Diabetes is one of the most common chronic diseases in society and is often associated with high blood sugar levels. When blood sugar is not controlled, complications of diabetes can develop. Approximately one-fifth of diabetic patients will develop non-healing wounds, ulcers, or infections on their feet over time, and if left untreated, these conditions can lead to the loss of a foot or leg. Treating diabetic foot wounds requires a comprehensive approach that involves a range of specialties.

Diabetic foot is a chronic foot ulcer that develops as a result of long-term diabetes or poorly controlled blood sugar levels. Diabetes typically affects capillaries by causing neuropathy (inflammation of the nerves) or vasculopathy (inflammation of the blood vessels). Foot ulcers can develop in diabetic patients due to both neuropathy and vasculopathy.

While a simple shoe injury or an ingrown toenail can heal quickly with appropriate treatment in healthy individuals, such conditions can develop into a diabetic foot ulcer in diabetic patients. Neuropathy and vasculopathy should be suspected in diabetic patients if they experience symptoms such as burning, numbness, loss of sensation in the feet, loss of sweating in the feet, dryness, or cracking heels. Necessary precautions should be taken before a diabetic foot ulcer develops, and appropriate treatment should be initiated early.

Diabetic foot stages

Diabetic foot is a condition that occurs in patients with diabetes and progresses through various stages. Impairment of the sweating mechanism due to autonomic neuropathy can lead to dry feet, cracks, fissures, and calluses. These cracks and wounds can provide entry points for fungi and other infectious agents. Infection can cause cracks to deepen and enlarge.

As a result of diabetic sensory neuropathy, a patient may not be able to feel an infected wound or pain. As the wound grows and the infection progresses, the patient is usually unaware of the wound through discharge or other symptoms. However, at this stage, the wound can often become a foot or leg threatening condition. Furthermore, wound healing can be delayed due to vascular damage caused by diabetes.

Diabetic foot stages are listed as follows according to the Wagner Classification:

• Stage 0 : Healthy skin
• Stage 1 : Superficial ulcer
• Stage 2 : Deep ulcer
• Stage 3: Ulcer with bone involvement
• Stage 4: Forefoot gangrene (fingers/toe)
• Stage 5 : Total foot gangrene

Diabetic foot ulcers can occur in approximately 10-15% of diabetic patients. It is estimated that there are approximately 10 million diabetic patients in our country, and the number of patients experiencing this condition is approximately 1-1.5 million.

Diabetic foot problems are more common in people who:

• Those with nerve damage or poor blood flow in the feet
• Those with long-term diabetes and those who cannot maintain blood sugar balance (those who experience frequent hyperglycemia attacks)
• Those with obesity problems (those with weight problems)
• Those over 60 years old
• Those with high blood pressure and high cholesterol problems

Diabetic foot symptoms 

• Foot sores and ulcers: Diabetic foot, uncontrolled sugar consumption, and diabetic complications can lead to foot sores. These often manifest as ulcers that are difficult to heal and slow to heal.
• Circulatory problems: Uncontrolled diabetes can be associated with blood vessel blockage and narrowing (diabetic vasculopathy). This can cause leg pain, cramping, and inadequate blood flow to the legs during walking. Initially, the pain may be mild but can become more severe as the disease progresses.
• Nerve damage: Nerve damage called diabetic neuropathy can cause numbness, tingling, or a feeling of numbness in the feet. This can cause foot sores to go unnoticed or unnoticed.
• Coldness and color change in the legs: Symptoms such as feeling cold in the legs, changes in skin color and hair loss may occur due to circulation problems.
• Non-healing wounds and ulcers: Diabetic foot can cause wounds and ulcers that are difficult to heal, reoccur, or do not heal properly. These wounds can increase the risk of infection and, if left untreated, can lead to serious complications.

These symptoms may indicate diabetic foot syndrome, and it's important to see a healthcare professional if one or more of these symptoms appear. Early intervention can help prevent serious complications.

