Diabetic Foot and Nail Care

Diabetic Foot and Nail Care

DIABETIC FOOT WOUNDS

Diabetic foot is one of the most common complications of diabetes mellitus and is the most common cause of amputation in the world. If appropriate treatment is not applied, it can also result in death due to an infective event. Vascular damage and neuropathy, the two main complications of diabetes mellitus, are the main causes of diabetic foot. Who is a candidate for this surgery? Diabetes mellitus is a very important health problem due to its incidence and the morbidities caused by its complications. Foot ulcers are one of the most important reasons for hospitalization of diabetic patients and cause serious problems for the patient and his family, as well as a high rate of morbidity and mortality. Diabetic foot wounds are among the issues that should be emphasized in terms of causing serious problems ranging from high level to leg amputation.

Studies have shown that approximately 15% of diabetic patients develop scars on their feet at some point in their lives. Diabetes is the most common cause of foot amputation worldwide. Diabetes-related amputations account for 51% of patients who underwent lower extremity amputation. Diabetic foot ulcers are caused by isolated or combined effects of peripheral neuropathy, vascular insufficiency, infection and immune system disorders. The most important and most common complication is peripheral neuropathy accompanied by peripheral sensory loss. The main responsible for the formation of diabetic foot ulcers is the deterioration in sensory, motor and autonomic nerve functions. Sensory neuropathy is in the style of glove-sock distribution. In other words, patients lose their foot touch sensation, hot cold sensation and pain sensation. When their feet get cold, they do not feel the burning of heat sources such as the stove they approach to warm up as a result of excessive heat. They do not feel the pain caused by foreign objects such as nails or small stones in their shoes. In advanced patients, similar losses occur in the hands.

Since the foot, which has completely lost its sense, becomes insensitive to repetitive traumas, there is a tendency to develop ulcers. In addition, the feet of diabetic patients suffer from sweating along with this loss of sensation. As a result of the lack of sweating, the skin of the feet dries up, cracks and most importantly, it becomes easier to open the wound by rubbing during walking. As a result of the development of autonomic neuropathy, there is a loss of function in the sebaceous and sweat glands. Normal sweating and heat regulation mechanisms are disrupted in the foot. As a result, the soles of the feet become dry, peeling and dead skin thickening, resulting in tiny cracks in the skin, and infection and subsequent complications develop as a result of the entry of bacteria from here. Since the detection of these damages is delayed due to sensory loss, early preventive and therapeutic interventions cannot be performed and scar formation accelerates. Dead skin thickenings, ie hyperkeratotic lesions (callus) on the skin, act like a foreign body and create additional pressure.

Deformities that develop due to motor neuropathy in the foot form the beginning of a series of events that lead to Charcot deformity, also called diabetic neuroarthropathy, as a result of which changes occur on the surfaces of the foot that are exposed to pressure. Preoperative preparations and evaluation for wound treatment In addition to hyperglycemia treatment, appropriate antibiotic therapy and, in necessary cases, hyperbaric oxygen therapy and Negative Pressure Wound Therapy are beneficial. When treating diabetic foot ulcers, basic wound care principles should be applied completely. Since cellulite and edema may be present on the dorsum of the foot, elevation should be applied to reduce foot edema. Cultures must be taken before starting antibiotic therapy. Surgical interventions: In diabetic foot ulcers, some of the ulcers can heal spontaneously with wet dressings made with saline without the need for surgical intervention, while a significant portion of them requires surgical intervention. There are many different reconstruction alternatives available for closure of emerging soft tissue defects. Foot reconstructions in diabetic patients are more difficult than in traumatic tissue defects because diabetic complications reduce the success rate of surgical interventions to be performed here.

Diabetic foot and nail care is crucial for individuals with diabetes, as they are at an increased risk of developing foot and nail problems due to reduced circulation, nerve damage (neuropathy), and a higher susceptibility to infections. Proper foot and nail care can help prevent complications and maintain good foot health. Here are some important tips for diabetic foot and nail care:

1. Daily Foot Inspection: Check your feet every day for any cuts, sores, blisters, redness, swelling, or changes in temperature. Use a mirror or ask someone for help if you have difficulty seeing the soles of your feet.

2. Wash Your Feet: Wash your feet daily with mild soap and warm (not hot) water. Gently dry them, making sure to pat them thoroughly, including between your toes. Avoid soaking your feet, as it can lead to dry skin and potential infections.

3. Moisturize: Apply a diabetic-friendly moisturizer to your feet, but avoid putting it between your toes, as excessive moisture can promote fungal infections.

4. Trim Nails Carefully: Trim your toenails straight across and not too short. Use a nail file or emery board to smooth the edges. If you have difficulty trimming your own nails, consider having a podiatrist or foot care specialist do it for you.

5. Wear Proper Footwear: Select comfortable, well-fitting shoes with adequate support. Avoid shoes that are too tight or have seams that could rub against your feet. Look for shoes with good arch support and cushioning. Diabetic shoes or orthopedic shoes can be beneficial. Make sure to inspect your shoes for foreign objects before putting them on.

6. Avoid Going Barefoot: Don't walk around barefoot, even at home. It's easy to step on sharp objects or injure your feet without realizing it due to reduced sensation from neuropathy.

7. Manage Blood Sugar: Keeping your blood glucose levels within the target range can help prevent or slow the progression of neuropathy and other diabetes-related complications.

8. Regular Check-ups: Visit a podiatrist or foot specialist regularly (at least once a year) for a comprehensive foot exam. They can detect any issues early and provide guidance on proper foot care.

9. Manage Calluses and Corns: Do not attempt to remove calluses, corns, or other foot growths on your own. Consult a healthcare professional for proper care and treatment.

10. Avoid Smoking: Smoking can impair circulation and delay wound healing, so quitting is beneficial for overall foot health.

11. Be Cautious with Hot and Cold: Use a thermometer to test bathwater and ensure it's not too hot. Also, be mindful of extreme cold, as it can reduce blood flow to your feet.

12. Be Prepared for Emergencies: In case of foot injuries, have an emergency plan. Know what to do and seek medical attention promptly if you notice any signs of infection, non-healing wounds, or worsening conditions.

Diabetic foot and nail care is an essential aspect of diabetes management. Regular self-examinations, proper hygiene, and seeking professional care when needed can help prevent foot problems and reduce the risk of serious complications, such as foot ulcers and amputations. Always consult with your healthcare provider for personalized advice and guidance on managing diabetes and maintaining good foot health.