Beware of early symptoms of diabetic foot to avoid amputation
The main symptom is ulcer. Once the ulcer appears, and then becomes infected, and does not heal for several months, it is basically no problem to diagnose diabetic foot, but this is already the advanced stage of diabetic foot.
In the early stages, there may be vascular lesions and decreased nerve sensation, which are difficult to detect. In addition, my feet often feel cold, numb, or even painful when touched.
Another symptom of diabetic foot is pain. You feel foot pain when walking, which can be relieved by resting for a while, but the pain reappears when you continue to walk. This shows that the blood vessels have been occluded or blocked and cannot walk long distances like normal people. This is clinically called intermittent claudication.
Some patients often experience another situation when sleeping, especially in the dead of night: they are in so much pain that they cannot sleep. We call this condition resting pain. This situation means that the patient is not far away from amputation.
What risk factors lead to diabetic foot?Diabetic foot is directly related to the course of diabetes. The longer the course of the disease, the easier it is to develop the disease. First of all, neuropathy will cause the feeling of the feet to become dull. When we wear new shoes to rub our feet, we will feel pain in our feet. When the foot bath water is too hot, we will feel hot feet. However, people with diabetes will not feel it. They will only find out after the feet are worn out or burned.
In addition, high blood sugar can lead to vascular occlusion and stenosis. If combined with risk factors such as hyperlipidemia, high blood pressure, smoking, or arteriosclerosis, the vascular lesions will be more serious. Moreover, the wounds of diabetic patients are not easy to heal. Once infected, very serious phenomena will occur, and amputation may be necessary in severe cases. Therefore, by controlling blood sugar early, amputation can be avoided as much as possible.
What examinations are needed for diabetic foot?Some neurological examinations will be done in the hospital. The simplest thing is to use a pin or paper clip to test the local sensation to see if there is any decrease in sensation.
In terms of blood vessels, it is relatively simple to measure the blood pressure of the upper and lower limbs at the same time. Under normal circumstances, the lower limbs are farther from the heart, so blood pressure will be higher than that of the upper limbs. Divide the systolic blood pressure of the lower limbs by the systolic blood pressure of the upper limbs, and the resulting value should be greater than or equal to 0.9. Once this value is less than 0.9, it means that the blood vessels in the lower limbs are blocked. There are also tests including ultrasound, CT angiography and angiography. There is a difference between angiography and CT angiography. The former can be treated at the same time as the examination, that is, balloon dilation or stent, while the latter is a simple examination, and its main function is to make diagnosis. The disease can be diagnosed by ultrasound alone, and then angiography can be performed directly. This avoids multiple injections of contrast media and is safer. However, the requirements for sonographers are relatively high, and it also requires teamwork.
How can you tell how far your diabetic foot has progressed?There is a very simple way to judge the degree of diabetic foot. The patient can feel the arteries on the instep. If the arteries are felt to be beating, it means that the arterial pulsation is okay and not to the extent that active surgical treatment is required. However, this does not mean that the patient can not pay attention to the disease of the blood vessels. If you can't feel the artery, but the doctor can still feel it, you should start intervention. Once the doctor can't feel the pulse, it's quite dangerous.
How to treat diabetic foot?Patients with diabetic foot may not have any abnormal sensations in the early stages. However, as it continues to develop, they may develop abnormal nerve sensations or experience limb pain after walking, which is called intermittent claudication. Both conditions can be controlled and there are corresponding drug treatments, such as antioxidants and anti-internal cell proliferation drugs.
Later, foot ulcers, gap pain, and even infection may occur, which requires surgical treatment, that is, the reconstruction of blood vessels. It is best to use your own blood vessel for surgery, that is, the great saphenous vein, which is much better than artificial blood vessels. However, the blood vessel conditions of diabetic patients are often not ideal, so artificial materials are needed to reconstruct blood vessels.
In the past ten years or so, there have been some new treatment trends in vascular surgery, namely interventional minimally invasive treatment. The method is to use interventional means to expand the blood vessels of the lower limbs and place stents inside the blood vessels. This intervention can even be applied to the most terminal blood vessels. This method has slowly replaced traditional surgery and become the mainstream method of treating diabetic foot.
Because this treatment method is minimally invasive, the trauma is very small and can be performed repeatedly. If it fails once, it can be done again. In other words, for diabetic foot patients at this stage, we first recommend interventional minimally invasive treatment. If the intervention is unsuccessful, traditional surgical treatment will be chosen. Traditional surgery uses the patient's own blood vessels or artificial blood vessels for treatment. However, the two surgical procedures are not contradictory. After repeated interventional treatments fail, traditional surgery can still be chosen as long as conditions permit; restenosis after traditional surgery can also be further improved through interventional treatment.
In addition, when treating blood vessels below the knee joint, we will treat the corresponding blood vessels in a targeted manner for ulcers that appear in different places. This is because there are three main blood vessels in the lower limbs, and they supply blood to different areas. In the past, there was not enough understanding of these areas, but now these areas have been gradually understood. Especially for patients who have already developed limb ulcers, interventional treatment of the blood vessels in the ulcer area can promote the healing of the ulcer better and faster.
But whether it is conservative treatment, interventional treatment, or surgical treatment, the most important thing is to control sugar, and at the same time prevent other risk factors, such as blood pressure, blood lipids, smoking cessation, exercise, etc. Only in this way can you protect your feet and ensure the quality of life of diabetics.
What should patients with diabetic foot pay attention to?In order to prevent the further development of diabetic foot, patients must change their living habits. You can do some exercises that suit you, such as playing badminton, swimming or walking every day. This can increase the body's sensitivity to insulin and androgens, thereby promoting the formation of blood vessels in the side limbs. If important blood vessels are blocked, these side limb blood vessels can ensure that blood continues to circulate, at least not causing too bad consequences such as amputation.
In terms of details of daily life, when people with diabetes wash their feet every night, they should carefully check whether their feet are ulcerated, be sure not to cut the skin when cutting nails, and wear comfortable shoes.
Reprint mark: Diabetes NO.04 / Total Issue 43, Li Yongjun, Chief Physician and Professor, Vascular Surgery Department, Peking Union Medical College Hospital