Diabetic Foot and Neuropathy

Diabetic Foot refers to complications resulting from poorly managed diabetes, often characterized by foot ulcers, infections, and deformities. Diabetic Neuropathy is a frequent underlying condition, leading to nerve damage that reduces sensation in the feet and increases vulnerability to injuries.

Key Characteristics:

• Loss of protective sensation due to peripheral neuropathy.
• Poor circulation (peripheral arterial disease), delaying wound healing.
• Deformities such as claw toes or Charcot foot.
• Increased susceptibility to infections due to impaired immunity.

Risk Factors:

• Long-standing diabetes with poor glycemic control.
• Smoking, hypertension, and hyperlipidemia.
• Previous history of foot ulcers or amputations.
• Inappropriate footwear causing pressure points.

Complications:

• Chronic non-healing ulcers.
• Wet gangrene (infected tissue with pus and foul smell).
• Dry gangrene (tissue death without infection, presenting with darkened, shriveled areas).
• Osteomyelitis (bone infection).
• Amputation in severe cases.

Treatment Options

Non-Surgical Approaches:

1. Regular Dressing and Wound Care:

   • Use of antiseptics and advanced dressings (e.g., hydrocolloid, foam, or silver-impregnated).
   • Frequent debridement of necrotic tissue.

2. Diabetic Foot Care:

   • Proper footwear to reduce pressure and prevent injuries.
   • Regular foot inspections and hygiene maintenance.

3. Management of Neuropathy:

   • Medications like pregabalin, gabapentin, or duloxetine for neuropathic pain.
   • Vitamin B12 and alpha-lipoic acid supplements for nerve health.

4. Ozone Therapy:

   • Promotes tissue oxygenation and microbial control.
   • Can improve wound healing in resistant ulcers.

Treatments for Gangrene:

1. Wet Gangrene:

   • Aggressive debridement or minor amputation if necessary.
   • Antibiotics targeting polymicrobial infections.
   • Hyperbaric oxygen therapy (HBOT) in selected cases.

2. Dry Gangrene:

   • Conservative approach if not infected, allowing auto-amputation.
   • Revascularization procedures to improve blood flow.

Surgical Approaches:

1. Revascularization:

   • Angioplasty or bypass surgery to restore circulation.

2. Major Surgery:

   • Partial or total amputation for severe, non-salvageable infections.
   • Limb salvage surgeries to preserve function.

Preventive strategies, including tight glucose control, smoking cessation, and early detection, remain critical in reducing the incidence and severity of diabetic foot complications.