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ABOUT DIABETIC FOOT
Popularly called “Diabetes Mellitus”, is a chronic disease that occurs in the metabolism of sugary foods due to a decrease in the amount or effect of the hormone insulin, and blood glucose levels are higher than normal. Diabetes mellitus is a chronic disease that occurs in the metabolism of sugary foods due to a decrease in the amount or effect of the hormone insulin. The frequency of this disease, which is observed in almost one out of every 10 people, has increased significantly today due to reasons such as increased inactivity, irregular and unbalanced nutrition. An increase in blood glucose in the body can cause problems in many organs and systems, especially eye, kidney, vascular and nerve damage. Diabetes, which also causes significant problems in the heart and especially in the vascular system, is a chronic disease that reduces life expectancy and quality of life.
One of the first complications that comes to mind when diabetes is mentioned is diabetic foot. Diabetic foot is a clinical picture that occurs due to the damage caused by diabetes in the small vessels and end sensory nerves, which can range from simple wounds on the feet to complicated conditions that can cause the loss of feet and legs.
One out of every 7 diabetes patients encounters a diabetic foot wound at some time in his life. Even if these wounds are treated under the best conditions after opening, there may be loss of the foot and leg at certain levels. For this reason, the best treatment in diabetic outpatient is to take measures to prevent the occurrence of the disease. For this reason, it is of great importance to know who is at risk for the development of diabetic feet and for patients in this group to undergo regular check-ups. The risk is significantly higher in patients with high blood sugar levels (uncontrolled diabetes). However, in people with diabetes who have had a wound on their foot once, the wound is more likely to recur. Those with minor vascular damage or nerve damage to the foot are both more likely to open wounds and less likely to recover with treatment. In addition, it means that the risk of diabetic feet is increased in patients who develop damage to their kidneys, eyes and other vessels due to diabetes. Other systemic factors, such as smoking, obesity, increase the risk by adding to diabetes mellitus. In addition to these negative effects of diabetes, the risk is also high in patients who do not care about foot care, have a disfigured foot, have a fungal infection on their feet and nails, and have dry and cracked foot skin.
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The treatment of patients should be carried out with the joint participation of Internal Medicine, Orthopedics, Cardiovascular Surgery, Plastic and Reconstructive Surgery, Underwater Medicine and Hyperbaric Medicine and Infectious Diseases clinics.
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The first step in treatment in patients with advanced diabetic foot is to determine the condition of the vessels in the relevant leg after checking the blood glucose level and to eliminate the problems that exist in the vessels in that area. It is possible to make a diagnosis with a medicated tomography or angiography to be performed for this purpose. According to the characteristics of the affected vessels, surgical interventions may be required in addition to treatment methods such as balloon, stent and vascular calcification cleaning to be applied by angiography. After vascular problems are eliminated and tissue blood supply is brought to an adequate level, it is time for wound care and wound healing. There are a wide variety of methods used for this purpose; depending on the condition of the foot and the wound, the doctor must decide which method to use. Hyperbaric oxygen therapy along with various wound care and wound debridement methods are among the treatments that can be used during this period. Since some of the patients may also have an infection in the wound, antibiotic treatment may be required. Wound healing depends on various factors such as the condition of the wound, the patient’s compliance with treatment, and the control of blood sugar during recovery, and some patients may require months-long treatments and wound care. Despite all efforts, amputation of the foot or leg may be required from certain levels in some of the patients.
After the completion of the treatments, it is necessary to pay attention to some issues in order to prevent new wounds. Blood sugar control comes first of all. It is very important that the doctor’s controls are not disrupted in terms of blood vessels and nerves. Patients are advised not to cut their nails too short or too long, to take care that the feet do not dry out, to dry the fingers decently after washing, to go to foot care every month or 15 days. Along with these, avoiding open shoes in summer, not contacting rough and hot surfaces such as sand with bare feet are among the precautions that should be taken.
I wish you a healthy week.
Assoc.Dr.
Cardiovascular Surgery Specialist MedicalPark Istanbul Hospital
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