Microcirculation and Diabetic Foot

Introduction:

In today's era, the number of people with diabetes mellitus is exceedingly large. Hence, the health hazards experienced by the diabetic population are also extensive. This requires special attention from a medical perspective so that the quality of life is not compromised in such individuals. One such important consequence of diabetes mellitus is the diabetic foot. Microcirculation plays a pivotal role in the causation of this diabetic foot. This article focuses on the connection between microcirculation and diabetic foot and how to prevent this complication.

What Is Microcirculation?

Microcirculation is the circulation of blood through the smallest blood vessels of the circulatory system, like the arterioles, venules, and capillaries. They form an intricate network to supply the organs and tissues and are responsible for the gas exchange at the end tissues. They also help in providing nutrients and removing waste products by exchanging substances between the blood and surrounding tissues. A healthy microcirculation is essential for the proper functioning of the tissues, and in cases of injury, microcirculation is highly essential for proper and timely wound healing. Microcirculation also helps in maintaining the temperature and immune response in the body.

What Is Diabetic Foot?

Diabetic foot occurs due to a chronic and persistent hyperglycemic state, thus resulting in damage to nerve supply and blood supply to feet. Such individuals do not get adequate nutrients and oxygen, and the waste products are not removed completely. This may result in reduced sensation in the feet, increased incidence of infection, and other complications like foot ulcers and necrosis of tissue in the feet.

What Causes Microcirculatory Dysfunction and Diabetic Foot?

Several mechanisms contribute to microcirculatory dysfunction in diabetes.

• One of the primary factors is endothelial dysfunction, which refers to impaired function of the inner lining of blood vessels. In diabetes, endothelial cells become damaged due to the accumulation of advanced glycation end-products, oxidative stress, and inflammation. This dysfunction leads to vasoconstriction, reduced vasodilation capacity, and increased permeability of blood vessels.

• Another factor is the formation of small blood clots within the microvessels, known as microthrombi. These microthrombi can obstruct blood flow and further impair tissue perfusion.

• Additionally, diabetes-related changes in red blood cells, such as increased rigidity and altered deformability, hinder their ability to pass through the narrow capillaries, exacerbating microcirculatory impairment.

The compromised blood flow to the feet and lower legs results in inadequate oxygen and nutrient supply to the tissues, impairing wound healing and increasing the risk of infections. The reduced perfusion also impairs the immune response, making individuals with diabetes more susceptible to infections and delaying their resolution.

What Is the Role of Nerve Damage in Diabetic Foot?

The nerve damage to the end nerves supplying the foot can exacerbate the complications caused by dysfunctional microcirculation. Some common nerve problems encountered include:

• Loss of sensation is known as sensory neuropathy. When there is an absence of feeling in feet, diabetic individuals may be unaware of injuries, cuts, blisters, or pressure points that can lead to complications such as ulcers or infections. The lack of sensation makes it difficult to detect and address foot problems at an early stage.

• Their pain threshold increases, and the perception of pain is also diminished in advanced and chronic diabetic cases. This, in turn, causes a delayed diagnosis of infections or necrosis in the feet.

• Weakness and muscle imbalances can develop in the feet, leading to altered gait patterns and abnormal pressure distribution during walking.

Thus, reduced blood flow, altered immune response, and nerve damage in the affected area contribute to delayed wound healing. Even small wounds or ulcers can take a long time to heal, increasing the risk of infections and other complications. If the complications are not treated at an early stage, it can lead to amputation of the particular area or the entire feet.

How to Improve Microcirculation and Manage Diabetic Foot?

Improving microcirculation and effectively managing diabetic foot requires a comprehensive approach. This includes:

• Maintaining optimal blood glucose levels is essential for preserving microcirculatory function. Lookout for any complications at an early stage to prevent further damage.

• Adopting a healthy lifestyle can positively impact microcirculation and overall foot health. Regular physical activity, such as walking or low-impact exercises, promotes blood flow, enhances vasodilation capacity, and stimulates the release of beneficial substances that support vascular health.

• Abstaining from tobacco use and evading contact with environmental tobacco smoke is crucial, as smoking constricts blood vessels and worsens microcirculatory impairment.

• Practicing good foot hygiene and regular monitoring of the feet is essential for preventing complications in the diabetic foot. This includes daily inspection of the feet for any signs of injury, blisters, redness, or changes in skin temperature.

• Medications targeting endothelial dysfunction may be prescribed to improve endothelial function and promote vasodilation. Platelet-inhibiting medications can help prevent the formation of microthrombi and improve blood flow.

• In advanced cases where there is significant vascular impairment, therapeutic interventions like angioplasty may be necessary to improve blood flow to the affected site.

What Is the Role of Podiatrists in Treating Diabetic Foot?

Improving microcirculation is essential to manage diabetic foot, and podiatrists play a vital role in this.

• Podiatrists take a thorough examination of the feet and look for any ulcers, sensations, blisters, or infections in the feet that require immediate medical attention.

• Podiatrists debride the necrosed and infected tissues and employ techniques to improve wound healing.

• Podiatrists provide guidance on appropriate footwear for individuals with diabetic feet. They assess the patient's foot structure, biomechanics, and any existing foot deformities to recommend shoes that accommodate specific needs. Properly fitting shoes with adequate cushioning, support, and protection can reduce pressure points, improve comfort, and enhance circulation.

• They can also prescribe and fabricate custom orthotic devices, such as shoe inserts or insoles, to address foot biomechanical abnormalities and redistribute pressure.

Having good podiatric care is of paramount importance as it helps in the early diagnosis and management of complications associated with dysregulation of microcirculation in individuals with chronic hyperglycemia.

Conclusion:

In conclusion, microcirculatory dysfunction plays a significant role in the development and progression of diabetic foot. Understanding the intricate connection between microcirculation and diabetic foot is essential in managing this debilitating condition. Timely diagnosis of this condition through constant monitoring is the most crucial part of preventing complications and improving foot health in diabetic individuals.