Diabetes is a chronic disease caused by abnormally high blood sugar (glucose) levels. It is common in Türkiye; with the right treatment, positive lifestyle changes and patient education, people with diabetes can lead normal daily lives.

Like any disease, diabetes has complications, including blindness, kidney disease, nerve damage, heart problems and stroke. Another of the most common complications is diabetic foot, which causes wounds, particularly on the feet.

Causes

Diabetic foot has two causes: nerve damage (diabetic neuropathy) and poor circulation due to narrowed or blocked arteries (diabetic vasculopathy).

With diabetic neuropathy, many patients lose sensation in their feet and do not notice wounds caused by minor knocks, rubbing shoes or ingrown nails. Because they cannot tell hot from cold, frostbite or burns can occur. High blood sugar also makes infection more likely. When the arteries are narrowed or blocked, the tissues do not receive enough blood. Together, these can turn into non-healing foot wounds that may ultimately lead to losing the foot.

Symptoms

• Pain when walking caused by narrowed or blocked arteries
• Swelling of the feet or legs
• Wounds that do not heal
• Skin discolouration, dryness and hair loss
• Cramps, numbness and tingling
• Local warmth due to infection

Prevention

First and foremost, blood sugar must be kept within normal limits. People with diabetes should be taught how to examine their own feet and what to look out for. Suitable footwear, foot hygiene, nail care and exercise are also very important in preventing diabetic foot. Even a minor wound can become serious if left untreated, so medical help should be sought for even the smallest wound.

Diagnosis

A thorough physical examination checks for pulses at the ankle and in the foot, and for any difference in blood pressure between the arms and legs. Imaging methods such as Doppler ultrasound, CT angiography, MR angiography and catheter angiography are used to detect narrowing or blockage in the arteries. After an initial diagnosis with Doppler ultrasound, the other methods are used for further assessment.

Treatment

The first steps are controlling blood sugar, wound care, treating infection and, where there is narrowing or blockage, starting blood-thinning medication. In small wounds, dead tissue is removed to restore blood supply. Larger wounds are supported with a skin graft taken from another part of the body. If a wound can no longer close or gangrene has developed, amputation above the wound may be needed to stop the infection causing further harm. Amputation is always the last resort.

When an artery is found to be narrowed or blocked, it must be reopened. These procedures, once performed with open surgery, have largely been replaced by minimally invasive methods. Because these patients often have other systemic diseases, the minimally invasive approach has clear advantages over open surgery: no general anaesthesia, a shorter hospital stay, lower risk and cost, and the option to repeat the procedure if the artery narrows again.

In the endovascular method performed in the angiography suite, the blocked segment is opened with a balloon catheter or stent. To prevent the arteries from narrowing again, a balanced diet, not smoking and regular blood sugar monitoring are very important.

Studies have shown that the high-concentration oxygen given in hyperbaric oxygen (HBO) therapy helps wounds heal, so it is also used as a supportive treatment for diabetic foot.