Diabetes is one of the most common chronic diseases in the society and is characterized by high blood sugar. Diabetes complications occur in patients when high blood sugar cannot be controlled.
What is Diabetic Foot?
One-fifth of diabetic patients develop an untreated wound, ulcer or infection at some point in their lives, and this is not treated well. If left untreated, it can lead to loss of foot or leg. Diabetic foot wound treatment requires an approach that incorporates many expertise. Diabetes disease affects the capillaries and causes neuropathy, that is, inflammation in the nerves, or vasculopathy, that is, inflammation in the vessels. Foot ulcers develop in diabetic patients due to both neuropathy and vasculopathy. If there are signs such as burning in the feet, numbness, loss of sensation, loss of foot sweating and dryness, cracked heel in diabetic patients, neuropathy and vasculopathy should be suspected and necessary precautions should be taken before diabetic foot wound develops.
What are the Causes of Diabetic Foot? Diabetic Foot Symptoms
Diabetic foot is a serious disease that develops slowly and over time. Therefore, it does not show any symptoms at first. Irregular and uncontrolled blood sugar for a long time disrupts the structure of the capillaries in the feet. When narrowing and blockages develop, pain is felt in the legs while walking. This pain intensifies over time, preventing the person from continuing to walk. The patient has to rest.
Diabetes patients are informed about foot care. If the patient does not take the necessary foot care, does not use appropriate shoes and does not pay attention to the blood sugar regulation protocol, a diabetic foot starts with a small wound.
How to Care for Diabetic Foot?
"What is a diabetic foot? ?" After answering the question, the most important issue for diabetics is "How is diabetic foot care done?" should be. Diabetes patients have dry feet It tends to. Heel cracks are more common in dry feet. Microbes entering through these cracks cause easier and more serious infections in feet with impaired blood flow. Thus, diabetic foot infections begin. Therefore, the feet should be washed daily with warm water and soap and dried thoroughly. Cracks that may develop should be prevented by applying moisturizing creams. It is necessary to avoid applying moisturizing cream between the toes, because if these areas remain moist, fungal disease may develop and this may cause progressive diabetic foot ulcer. Nail care is very important in diabetic foot care. Nails should not be left long, they should be cut at the level of the meat. In order not to cause ingrown nails, the edges of the nails should be cut straight without leaving the flesh.
It is also necessary to pay attention to the selection of socks and shoes. Seamless wool or cotton socks should be preferred. Socks should be changed every day and washed with detergents that will not irritate sensitive feet. Pointed-toed, high-heeled shoes and flip-flops should not be used. Small or large shoes should be avoided. Soft leather or cloth shoes should be preferred, plastic shoes should not be worn. Diabetic patient shoes can be made by taking personal measurements in order to avoid hitting shoes. Diabetic peripheral neuropathy, which develops due to sensory damage and loss of sensation, is one of the most important predisposing factors in the development of diabetic foot ulcer. Loss of sensation and insensitivity, especially due to sensory neuropathy, are the most important factors preventing awareness in traumatic foot wounds.
Diagnosis is made by nerve conduction tests. Neuropathies detected in the early period with EMG (electromyography) to be performed at regular intervals are important in prevention.
How to Treat Diabetic Foot?
When diabetic foot ulcers and pressure sores are not treated properly, they can turn into gangrene and amputation may be required. Amputation means cutting off the infected limb to prevent the infection from progressing. Diabetes cause Approximately 85% of patients who undergo foot or leg amputation have a history of wound prior to amputation. For this reason, it is of great importance to prevent the opening of foot wounds in diabetics or to repair the wound if it is opened. The first priority in wound care is the removal of dead tissue. This can be done with surgical methods as well as with wound care products developed with new technologies today. With the dead tissues gone, the next step is to provide an environment where the cells that will heal the wound can proliferate properly. For this, an appropriate wound care strategy should be determined, various diabetic foot dressings should be made, the most suitable wound care products should be selected for the patient and used correctly.
The course of the wound should be evaluated by continuous observation. In wounds that do not heal or in wounds that are difficult to close on their own, it is possible to repair by taking tissue from other parts of the body when necessary. Many treatment methods are applied to avoid reaching this stage.
Gene and stem cell therapies have come to the fore in the treatment of diabetic foot wounds in recent years. Especially skin wounds are very suitable for gene therapy due to the ease of direct access. Naked DNA, viral transfection, high-pressure injection methods can be used in gene therapies containing growth factors. Promising clinical results are reported in the applications of stem cells (MSCs) in the treatment of chronic wounds. MSCs may contribute to wound healing by reducing inflammation, supporting angiogenesis (new vessel formation) and reducing scar tissue. An effective alternative for wound treatments is an amniotic membrane product applied alone or in combination with MSC.
Amniotic membrane is derived from the placenta. obtained, of human origin and in e is a tissue containing many growth factors. When used as a wound dressing in acute and/or chronic wounds, it accelerates the healing of the wound and acts as a barrier to protect from infection thanks to the healing molecules it contains. The wound and tissue healing capacity and effect of the amniotic membrane used with MSC increases considerably. Patients with ischemia, that is, insufficient vascular nutrition, are candidates for the repair of vascular disorders. Doppler, computed tomography (CT) or magnetic resonance (MR) angiography examinations are performed as imaging methods. Vascular reconstruction, that is, the removal of occlusions in the vessels or the methods of opening the completely occluded vessels should be chosen specifically for the patients. Generally, these methods are endovascular (Balloon angioplasty and/or stent) and open surgery (Endarterectomy or bypass).
Hyperbaric Oxygen Therapy in Diabetic Foot Wound
Hyperbaric (pressurized) ) oxygen (HBO) therapy is one of the important supportive treatments in the treatment of selected chronic wounds. Providing an increase in oxygen in the blood and tissues, that is, hyperoxygenation, constitutes the main mechanism of action of this treatment method. Sufficient oxygen is provided in the vascularized connective tissue compartment around the wound and reinitiates wound healing remaining in the inflammatory stage. HBO therapy is particularly effective in infected foot wounds and hypoxic/ischemic wounds. Depending on the condition of the wound, an average of 20-30 sessions can be applied. It is generally recommended to apply 1 session a day and 5 sessions a week. With a multidisciplinary approach, at the Diabetic Foot and Chronic Wound Treatment Center under Florence Nightingale Hospitals Group, the patient with diabetic foot problem can be diagnosed and treated at the same time, without visiting more than one clinic. planning is done, so it is aimed to produce fast and accurate solutions.
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