Diabetes mellitus (DM) often leads to such dangerous complications as diseases of the cardiovascular system, visual impairment and kidney function. Legs are among the target organs for diabetes
How to prevent the development of diabetic foot syndrome (DFS) and what remedies will help in its treatment?
The main mechanisms of leg damage in diabetes are diabetic neuropathy (damage to the nerve endings in the limbs, leading to a decrease in all types of sensitivity) and diabetic angiopathy (impaired vascular patency). Neuropathy occurs 2-3 times more often than angiopathy, so the widespread opinion that all problems in diabetes are caused by vascular pathology is incorrect.
Due to neuropathy, sensitivity is impaired, and the patient can injure his leg (burn, injure with shoes, etc.) and not feel it. Any diabetes wound may take a long time to heal due to high blood sugar levels. The occurrence of trophic ulcers in DFS (85-90% of cases) can ultimately lead to disability: more than half of all amputations (not related to trauma) occur in patients with foot diabetes.
What to do to prevent this from happening?
First, to treat diabetes by maintaining blood sugar levels within acceptable limits (up to 5.5-6.0 mmol / L on an empty stomach and up to 8-9 mmol / L after meals). Without normalizing blood sugar levels, treating leg lesions will never be effective!
Secondly, follow special rules for foot care. It is necessary to exclude any damage to the feet: do not walk without shoes on the floor, check the condition of the shoes (they should not be tight or chafe), wear special socks with DIALINE silver ions. You should also inspect your legs daily in order to timely detect injuries that, due to impaired sensitivity, may not appear painful.
Third, timely pharmacotherapy of diabetic neuropathy and angiopathy. Medicines should be prescribed by specialists from Diabetic Foot offices, as well as by endocrinologists, neurologists, etc.
Fourthly, to eliminate the so-called “minor problems of the feet” (dry skin, moisture in the skin of the interdigital spaces, calluses), which are risk factors for SDS. Dryness, first of all, affects the skin of the heel area, where cracks can form, which, against the background of diabetes mellitus, turn into trophic ulcers. To eliminate dryness, apply a cream (for example, DIALINE foot cream) and treat thickened skin with a special DIALINE pumice stone. With pronounced coarsening of the skin, which is poorly eliminated with the help of a cream, the patient is recommended to wear slippers with a heel (in them, the shock load on the heel when walking is minimal). In case of severe dryness, the cream should be applied 2-3 times a day. To soften the skin, use creams, balms, sprays containing vegetable oils or waxes. But the most effective in eliminating dryness are products containing urea, which increases the water content in the stratum corneum.
Fatty creams are contraindicated in case of extensive mycosis of the plantar surface of the feet due to the risk of aggravating the phenomena of mycosis under the cream, which forms a greasy film on the skin. For this purpose, there are creams with antifungal components, but it is better to start using them after visiting a dermatologist and prescribing appropriate therapy.
The moisture of the skin of the interdigital spaces leads to the formation of diaper rash and cracks in the skin of this zone. The cause may be athlete’s foot (cheesy plaque on the skin) or improper foot care (applying cream between the toes, excess moisture inside the shoe). No creams should be applied between the fingers!
In the absence of reliable signs of mycosis, a decrease in moisture is sufficient (temporarily – gauze pad, then – talcum powder or socks with compartments for fingers).
With a fungal infection, antifungal drugs are prescribed, preferably in solutions rather than creams ( Lamisil spray , Clotrimazole solution 1% or Nit-rofungin ). If there is mycosis of the nail plates, a dermatologist should prescribe the treatment! Removal of the nail plate has not been practiced in recent years due to its low efficiency and trauma .
Only antifungal agents for oral administration can cure onychomycosis . For this, there are various drugs without pronounced side effects. Antifungal varnishes or creams have only a preventive or auxiliary (in relation to the main treatment) effect in onychomycosis . In case of contraindications or patient fears regarding systemic antimycotic therapy, the most effective topical agents are drugs that dissolve the nail plate, for example, Mikospor (cream + patch) for 2-3 weeks. After that, for several months, an antifungal cream ( Mikospor , etc.) should be applied to the nail .
Hyperkeratosis (calluses) are formed as a result of excessive pressure, leading to hemorrhage, followed by suppuration and the formation of a diabetic ulcer. Overload occurs due to orthopedic problems, deformation of the feet, and improper selection of shoes. Patients with diabetes should promptly remove calluses with a pumice stone (or a special device in the Diabetic Foot office or pedicure salon).
Special plasters and liquids for removing corns are contraindicated in diabetes mellitus, since their use often leads to diabetic ulcers.
If the overload of the skin area persists, the callus will inevitably form again. To reduce the load, wearing special prophylactic or orthopedic shoes, the use of “small orthopedic” means ( gel pads, correctors for beak-shaped toes, insoles-instep support, etc.) allows you to reduce the load . However, these funds should be prescribed by an orthopedic surgeon or a specialist from the Diabetic Foot . The patient should be trained in their correct use and precautions (due to the risk of skin damage due to impaired sensitivity).
Magnetic massage insoles (with protrusions) are contraindicated in diabetes mellitus, because there is a high risk of skin damage and diabetic ulcers.
How to treat the resulting foot injuries?
The patient can provide first aid to himself. He should first rinse the wound with a solution of hydrogen peroxide, miramistin , chlorhexidine, or acerbine .
Acerbin is a universal drug and has not only an antiseptic effect, but also relieves inflammation, stimulates the regeneration of damaged tissues, therefore it can be used at all stages of the wound process (treatment and prevention of diabetic foot and household injuries).
Then apply a sterile bandage or a special napkin like Coletex to the wound and fix it with a bandage. If the wound does not heal for 2-3 days, it is necessary to urgently consult an endocrinologist or visit the Diabetic Foot office. Most amputations occur in patients who did not seek help from specialists at the time. Remember that more than 90% of people with DFS are cured without amputation if the necessary measures were taken at the time.