Diabetic Foot. Diagnostics & Therapy
Important: The treatment strategy for a diabetic foot.
The treatment strategy depends on the degree of severity and the stage of the disease as well as concomitant diseases.
An important focus is the wound management by a specialized team of doctors, nurses and therapists. Thereby wound healing disorders can be treated as best as possible.
In case of serious deformities or inflammation a surgical intervention may be needed to prevent further progression of the disease.
Information from diagnostics to treatment and rehabilitation.
Diagnostics. How a diabetic foot is detected
Diabetic Foot. Examination of the foot
- Abnormally warm foot, swelling and freedom from pain
- Change in the shape of the foot
- Prominent bone edges
- Newly appearing pressure sores even ulceration
- Depending on the stage, there is slight to extremely severe destruction of the bone and joints in the foot
- Malpositioning of the bones in relation to each other
- Dislocated joints with displacement of bone edges towards the skin, which are often palpable on examination
Nuclear spin tomography.
- Severe oedema. The nuclear spin tomography image can often confuse this with osteomyelitis
- Dead bone and signs of increased blood flow
Normal findings for inflammatory values in the blood are the most important criterion for differentiating between inflammation of the bone (osteomyelitis) and diabetic neuroarthropathy. It is possible that raised blood glucose values are found, which are nothing to do with an acute increase in blood glucose, but are the result of poorly adjusted blood glucose levels over many years.
Therapy. Treatment possibilities of diabetic foot
Diabetic Foot. Conservative treatment
If the condition is diagnosed in its early stages, further destruction of the foot skeleton can be halted or delayed using conservative treatment. Depending on the degree of progression an attempt is made to preserve the shape of the foot by stabilising it externally with a plaster or splint or with a diabetic shoe, in order to prevent the bones collapsing. If the critical stage for the "soft bones" can be tided over in this way, then frequently the bone stabilises again to such an extent that a permanent solution with diabetic shoes is possible.
Diabetic Foot. Surgical Treatment
In the advanced stages if the circulation and the skin are intact, surgery is performed to remove dead and softened bone. The intact bones are kept stable with screws and plates and the gaps are filled with bone taken from the iliac crest. In addition bone growth factors can be applied. If circulation is poor or there are open wounds with infections in the skin and bone, stabilisation is achieved with an external tension element (external fixation). Here, the areas of infected soft tissue and bone are removed and the skeleton stabilised externally with the aid of a steel frame. Until adequate stability is achieved, the frame must be worn frequently for many months. Frequently several operations are necessary until the infections have healed.
The aim of all these procedures is to maintain a foot which is capable of weight bearing. Should an amputation be unavoidable because of totally hopeless circumstances, which luckily today is the exception, then amputation is kept to the absolute bare necessity. Often the removal of individual bones is totally adequate. Lower leg amputation, which is suggested time and time again for a diabetic foot, is the worst possible solution for patients in terms of physical function. Various investigations have also shown that in more than half of patients who have had a lower leg amputation, within 4 years amputation on the opposite side has been necessary, which is another reason to avoid amputation at all costs.
Diabetic Foot. Rehabilitation
Diabetic patients heal 50% more slowly than a healthy person. Endeavours are made to achieve the best possible blood glucose levels. Also in individual cases improvements in circulation are possible by means of vascular surgery. Apart from in the very early stages of the condition with mild symptoms, it usually takes 6 months to achieve a foot which is capable of weight bearing again. Depending on mobility the patient can usually get by using underarm crutches for this period of time. Alternatively a wheelchair can be used. Immobilising in plaster with full weight bearing on the foot alone is only sufficient in very rare cases.
The signs of this condition include impaired sensations, as well as a high risk for the occurrence of breaks in the skin.
Experts for foot disorders: Specialised clinics and hospitals for diagnostics, treatment and therapy of the diabetic foot at a glance.