How do you develop diabetic foot?

Diabetes Mellitus is a chronic disease that affects a large number of people worldwide and is a major health problem. The resulting hyperglycemia increases the risk of developing neurologic and vascular changes, as well as the risk of suffering from infection. These factors favor the appearance of lesions or ulcers on the feet and these have a poorer evolution and a poorer prognosis. These complications cause great suffering to the person and their family and result in high direct and indirect financial costs.

2. How many patients come to suffer from it?

In Spain, it is estimated that 14.8% of the population suffers from diabetes and all these patients are at risk for complications that can lead to diabetic foot disease, which is why it is important to establish prevention strategies.

3. How does it manifest itself?

The diabetic foot causes decreased sensitivity which in most cases is accompanied by changes at the vascular level and predisposition to infection. It is important to emphasize that people with diabetes may not show symptoms even though they have experienced changes.

4. So is it something that is difficult to diagnose?

In many cases, the development of symptoms is slow but progressive, so that people “get used to” and live with them. Proactive interviews aimed at looking for specific signs or symptoms can help us make an early diagnosis. On other occasions, the appearance of symptoms such as tingling, numbness in toes or nighttime pain, cold and pale skin, and disabling pain when walking may help us establish the diagnosis.

5. What were the consequences?

Early detection of ulceration risk is the key to prevention. The bad evolution of the injury can end in the dreaded amputation. Keep in mind that Spain is the European country that has the most amputations due to complications of diabetes, twice the number of neighbors such as France, Italy or the UK.

6. What do you recommend for diabetic foot patients?

Therapeutic education is one of the fundamental pillars in the treatment of diabetes and its complications. Our recommendations are part of a structured and personalized program aimed at adopting a daily routine for foot care such as hygiene, check-ups, nail care, skin hydration… In addition, we offer personalized advice on the most suitable footwear, stockings or socks . It also informs about certain habits that should be avoided to minimize the risk of injury. The aim is to reduce the risk of ulceration to a minimum by promoting self-care and, when this is not possible, involvement of family members or caregivers.

7. How to prevent it?

It can and should. Diabetic foot checks should be part of their comprehensive care. All people with type 2 diabetes should be evaluated by a trained professional for risk stratification for developing ulceration. Also those with type 1 diabetes are older than 25 years and the evolution of the disease is more than five years.

8. How can ulceration be avoided?

Determining the level of ulceration risk through neurological and vascular examination has been shown to reduce the risk of developing ulceration. Once the risk has been identified, following international scientific guidelines, the review frequency is determined.

9. You are in charge of the new diabetic foot prevention clinic launched by the Ruber Juan Bravo Hospital Complex and Quirónsalud University Hospital. What is the aim of this initiative and what actions are taken?

The goal is prevention through education and involvement of patients and their families. The person must know the risk of suffering from a foot injury, learn specific self-care skills and techniques. First, we analyze the patient’s history, which provides us with important data. This is followed by a thorough examination of the feet, shoes and socks. We observe the condition of the skin, coloration, temperature, condition of the nails, presence of lesions, changes in anatomy, etc. Next, a neurologic examination of different sensitivity (tactile, pain, temperature, pressure) and vascular examination was performed. All this information makes it possible to categorize the risk of developing ulceration and to prepare a personal treatment program and, if necessary, referral to relevant professionals. Depending on the detected risk, a quarterly, semi-annual or annual calendar is programmed. The goal is to anticipate problems and work with a multidisciplinary team, podiatrist, neurologist or vascular specialist, as the case may be.

10. When to do the surgery?

The function of consultation is prevention to avoid intervention which, if necessary, must be determined by the relevant professional.