Diabetic Foot Treatment
Today, diabetes, also known as diabetes, is a progressive disease that occurs as a result of high blood sugar and causes many organ involvements. Diabetes has been one of the most important health problems of societies throughout history. Fatal acute complications of diabetes are less common, as blood-sugar levels can be kept under control thanks to new treatment approaches and developed drugs. Especially long-term complications can often be life-restricting. Different findings are observed depending on the affected organ, neuropathy in the hands and feet, nephropathy in the kidneys, retinopathy in the eyes, and diabetic foot can develop. The incidence of diabetes is 6-7%. 20% of the reasons why diabetic patients apply to the hospital are foot problems. In general, it has been determined that 50-70% of amputation surgeries are made up of patients with diabetes. In diabetics with organ loss, the risk of a second operation is 50% within 2 years. In 70% of people with diabetes, foot problems develop and diabetic foot wounds occur.
Diabetic Foot Symptoms
In diabetic patients, the first symptom may be foot sores. There are several main reasons for foot sores: uncontrolled diabetes, uncontrolled diet, vascular occlusion and stenosis (diabetic vasculopathy), nerve damage (diabetes neuropathy), poor foot hygiene conditions. The main reason for the pain in the legs is the inability to send the needed blood to the calf muscles due to vascular stenosis and congestion during walking. Initially, it does not cause any symptoms, as the narrowing and occlusion of the vessels increase, the legs develop with walking. This pain gets worse and forces the person to stop and rest. The pain that passes with rest also occurs during rest in later times. Apart from this, coldness, feeling of coldness, color change, hair loss and non-healing wounds and ulcers may occur on the legs.
Leg Vascular Disease and Diabetic Foot Diagnosis
When impulses cannot be obtained during the examination of the patient, the first diagnosis method is Doppler ultrasonography. After the problem is detected with this, angiography (imaging of the vessels) is performed for pre-treatment planning. This technique can be done by computed tomography (CT), magnetic resonance (MR) or catheter angiography. Although the most accurate diagnosis can be made by catheter angiography, today it can be diagnosed with high accuracy in CT or MR angiography.
Leg Vascular Disease Treatment Methods
Medical treatment (antibiotics, blood thinners, blood sugar regulation) is initiated in the case of an ulcerated and gangrenous wound in a patient presenting with diabetes foot and is performed by orthopedics if urgent debridement is required. The treatment of vascular stenosis and occlusion is started on the same day or the next day. In interventional radiology, vascular stenosis and occlusions are treated by direct vascular access. The main treatment method is to remove the stenosis or obstruction with balloon or stent. The advantages of direct skin (percutaneous) balloon and stent treatments performed with interventional radiology methods are shorter hospital stay, no large surgical incision, no need for anesthesia-narcosis, and less risks compared to surgical methods. Thrombus and atheroma plaques that because vascular occlusion can also be removed with new technology product thrombectomy and atherectomy systems. Bypass surgeries are performed by vascular surgery in long-distance stenosis and occlusions where stent or balloon cannot be applied and beneficial results are obtained. Combined treatment methods should definitely be applied when planning the treatment. In this context, along with vascular treatments, regulation of blood sugar, regulation of diet, antibiotic treatment and dressing for foot wounds, debridement for outpatient gangrenous wounds, hyperbaric oxygen therapy and supportive treatment methods should be planned. In general, tissue and organ loss rates fall below 15% in patients treated. In the first 6 months following the treatment, a re-narrowing of 5 to 50% may develop in the treated vessel. The structure of the treated vessel, the degree of stenosis or occlusion before the treatment, sugar control, treatment technique, and the general condition and habits of the patient determine the effectiveness of the treatment. Patients who develop tissue or organ loss in untreated patients may lose their feet. Life-threatening risks may also occur.
Diabetic Foot Polyclinic
The diabetic foot diagnosis and treatment process is extremely critical in terms of preventing foot loss. Tissue losses are inevitable if the process progresses slowly and treatment is delayed.
Functioning of Diabetic Foot Polyclinic
First application: Orthopedic specialist performs the first examination of diabetic patients with wounds and pain in their feet and intervenes in those who need urgent debridement. All required blood tests of the patient are requested.
- Endocrinology Specialist evaluates the patient’s blood tests and initiates the necessary glucose regulation and additional medical treatments.
- After the Interventional Radiology Specialist evaluates the foot vessels of the patient with Doppler ultrasonography, he / she plans the treatment with MRI or CT angiography. It applies balloon, stent or vein shaving in leg vascular stenosis and occlusion.
- Cardiovascular Surgeon performs bypass surgery with native or graft when necessary in patients with leg vascular stenosis and occlusion.
- Patients whose vascular stenosis and obstruction are resolved are re-directed to the diabetic foot polyclinic in terms of possible orthopedic interventions and medical treatment follow-ups.
- Diabetic Foot polyclinic follow-up is done regularly in the long term.
Diabetic Foot Protection
To prevent recurrence of the disease after treatment or to prevent diabetic foot development in diabetic patients.
- Careful use of diabetes medications by regular blood glucose monitoring
- Following the diet and gaining regular eating habits
- Absolutely avoiding smoking and alcohol
- Long walks (at least 8000 steps a day)
- Paying attention to foot hygiene and wearing clean socks by washing the feet every day.
- The use of shoes and socks for diabetic patients in the protection of feet.
- It is one of the necessary precautions not to walk around barefoot.