabetes treatment program (see below) or a type 1 diabetes treatment.
Prevention of amputation in type 2 diabetes:
Constant pain can be a symptom of stretching, deformation of the foot, bruising, overload, improperly selected footwear or infection.
Redness of the skin is a sign of infection, especially if the skin reddens around the wound. Also, the skin can rub badly matched shoes or socks.
Swelling of the legs is a sign of inflammation, infection, improperly selected footwear, heart failure or impaired circulation of blood in the vessels.
A rise in temperature on the surface of the skin means an infection or inflammation that the body tries to suppress, but does not cope because the immune system is weakened by diabetes.
Any damage to the skin is serious, because an infection can enter it.
Corns mean that the shoes are incorrectly matched, and when walking, the load on the foot is not correctly distributed.
Fungal diseases of nails and feet skin, ingrown nails - can lead to severe infection.
Pus flows from the wound - a symptom of an infectious infection.
Any symptoms listed in this section,mean that you need to see a doctor immediately. Procrastination can lead to leg amputation or death. It is advisable that you are examined by a specialized specialist, and not just a doctor on duty. The article above tells how to find the center of the diabetic foot closest to your place of residence.
Lameness or difficulty in walking can mean problems with joints, a serious infection or that the shoes are not properly matched.
A fever or chills in combination with a wound on the leg is a sign of a serious infection that threatens to kill or amputate a limb
Redness of the skin spreads around the wound - hence, the infection intensifies, the body can not cope with it, and it needs help.
Numbness in the legs - a sign of impaired nerve conduction (diabetic neuropathy).
Pain in the legs is also a symptom of the diabetic foot, but it is treated separately. Read more article "Sore feet in diabetes: how to treat."
Additional symptoms of circulatory disorders (intermittent claudication):
- pain in the legs, which increases with walking and subsides in rest;
- hair ceases to grow on the ankles and feet;
- the skin on the legs becomes coarse, it becomes dry.
The signs of the diabetic foot are typical problems with the legs that arise in patients:
- ingrown nails;
- bursitis of the thumb;
- plantar warts;
- hammer-shaped bending of fingers;
- dry and cracked skin;
- fungal disease of the skin of the feet (epidermophytia of the foot);
- nail fungus.
Corns occur when a portion of the footis subjected to excessive pressure or something rubs it. As a rule, the reason is unsuccessfully matched shoes. Officially, it is recommended that the corns be carefully removed with pumice stone after bathing. Dr. Bernstein objected: in no case do not remove the calluses! Do not do this yourself and do not let anyone, including a doctor. Because at the site of the removal of the callus there will be a wound, which with a high probability will turn into an ulcer.
Diabetics removed the callus on the toe. There remains a wound that will heal for a long time, and most likely it will be affected by an infection.
Dr. Bernstein points out that the removal of cornsIs the main cause of ulceration, which then infects the infection. Next - gangrene and amputation ... Instead of removing calluses, order and wear good orthopedic shoes. After that, the load on the foot when walking will be distributed correctly, and the corns will gradually pass by themselves.
Blisters are bulging skin areas filled withliquid. The blister is formed due to the fact that the shoes all the time rubbing the same patch on the foot. Also, a blister may appear if you wear shoes without socks. To avoid blisters, shoes should fit well in size, and do not go without socks. If there is a blister on the leg, a diabetic patient must necessarily appear to a specialist. The doctor will correctly apply the bandage. If an infection develops, the doctor will remove pus from the blister and prescribe antibiotics.
Nails grow if the person wrongs themshears or wears too tight shoes. Do not cut the nails around the edges. It is advisable not to cut them with scissors, but to process the nail file. A diabetic patient can not leave an ingrown nail without attention, you need to see a doctor. Perhaps the doctor decides to remove part of the nail to prevent further ingrowth. This is a lesser evil than an infected wound, gangrene and amputation. If an infection already appears in the toe, the doctor will prescribe antibiotics.
