Among the complications associated with diabetes, one of the best known is the diabetic foot, both for its severity and for the decrease in the quality of life of those who suffer from it, considered as the leading cause of non-traumatic amputation of the lower extremities in developed countries.

Its origin lies in the poor glycemic control of the diabetic person. Maintaining high blood glucose levels silently damages the blood vessels and in turn, the different nerves losing even the sensation in the feet.

The union of these two problems causes a greater difficulty to perceive any chafing or small wound in the feet, which, together with poor blood circulation, triggers the appearance of ulcers.

 How sensation is lost in the foot

 The loss of sensation in the diabetic foot is due to modifications or neuropathies that occur in the somatic and autonomic nervous system (SN).

Somatic nervous system

This system allows voluntary actions and is divided into two parts: sensitive and motor.

Psychic part

It allows to perceive pain, temperature changes, etc. If sensory neuropathy appears it produces:

Decreased sensitivity in the foot to possible trauma and involuntary changes in position

Cancels perception in the appearance of wounds, blisters or chafing

Erdida of sensitivity in fingers and heel

Motor part

It is responsible for executing the commands sent by the central nervous system about the movement of our feet. In addition, it has the mission to maintain its bone structure.

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If motor neuropathy appears it produces:

Deformations in the structure of the foot, causing the person to lean more on that area when walking

Increases friction with footwear and the appearance of tripe. Pain is not perceived due to loss of sensation, producing possible ulcers

Autonomic nervous system

It refers to the involuntary actions of the system, since its function is to regulate sweating and microcirculation. The alteration in this system is known as auto-vascular neuropathy that produces:

Decreased sweating. The skin becomes drier and the “ideal” situation is generated for wounds to arise, as it eliminates the original sweating of the body

At the level of the foot bone, it alters its bone structure, decreasing its consistency

Symptoms of diabetic foot

Given the real risk of suffering problems in the feet that a diabetic has, it is important to know the first symptoms to go quickly to the doctor:

    Pain or burning

    Sweating on the feet is disappearing, causing the skin to become drier and injured

    Loss of sensation in the feet

    Swollen feet

    Tingling sensation

If no measures are taken at these first symptoms, the diabetic foot continues its dangerous evolution leading to amputation. Therefore, it is very important to be aware of the symptoms if it is possible to have diabetic foot.

Change in the color of the feet due to lack of blood supply. Necrosation  of the foot gives it a purple color, increasing the risk of suffering an amputation of the foot

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The feet suffer deformations that the patient sees but that do not hurt and the wounds give off a bad smell

Causes of diabetic foot

neuropathy

In a diabetic foot the nerves are always affected (neuropathy). If these are damaged, the sensitivity in them is lost, which favors that no possible chafing, wounds or blisters are perceived.

ischemia

In addition to neuropathy, there may be a joint lack of blood supply, known as ischemia.

The blood vessels that supply the feet are progressively narrowed. This makes the contribution of nutrients and oxygen to tissues insufficient.

Therefore, there is a loss of skin protection that makes it difficult to heal wounds, raising the risk of infection.

Factors that increase the chance of having diabetic foot

On the one hand, we find those factors that predispose to have this problem such as neuropathy and peripheral vascular disease.

In turn, we find other types of factors that trigger diabetic foot such as:

Possible trauma and infections. When talking about trauma, let us not just think of bruises, but of simple friction caused by the seams of a sock.

The most common areas of appearance of ulcers or wounds are the heel, the fingers  some of the deformities that causes motor neuropathy.

Risk factors in diabetic foot

    Poor glycemic control, with HbA1c values > 9%

    Diabetes of more than 10 years of evolution and/or over 40 years

    Smokers

    Presence of other complications of diabetes that favor the development of infections

    Poor body hygiene

    Difficulty to check the feet, either due to poor vision or being in a situation of obesity or overweight producing difficulties to bend down

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    Low socioeconomic status

“The absence of symptoms does not indicate that the feet are healthy”

If you want to prevent the diabetic foot from appearing, it is essential that you control your blood glucose levels.

The best prevention is to maintain a good adherence to the treatment prescribed by your doctor (drugs, healthy eating and regular physical exercise). If your blood glucose levels still remain high, you should visit him to evaluate a possible modification in your treatment.

In the diabetic foot early detection is essential, so in the next article we will detail tips for daily self-care of the feet. Also, we will talk about the figure of the podiatrist, specialist in the care of the feet; and in the early detection of ulcers and wounds that may appear, some of which may be hidden under calluses.

At first glance, you can not see or feel them, but it is advisable to review them because it is possible that their growth is inside the foot, attacking the bone structure with the consequent risk of suffering an amputation.

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