Introduction:
Diabetes is a chronic condition caused by either insufficient insulin production by the pancreas or inefficient insulin use by the body. A hormone called insulin controls blood sugar levels. Diabetes patients frequently have foot issues. When the nerves and blood arteries in the foot get damaged by high blood sugar levels, different diabetic pedal conditions may eventually take place. Diabetic neuropathy, the term for nerve damage, can make the feet numb, tingly, or painful. Moreover, diabetic patients have a multitude of problems such as microvascular angiopathy, poor metabolic control, neuropathy, and nephropathy leading to chronic bacterial colonization, ischaemic wounds, osteomyelitis with recurrent cellulitis (bacterial skin infection), and bony deformity.
The complications of diabetes, including peripheral neuropathy and peripheral vascular disease, particularly on the legs and feet, make it harder for people to heal cuts and sores. If the sores or ulcers don't heal after considering other non-surgical therapies, they may become infected and spread to the nearby skin and underlying bone in chronic situations. Diabetic foot limb salvage refers to a medical procedure in which doctors try to prevent amputation due to a diabetic foot while maintaining limb function and stability. As a result, patients can avoid infection, maintain limb function, and reduce potential consequences.
What Is Diabetic Foot?
Diabetes can cause a wide range of typical foot issues. Diabetic neuropathy, which can cause tingling, discomfort, and a loss of feeling in the feet, is the most prevalent pathological condition that diabetics experience. Diabetes patients may lose sensation in their feet, making it difficult for them to detect a stone in their sock or a blister on their foot, which can result in cuts and sores. If not treated properly, cuts and sores may ultimately become infected. Diabetes can also reduce the quantity of blood flow to the feet, which can hinder the healing of a sore or an infection. Gangrene (death of tissue due to lack of blood flow) can sometimes result from a severe infection that never settles. A toe, foot, or portion of the leg may need to be amputated if gangrene or foot ulcers are not healed after therapy. An amputation may be done by a surgeon to preserve life and stop a serious infection from spreading to the rest of the body. To avoid gangrene and dangerous infections, it's crucial to take good care of the feet.
Diabetes can cause nerve injury, which is uncommon but can result in foot alterations like Charcot's foot. An initial sign of Charcot's foot may be redness, warmth, and swelling. Later, the bones in the feet and toes may move or fracture, giving the feet a strange form like a rocker's bottom.
As a result, a diabetic foot is a side effect of chronic hyperglycemia (long-term increases in blood glucose levels). It may be asymptomatic or result in severely ischemic (tissue death due to lack of oxygen) limbs that require amputation. Inflammation, deformity, neuropathy (damage to the nerves outside of the spinal cord), and external trauma are all risk factors for the development of diabetic foot ulcers. Additionally, if the patient has additional illnesses, such as hypertension or chronic renal disease, the chances are greatly raised. There may always be an effect on the patient's quality of life. It may be asymptomatic or result in severely ischemic limbs that require amputation.
What Is Diabetic Foot Limb Salvage?
The best way to treat a foot ulcer depends on the wound. The majority of the time, the goal of the treatment is to clear away any dead tissue or debris, maintain the area clean, and promote healing. At least once every one to four weeks, wounds should be examined. The only option for therapy may be an amputation if the ulcer results in significant tissue loss or a life-threatening infection. A surgeon will carefully remove the injured tissue while preserving as much of the healthy tissue as they can. People affected need to stay in the hospital for a few days following surgery. The wound may require four to six weeks to heal completely. However, diabetic foot limb salvage is a technique that involves removing the dead tissue, covering the debrided area with flaps, and repairing the fractured bone with metal implants, synthetic bone grafts, or a combination of metal and bone transplants. Diabetic foot limb salvage is seen to be the greatest option for a patient who faces the possibility of having an amputation.
What Are the Risk Factors for Diabetic Foot Limb Amputation?
The risk factors of having a diabetic foot limb amputation are:
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Peripheral sensory neuropathy.
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Peripheral vascular diseases.
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Chronic non-healing foot ulcers.
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People who had undergone amputation.
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Diabetic patients who are dependent on insulin.
When Is a Diabetic Foot Limb Salvage Needed?
If patients with chronic, persistent, and non-healing foot ulcers and infections satisfy one condition as below, who must have their feet amputated to avoid further problems can still choose to have their limbs saved. Having loss of soft tissue and bone with preserved sensitivity.
How Can Diabetic Foot Limb Salvage Be Planned?
To diagnose diabetic foot and assess the severity of the condition, the following imaging techniques can be used:
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X-ray - To determine the health of the bone in the affected region.
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Magnetic Resonance Imaging (MRI) - To evaluate the soft tissues.
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Ultrasound - To determine the brachial pressure.
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Computed Tomography (CT)- Angiogram - To evaluate the blood vessels and their texture and whether it is constricted or narrowed.
How Is Diabetic Foot Limb Salvage Done?
Surgery to remove an infected bony and soft tissue in a limb (arm or leg) without removing the whole limb. The bone and tissue around the infected site may also be removed, and an implant may be used to replace the part of the limb removed. Hence, it is also called limb-sparing surgery.
What Foot Care Practices Can a Diabetic Patient Employ to Prevent an Amputation?
Non-Surgical Options:
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Blood Glucose Control - To reduce the chance of blood infection.
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Gait Adjustment - To gain better balance of the body while walking.
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Wearing Well-fitting or Orthopedic Footwear - Always choose to wear shoes and socks.
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Hyperbaric Oxygen Therapy - To improve oxygen availability to the limb.
Surgical Options: In case of persistent but not repetitive, unhealing and extensive ulcers:
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Debridement - Removal of damaged or infected wound tissue and bone and surgical closure.
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Stenting - This procedure widens the narrowed blood vessels of the legs, which helps ulcers heal better.
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Atherectomy - Minor surgery to remove the plaque or block from the blood vessels by inserting the catheter.
Conclusion:
If the limbs' sensitivity is preserved despite the loss of soft tissue and bone, diabetic foot limb salvage is the best option for the patients to preserve the function of their limbs. It is advised to employ better foot care practices to prevent complications of diabetes that may need an amputation. And therefore, regular check-ups are significantly helpful.