How is diabetic foot diagnosed?

• Physical exam: The doctor examines the patient's feet to assess for physical signs such as sores, ulcers, skin changes, or signs of nerve damage. They also look for signs such as a lack of pulse or circulatory problems.
• Doppler ultrasonography: This is a method used to evaluate circulatory problems. Doppler ultrasonography is frequently used in cases where pulses cannot be detected or to identify circulatory problems.
• Angiography : This technique is used to visualize blood vessels. Angiography can be performed using computed tomography (CT), magnetic resonance imaging (MRI), or catheter angiography. These techniques provide detailed images of blood vessels and can reveal blockages or narrowings.
• Biochemical tests: Blood tests can evaluate the level of diabetes control and other medical factors. These tests are often used to understand a patient's overall health.

These diagnostic methods are the primary methods used to diagnose diabetic foot syndrome. A physician can make a diagnosis based on the patient's symptoms, physical examination, and, if necessary, imaging techniques. The treatment plan is determined based on the accuracy of the diagnosis and the patient's condition.

Diabetic foot treatment 

Diabetic foot treatment requires a comprehensive and multidisciplinary approach. Some methods used in diabetic foot treatment include:

• Wound care: The priority in treating diabetic foot wounds is to remove dead tissue and maintain a hygienic environment. This requires special dressings, meticulous wound cleansing, and hygiene.
• Improving circulation: Circulation problems can make it difficult for diabetic foot wounds to heal. Therefore, recommended treatments to improve circulation may include medications, exercise programs, and surgery.
• Infection control: Diabetic foot wounds tend to become infected, so antibiotic treatment may be necessary to reduce the risk of infection.
• Surgery and reconstructive surgery: If diabetic foot ulcers become severe, amputation may be necessary. Amputation involves cutting off the affected limb to prevent the spread of infection. Reconstructive surgery may also be performed to restore circulation or treat non-healing wounds.
• Innovative treatments: In recent years, gene and stem cell therapies have shown promise in the treatment of diabetic foot wounds. Gene therapies, treatments involving growth factors, and stem cell applications are areas being researched to accelerate wound healing and promote tissue repair.
• Vascular assessment and interventional treatments: Imaging methods such as Doppler ultrasound, computed tomography (CT), or magnetic resonance (MR) angiography are used to determine the status of blood vessels. Treatment may be performed with endovascular procedures (balloon angioplasty or stenting) or open surgery (endarterectomy or bypass) to open or repair blockages.
• Use of amniotic membrane and mesenchymal stem cells: Amniotic membrane has wound-healing properties and is used in the treatment of diabetic foot wounds. Mesenchymal stem cells are also a promising treatment option to support the healing process.

Diabetic foot treatment requires a multidisciplinary approach and may vary for each patient. Depending on the patient's condition and the severity of the injury, the appropriate treatment plan and methods should be determined by specialists.

Hyperbaric oxygen therapy for diabetic foot wounds

Hyperbaric oxygen therapy is an important supportive treatment for diabetic foot wounds. This treatment method is used to accelerate the healing process of chronic wounds and support tissue healing by increasing the body's oxygen levels. By delivering oxygen under high pressure to the tissues surrounding the wound, the healing process is encouraged.

Hyperbaric oxygen therapy is particularly effective for infected foot wounds and insufficient oxygen in the tissues. Treatment is usually administered in a series of sessions, ranging from 20 to 30 depending on the patient's condition. Five sessions per week, one per day, is generally recommended during the treatment period.

Healthcare facilities that offer multidisciplinary approaches, such as the Diabetic Foot and Chronic Wound Treatment Center, coordinate these treatments within a single center, allowing you to manage your health more quickly and effectively. These centers bring together doctors and healthcare professionals from various specialties to provide a comprehensive approach to meet all patient needs. This helps ensure faster and more accurate treatment planning.