Bursitis is a bulge on the outer edge of a largetoe. Over time, it can be filled with bone tissue and liquid. Bursitis is formed if the thumb is deflected towards the rest of the fingers. It can be a hereditary problem. High heels and shoes with pointed socks also increase the risk. To bursitis does not expand, the doctor may suggest using soft insoles for shoes. Pain and inflammation are removed with medicines. If bursitis causes frequent bouts of severe pain, then it is removed surgically. For prevention, wear shoes that fit well with you in size.
Bursitis of the big toe, on which the ulcer appeared. It can be seen that the wound is infected.
Plantar warts are small growthsflesh color. Sometimes they have tiny black dots. Plantar warts cause human papillomavirus. This virus penetrates through small lesions on the skin of the legs. Warts can be painful and stop walking. To reduce their spread, wash your hands every time you touch your soles. The legs should be clean and dry. Do not go barefoot in public places. The doctor may suggest the removal of plantar warts by laser, liquid nitrogen or surgically under local anesthesia.
Hammer-shaped curvature of the fingers arisesdue to the fact that one or two joints of the small toe are unnaturally bent. This is because the muscles on the foot are weakened due to diabetic neuropathy. If there is a problem of curving the fingers, then the shape of the feet changes. There may be difficulties in walking. It is difficult to find the right shoes. The main danger - there may be wounds and ulcers that are prone to infection. Treatment - orthopedic insoles in shoes, as well as medications for pain and inflammation. In extreme cases - a surgical operation.
Dry and cracked skin - rough and flaky. Skin color changes, it can itch. This problem is caused by various causes - high blood sugar, damage to nerves and worsening of blood flow to the legs. Cracks in the skin are dangerous because they are infected. Maintain the moisture and elasticity of the skin of your feet. Regularly lubricate it with oil, as described below under "Foot Care: Detailed Instructions". If you do not cope and the skin condition worsens, show your doctor. Perhaps you will write a prescription for a potent ointment. Discuss with your doctor whether you should prescribe vitamin A and zinc supplements. Do not arbitrarily take these funds! Of course, the main thing is to lower blood sugar and keep it stably normal.
Blister or callus, passed into an infected ulcer. You can also see the corn from below on the base of the thumb.
Fungal diseases of the skin of the feet are manifestedsymptoms - itching, burning, redness, cracks in the skin. The fungus multiplies on the soles and between the toes. To prevent him, keep your feet as dry as possible. Do not wear the same pair of shoes all the time. Have a few pairs of shoes to alternate them. While you are wearing one - the other is drying. Overnight shoes do not have time to dry out. In public places do not go barefoot, wear flip-flops. Socks should be made of natural material - cotton or wool. The pharmacy sells creams and aerosols against the fungus on the legs. If necessary, the doctor will write out a prescription for potent drugs in tablets.
Nail fungus - the same prevention measures,as for fungal diseases of the foot skin. The fungus makes the nails tight, it becomes difficult to cut them. The color of the nail is changing. Sometimes nails, infected with a fungus, fall off. The doctor can prescribe the pills, remove the nail surgically or chemically. Nail fungus is also treated with a laser, but experts are still debating how well this method helps.
Symptoms of infection, which should immediately appear to the doctor:
- redness of the skin, increase in temperature on its surface.
Problems with feet in diabetes can be causeda violation of nerve conduction, clogging of blood vessels, feeding feet with blood, or both. This is called the neuropathic, ischemic or mixed form of the diabetic foot syndrome. The doctor determines the form of the disease and makes a diagnosis to prescribe the optimal treatment.
