The subtitle of the article may seem somewhat provocative. “How to save your legs...” Unfortunately, this is the question that those who are faced with a diagnosis of “diabetic foot” have to look for answers to.
THE INSANE OF DIABETIC FOOT
I have no doubt that the name of this terrible syndrome is well known to all those suffering from diabetes. Doctors probably talked about precautions and warned about symptoms. But unfortunately, diabetes is difficult to control, and diabetic foot syndrome can take decades to develop. Slow changes do not attract attention until the development of the pathology enters the “high” stage.
A FEW NUMBERS
I don’t want to scare anyone, but I think that every person with diabetes should know these statistics. This is an excellent incentive for strictly following the rules of prevention. So
- The diagnosis of “diabetic foot” confidently ranks first in the number of amputations in non-war times.
- Diabetes mellitus greatly (up to 47 times!) increases the risk of amputation.
- After amputation, patients are at risk of amputation of the second limb within three years with a probability of up to 30%.
- The risk of repeat amputation within five years increases to 51%.
These numbers are too eloquent to be ignored.
DIABETES DESTROYS VESSELS
The peculiarity of human anatomy is such that surges in blood sugar have a destructive effect on the blood vessels of the lower extremities. Irreversible damage to small-diameter arteries occurs and, accordingly, circulatory impairment. The so-called ischemic form of diabetic foot occurs - due to insufficient nutrition, tissues on the legs degrade, non-healing wounds form and grow, bone tissue, nerves, joints, and tendons are destroyed. There is a growing serious risk of developing gangrene, sepsis, and amputation.
DIABETES KILLS NERVES
High blood sugar levels lead to decreased conductivity of nerve fibers located in the feet. As a result, sensitivity is lost and the risk of accidental injury increases dramatically. The patient simply does not notice the damage to the legs, and ischemia does not allow the wounds to heal. The disease is progressing.
DIABETIC FOOT: DIAGNOSIS
Diagnosis of diabetic foot syndrome is a complex medical task. A hardware examination of the condition of the arteries is required, the condition of the bones of the foot is determined, and sensitivity is analyzed - tactile, temperature and vibration. A bacterial analysis and, of course, a detailed blood test are required.
The vascular surgery clinic has installed the most advanced equipment to date, which allows you to quickly and accurately determine the condition of the limbs and create an adequate treatment strategy.
TREATMENT OF DIABETIC FOOT: REMEMBER ABOUT DIABETES!
I must emphasize that when treating diabetic foot, you must always remember the root cause of the disease - diabetes. Qualified observation by an endocrinologist, strict adherence to recommendations and prescriptions, as well as constant monitoring of glucose levels are required. Normalization of carbohydrate metabolism is a fundamental condition for successful treatment.
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What are the symptoms of severe pain in the legs with diabetes?
Pain in the legs in diabetes is distinguished by the degree of intensity, nature, and location. Most often, patients complain of discomfort at night, while during the day the pain is usually less pronounced. Often night pain is accompanied by a symptom such as burning in the legs in diabetes.
The localization of pain also varies:
- toes hurt due to diabetes;
- discomfort in the sole area (tingling, numbness, goosebumps, feet “burning” or, conversely, too cold);
- painful symptoms in the ankle area;
- aching pain in the calf muscles;
- aches in the shins, etc.
Each type of pain, as well as its intensity, nature, time of occurrence and localization indicates different reasons for its occurrence, and therefore a method of treatment.
That is why diagnosing diabetic foot includes a detailed questioning of the patient about existing symptoms.
For example, redness of the leg below the knees in diabetes in most cases indicates an existing inflammatory process, and if such redness is accompanied by a high temperature, then there is a possibility of developing a gangrenous infection.
Other studies
The doctor may also consider other tests necessary:
- Electromyography
– to determine the type and extent of nerve damage. A special device sends an electrical current to the nerve, and the electromyogram shows how the muscles respond to the electrical impulses delivered through the nerves; - Heart rate variability
. The doctor must know how the heart reacts to deep breathing, exercise, blood pressure and other changes; - Ultrasound examination of the pelvis and other systems
. Using ultrasound, the structural state of organs and some functions are assessed. For example, how the bladder works.
