Complicated Diabetic Foot

The chances of a diabetic patient to suffer from a diabetic foot throughout his life are estimated to be 15-25% percent

. The initial cause for developing a diabetic foot is the development of small cracks and wounds in the skin of the diabetic patient's feet that can grow and become a major ulcer.

Feet wounds, ulcers and boney changes are a significant cause of morbidity and mortality of the diabetic patient, including the main cause for patient hospitalizations. The average hospital length of stay of a diabetic patient with limb morbidity is approximately 60% longer than a patient without any diabetic limb complications.

This type of morbidity could potentially lead to limb amputation, a fact that explains pretty clearly the enormous damage to the patient's life. 85% of lower limb amputations in the diabetic patient are caused by a small diabetic wound. It is known nowadays that diabetes is the number one cause for lower limb amputation in the U.S and Europe, with high mortality rates (up to 40% one year following amputation).

Aside from the massive personal damage to the patient, this type of morbidity causes indirect public damage, due to very high costs to the health systems worldwide. Large amount of money is spent on treatment, advanced equipment, surgeries and long-term rehabilitation which these patients require.

Because diabetic foot ulcers tend to recur (over 50% in three years), it is understandable that the best treatment for the diabetic patient is prevention of the initial wound. The pathogenesis of diabetic ulcers is multi-factorial, and derives from several mechanisms. First it is important to understand that diabetes itself involves injury to small nerve fibers (also known as diabetic neuropathy). This neuropathy progresses with time, and exists in about 50% of the diabetic patients age 60 and older.

This damage affects all nerve fibers, both of the sensory nerve system, and the motor nerve system. The sensory damage is the main nerve damage, causing lack of sensation in the distal areas of the body (the periphery). This loss of sensation leads to untreated wounds and cracks, because if the patient doesn't carefully examine his feet daily, he can miss these wounds, leaving them untreated, therefore they grow and become ulcers.

The loss of sensation also leads to boney changes in the feet, due to lack of proper balance between the two feet, so that the patient sometimes puts extra pressure on one foot as opposed to the other. This pressure can further worsen existing wounds and ulcers. Another mechanism of diabetic feet injury is due to damage to small blood vessels, leading to ischemia (lack of blood and oxygen flow) to the limbs. The damaged blood flow doesn't allow proper healing of any wound/ulcer that has developed. As we previously mentioned, preventing these wounds from occurring is currently the best treatment we can offer diabetic patients.

by: Maria Gonzales

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