What the doctor usually does
- Metronidazole 500 mg 3 times a day
- Clindamycin 150-600 mg 4 times a day
Coliform (E. coli, Proteus, Klebsiella, Enterobacter)
- Ciprofloxacin 500 mg 2 times a day
- Cefadroxil 1 g 2 times a day
- Trimethoprim 200 mg 2 times a day
- Ciprofloxacin 200 mg 2 times a day
- Ceftazidime 1-2 g 3 times a day
- Ceftriaxone 1-2 g / day
- Tazobactam 4.5 g 3 times a day
- Trimethoprim 200 mg 2 times a day
- Meropenem 500 mg-1 g 3 times a day
- Ertapenem 500 mg-1 g per day
- Ticarcillin clavulanate 3.2 g 3 times a day
The genus Pseudomonas (P. aeruginosa)
- Ciprofloxacin 500 mg 2 times a day
- Ceftazidime 1-2 g 3 times a day
- Meropenem 500 mg-1 g 3 times a day
- Ticarcillin clavulanate 3.2 g 3 times a day
Often in patients with diabetic foot syndromecombined with a deterioration in kidney function. In such a situation, if you prescribe antibiotics or other drugs in standard therapeutic doses, you can inflict considerable harm on the patient's health. Why there is such a risk:
- if the excretory function of the kidneys is reduced, the probability that the drug and its metabolites will have a toxic effect on the body increases;
- in patients with impaired renal function, tolerance to the side effects of drugs is often reduced;
- some antibiotics do not fully manifest their properties, if the excretory function of the kidneys is weakened.
In view of these factors, if a patient has complications of diabetes on his feet combined with nephropathy, the physician should individually adjust the choice of antibiotic and its dosage
Surgical treatment of the wound is the removal of dead skin and pus. It must be done so that the tissues that died off did not serve as a haven for harmful bacteria.
How is this procedure carried out:
- The skin is cleaned and disinfected.
- It is determined how deep the wound is and whether some foreign object has fallen into it.
- The doctor removes dead tissue with a scalpel and surgical scissors, and then he washes the wound.
At the end of the surgical treatment, the wound may appear larger and deeper than it was before. It should be pink or red, look like fresh meat.
Infected toe ulcer before and after debridement
In addition to surgery, there are other ways to treat a wound:
- Enzymes can be applied that will dissolve nonviable tissue.
- Even special insect larvae, which eat only dead cells, are used. However, they release substances that stimulate the healing of ulcers.
The method with the larvae has been known since the times of the First World War. Since the 2000s, interest in him has returned.
Wound treatment is not considered surgical.operation. Real surgery only comes into play if all other treatments have failed. A description of the details of amputation is beyond the scope of this article. Healing after surgery may take several weeks or months, depending on how well the patient controls his diabetes.
Orthopedic shoes - the most important preventiveremedy for diabetic foot syndrome. If the patient wears orthopedic shoes suitable for him, then this reduces the probability of ulceration on the foot by a factor of 2-3.
Custom-made orthopedic shoes.
The toe cap is a piece of hard material.which strengthens the socks of the shoes. In orthopedic shoes hard toe should not be. The top of the shoe should be soft, comfortable and safe for the diabetic foot. In the internal space of orthopedic shoes there should be no seams, so that there are no scuffs.
The sole must be rigid, i.e. firm, not elastic. Thus, the pressure in the area of the front sole surface of the foot decreases, and the load on the areas of the foot is distributed more evenly. Orthopedic shoes should be perfectly comfortable and comfortable from the very first fitting.
After reading the article, you learned everything you need aboutdiabetic foot syndrome. There are numerous photos that will help you assess the situation - how badly your legs are and what the prognosis is. A diabetic foot is a terrible complication of diabetes that can lead to amputation. Nevertheless, not all patients are doomed to become disabled. Follow the recommendations listed above - and be guaranteed to be able to move "on your own two feet". The main thing is to consult a doctor in time, as soon as you find any damage to your legs. Doctors now have in their arsenal effective dressings and ointments that fight infection and stimulate healing.
Diabetic foot syndrome is treated with:
- careful hygiene of the feet;
- orthopedic shoes;
- dressings and ointments that stimulate the healing of ulcers;
- dressing Total Contact Cast for unloading the affected foot;
- surgeries - in extreme cases.
Do not count on any miracle pills. Do not take antibiotics on your own! The main thing is that the patient began treatment on time, even if his legs do not yet hurt. You can try alpha lipoic acid. to facilitate diabetic neuropathy and restore sensitivity in the legs. But the best thing you can do is go on a low-carb diet. to normalize blood sugar. Read more about the treatment of type 2 diabetes and type 1 diabetes treatment. A low-carb diet lowers sugar and helps keep it stable and normal, like in healthy people. Because of this, diabetic neuropathy passes. The sensitivity in the legs is fully restored. This is a real way to cure diabetic foot and other complications.