Electromyography
Pelvic ultrasound
Why do my legs hurt with diabetes?
The main reasons why legs and feet hurt and go numb in diabetes are:
Significant reduction in foot sensitivity.
For this reason, a person often receives various foot injuries, but due to reduced sensitivity he does not feel them. Also, decreased sensitivity leads to hypothermia or overheating of the legs. Patients often complain that their legs burn in diabetes mellitus when it comes to simple overheating.
Problems with blood vessels.
Blockage of the blood supplying vessels to the extremities leads to poor circulation; pain is associated with insufficient oxygen supply to the muscles. Spots appear on the legs in diabetes mellitus, looking like “stars”, swollen veins, the skin takes on a bluish-purple color.
Decreased muscle tone.
When pain occurs, a person tries to limit his activity and spends time mainly in a sitting or lying position. This leads to atrophy of the leg muscles and the pain becomes even more intense.
Of course, this does not mean that it is necessary to lead an active lifestyle when experiencing severe pain, but after completing a course of treatment and relieving acute pain, mobility should not be limited. It is important to wear properly fitted orthopedic shoes and use special insoles for diabetics to relieve stress on the feet.
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Presence of calluses and ulcers.
Calluses, abrasions, corns, areas of rough skin, ulcerations, ulcers, and fungal infections are the causes of pain when walking and at rest. These symptoms require immediate treatment, which is aimed at suppressing the infection.
Excess weight and old age.
Patients over 55-60 years of age and obese people often experience swelling of the legs due to diabetes, which is accompanied by pain. The cause of pain in this case is the increased load on the legs due to excess weight and degenerative changes in bones and muscles that appear with age.
Stages of pathology development
Regardless of the form of the disease, it develops sequentially. When moving to a new stage, existing symptoms become more acute and new ones are added.
The course of diabetic foot, regardless of classification, is as follows:
- Initial stage. It is characterized by changes in the shape of the foot, bone deformation, and the formation of blisters and calluses.
- Stage 1. Accompanied by the formation of ulcers and necrotic wounds, while the deep structures of the skin are not damaged.
- Stage 2. Ulcerative and necrotic skin lesions deepen into the dermis, affecting muscles, joints, and tendons.
- Stage 3. The ulcer deepens to the bone tissue, and in the vast majority of cases a wound infection is associated. An abscess and osteomyelitis develop.
- Stage 4. It is characterized by the formation of limited gangrene on the supporting part of the foot. The tips of the fingers turn black, the destructive process has smooth and clear edges. At this stage, the limb can still be saved through surgery.
- Stage 5. Accompanied by a significant increase in the area of tissue death. Gangrene affects the lower leg. In this situation, the process is irreversible, and the only option to save the patient’s life is amputation.
Pain in the legs with diabetes: treatment and pain relief
Treatment of pain in diabetic foot is carried out in three areas:
Elimination of the causes that stimulate the appearance of pain.
For example, if there is an infection, antibiotics are prescribed, wounds and ulcers are treated with antibacterial agents. The symptom of blackening of the leg in diabetes is eliminated by normalizing blood circulation.
The effectiveness of pain treatment depends on how correctly the cause of pain was identified and adequate treatment was prescribed.
Relief of pain symptoms.
To reduce the intensity of pain, use:
- painkillers;
- therapeutic exercises and massage;
- physiotherapeutic procedures;
- external agents (anti-inflammatory ointments, creams with a warming or cooling effect, etc.);
- medicinal baths, lotions and other folk remedies.
The specific method of reducing pain symptoms is selected based on the intensity and location of the pain.
For example, if the soles of your feet burn in diabetes mellitus, then baths with sage, pine needles or chamomile, and the use of creams with a cooling effect can help reduce discomfort.
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Restoration of motor activity.
A sedentary lifestyle in diabetes is often associated with pain when walking. For example, if your toes hurt if you have diabetes, what should you do?
