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Diabetic foot
Where does diabetic foot hurt?
Diabetic foot primarily involves changes in the blood vessels and nerves of the lower limbs and feet, so early symptoms may include numbness, a feeling of stepping on cotton, and weakness in the legs. Furthermore, pain can manifest as numbness and pain in both soles of the feet, or as vascular and neurological pain in the lower limbs and the inner thighs. If diabetic foot is accompanied by venous thrombosis in the lower limbs or arterial embolism, the resulting pain can affect the entire lower limbs symmetrically and present as intermittent claudication. Therefore, the main sites of pain in diabetic foot are determined by the locations of vascular and nerve damage.
Early symptoms of diabetic foot
The initial symptoms of diabetic foot mainly manifest in several aspects. The first symptom is abnormal sensations in the feet, including numbness, pain, a feeling of foreign objects, or as if stepping on cotton. The second situation involves pain in the feet, intermittent claudication, and even pain at rest. If these symptoms occur, it is advised to promptly visit an endocrinology specialist. Treatments may include medications for nourishing the nerves and improving circulation in the lower limbs. Without timely treatment, it's easy for wounds on the feet to ulcerate, leading to infection and severe adverse consequences. It is recommended to treat diabetic foot early to prevent the worsening of the condition and even the risk of amputation.
What are the early symptoms of diabetic foot?
Diabetic foot is a complication of diabetes, relatively late-stage and severe. One of the most dreadful consequences it can cause is amputation, leading to lifelong disability. Many patients worry about developing diabetic foot and should pay attention to the early stages of diabetic foot, which actually manifest as changes in the blood vessels and nerves. For example, vascular changes can make certain areas of the skin appear whiter and cooler, and the pulsation of the dorsal artery of the foot may weaken. Nerve changes are characterized by numbness, tingling, or alternating sensations of heat and cold in the foot, as well as other abnormal sensations. These are all signs of complications and early manifestations.
Treatment of diabetic foot numbness
If diabetic foot feels numb, it is a manifestation of diabetic peripheral neuropathy. Diabetic foot is a complication that occurs after diabetes has advanced to a certain degree, so it is normal for a person with diabetic foot to feel numbness. Some patients with severe diabetic neuropathy may not even feel pain during debridement, which involves cleaning the local tissues. A healthy person would definitely feel pain, but a diabetic patient, due to their neuropathy, may not feel much, if any, pain. For such patients, the main treatments are firstly, definitely controlling blood sugar and blood pressure; secondly, using medications that nourish the nerves; and thirdly, improving circulation to aid local blood flow.
What to do if diabetic foot ulcer occurs?
If diabetic foot ulceration occurs, the most important first step is surgical debridement to remove necrotic tissue and thoroughly clean the wound. If the ulceration is particularly severe and there is gangrene, and the foot can no longer be preserved, amputation may even be necessary. Secondly, anti-infection treatment should be administered, choosing sensitive antibiotics. The third step is to control the underlying condition; treatment must control blood sugar levels to avoid hyperglycemia, as high blood sugar serves as a culture medium for bacteria. Fourth, it is necessary to improve local blood circulation; diabetic foot often coexists with arteriosclerosis of the lower limb arteries, even leading to occlusion. Therefore, it is necessary to improve the circulation of local blood vessels and open up the vessels. Fifth, the nutritional treatment of peripheral nerves must be improved. Treatment of diabetic foot is a comprehensive approach.
Is it good for people with diabetes to soak their feet?
Whether soaking the feet is beneficial for diabetic foot or not first depends on whether there are any wounds on the feet. If it is a grade 0 diabetic foot, where the diabetic only experiences abnormal sensations, numbness, or pain in the foot without any wound, then soaking the feet is permissible. However, it is crucial to be mindful of the water temperature during soaking; it generally should not exceed 40°C to avoid burns. If the diabetic foot has open wounds, foot soaking is not recommended. Soaking feet with wounds can easily lead to increased infection of the wounds.
How to relieve pain in diabetic foot?
If diabetic foot is combined with pain, it often depends on the severity of the diabetic foot. It has a Wagner grading system. If there is an obvious wound that extends to the bone, anti-infection treatment is very important, and surgical assessment is necessary to determine if the foot can be saved. If the wound is superficial and only involves the epidermis, local anti-infection and circulation improvement are fundamental. In such cases, COX-2 inhibitors and non-steroidal analgesic drugs may be used. If the pain is caused by peripheral neuropathy, the first step is to nourish the nerves, for example with mecobalamin, and treat the neuropathy with drugs like epalrestat, along with drugs like cilostazol that improve microcirculation. Effective treatments targeted at this type of neuropathic pain include drugs like pregabalin and etoricoxib, designed for bone pain, and gabapentin-related medications can also be used. (Medication should be used under the guidance of a doctor.)
Care of diabetic foot wounds
In terms of caring for diabetic foot wounds, medical treatment, surgical intervention, or debridement is of course necessary. Regarding foot care, it's important to examine the condition of the wound. The primary principle is first, in dietary care, to ensure a high protein diet under the allowance of liver and kidney functions, and then a low-fat diet. It's important to include high-quality protein, which is beneficial for wound healing. Locally, the wound area must be kept clean and dry. It is crucial to maintain a concept of sterility, avoiding actions like breathing over the wound with the mouth or touching the wound area with hands. The wound should be cleaned or locally disinfected regularly every day. Additionally, foot wounds in diabetics should slightly elevate the feet to facilitate blood return. Moreover, regular observations of changes in the wound should be made and communicated timely to the doctors at the hospital.
Symptoms of diabetic foot
The symptoms of diabetic foot can be categorized into those without wounds, commonly referred to as stage 0 diabetic foot. The main symptoms of stage 0 diabetic foot include lower limb paralysis, pain, intermittent claudication, severe lancinating pain, and other sensory abnormalities. This is what constitutes a stage 0 diabetic foot. Stages 1 to 5 of diabetic foot progressively involve wound ulceration, typically presenting as progressive ulceration, pain, and exudation. Therefore, it is recommended for diabetic foot patients to seek timely treatment from an endocrinology specialist, and to use medications under the guidance of a doctor to avoid worsening of diabetic foot infections and to prevent severe consequences.
What to eat for diabetic foot?
Typically, patients with diabetic foot have had diabetes for a long period, and often have diabetic nephropathy, or serious hypoproteinemia and malnutrition. In such cases, patients with diabetic foot need to supplement with protein, specifically high-quality protein, and must avoid low-quality protein. What constitutes low-quality protein? This includes soy products and plant proteins. High-quality protein, on the other hand, includes sources like milk, eggs, poultry, and meat. However, if renal insufficiency is present and creatinine levels have increased, the amount of protein must be limited. Protein intake should be calculated based on body weight and creatinine levels, using different coefficients to determine the total daily protein allowance. It is crucial to make these protein adjustments within the framework of a diabetic diet.