Aches and pains in the toe area are usually associated with wearing the wrong shoes and increased stress on the toes and metatarsus. In this case, the main principle of treatment will be the selection of high-quality shoes and wearing unloading insoles.
Treatment of diabetic foot
At different stages of the disease, different methods of treating diabetic foot syndrome are used. They are selected depending on the level of arterial insufficiency in the distal parts of the lower extremities and the severity of pathological changes in the tissues.
- Drug therapy
Pain reduction is achieved by using antispasmodics and muscle relaxants. Preparations containing lipoic acid are prescribed to improve tissue metabolism and have an antitoxic effect. To improve the functioning and restore the walls of blood vessels, drugs that stimulate venous outflow are used. In case of infected wounds, treatment with antibacterial drugs is indicated.
It is necessary to combine these drugs with basic drugs for the treatment of the underlying disease - diabetes mellitus (DM). For this purpose, the doctor prescribes drugs that improve carbohydrate and lipid metabolism.
- Surgical intervention
Surgical treatment is used only when conservative methods have proven ineffective. These include:
- vascular bypass and arterial restoration;
- necrectomy of individual areas;
- amputation, including high amputation.
- Physiotherapy
Physiotherapeutic treatment is the most universal method used for diabetic foot syndrome at different stages of the disease. The physical effect is aimed at increasing the elasticity of the walls of blood vessels, improving blood flow, and relieving spasms. Physiotherapeutic procedures must be performed in a specialized vascular center under the supervision of experienced doctors.
Magnetic therapy helps reduce pain and is especially indicated for patients whose diabetes is associated with hypertension and coronary heart disease. In addition, magnetic therapy has a mild sedative effect.
Laser therapy is used in the treatment of foot ulcers and intravenous blood irradiation. Electrophoresis and phonophoresis can increase the effectiveness of administered medications. And to improve blood flow, reduce swelling and restore sensitivity to the tissues of the foot, barotherapy and hyperbaric oxygenation are used.
The complex of measures used aimed at treating diabetic foot syndrome makes it possible to achieve a significant improvement in the patient’s condition both in the clinic and in outpatient treatment.
Prevention of leg pain in diabetes mellitus
To prevent pain in the lower extremities, you must follow the following recommendations:
- Treat the skin of your feet daily with special products. These foot care products for diabetics contain a moisturizing complex that prevents the formation of calluses and ulcers.
- Treat concomitant diseases in a timely manner. If your legs below the knees turn red with diabetes, then a visit to a cardiologist is necessary, because there is a high probability of problems with the cardiovascular system.
- Therapeutic exercises and walks. It is necessary to maintain physical activity at a level acceptable for your age and condition.
- Normalization of weight and metabolism.
- Unloading the foot. To do this, it is recommended to use insoles to unload the foot when walking, which evenly distribute body weight and help the foot take an anatomically correct position.
- Maintain personal hygiene. You must not walk barefoot, allow yourself to become overheated or hypothermic, use someone else’s shoes, etc.
If all recommendations are followed, preventing the onset of pain due to DFS turns out to be very effective. If you experience any pain, you should contact a podiatrist or endocrinologist.
Remember that diabetic leg pain is a symptom of serious conditions that require treatment.
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What to do?
Of course, such warning signs cannot be ignored. If loss of sensation occurs, you should consult a doctor as soon as possible. In addition, you should include a daily examination of your limbs in your daily schedule. “It is very important to conduct a daily examination of the feet, and you need to examine not only the lateral parts of the feet, but also the heels, as well as the spaces between the toes,” says Tatyana Romanenko. This will allow you to detect any defects and changes in time and prevent infection and the subsequent development of gangrene.
If a person experiences dull, aching, tingling or twitching pain, they should consult a doctor. As a rule, such sensations intensify at night. They also increase with increasing blood glucose levels, and then may disappear when it normalizes. And such pain often manifests itself when diabetes has not yet been diagnosed.
So it’s better not to delay, but at the first problem with your legs, seek advice from a specialist. This is also important to prevent diabetes from moving to another stage.
