Alternative names: plantar perforating disease; diabetic arteriopathy of the feet, diabetic gangrene.

What is it?

The problems that appear in the leg and, particularly, in the foot of diabetics pose a constant challenge to science and medicine.

The anatomicopathological alterations from diabetes mellitus are numerous, affecting the entire body in a variety of ways, mainly in the advanced period of the illness and in the region between the leg and the ankle, as well as in the foot proper.

Diabetic neuropathy and its alterations in the sensitivity of the feet have been largely responsible for the appearance of lesions hard to treat and of limited prognosis.

Usually, the diabetic only becomes aware of the lesion when this is found at an advanced stage, being almost always associated with a secondary infection, which makes treatment quite difficult due to circulatory insufficiency.

What does one experience?

Disappearance of or decrease in the reflexes of the tendons, kneecaps and heels is common
A decline in thermal and pain sensitivity and areas of numbness account for the very frequent lesions
Actually, the diabetic´s major problem – in view of the lack of sensitivity – is that they only become aware of how severe their case is when they smell the foul odor given off by the diabetic gangrene

How is the diagnosis made?

The diagnosis is made by means of the clinical history and physical examination of the lesion, which generally is painless, yet extensive, and produces an extremely unpleasant odor due to the wet necrosis it causes.

How is the treatment carried out?

In the treatment of the diabetic foot, it´s crucial to regard the patients as severe cases, since the evolutional potential of diabetic lesions is unpredictable, particularly when these are associated with polyneuropathy, vasculopathy, and infections.

A strict management of glycemia is necessary through diet and use of insulin or oral hypoglycemic agents, in addition to daily hygiene and early treatment of lesions – as soon as possible.

Direct arterial surgery and sympathectomy are possibilities that may be used.

How is it prevented?

Prevention for the diabetic foot is the most important chapter in this pathology:

A daily exam of the feet, as well as protection of the toes and malleolus, is the easiest way to avoid the appearance of unpleasant and dangerous ulcers;

the feet must be properly dried, and the toenails must be trimmed carefully on a regular basis;

it´s necessary to avoid exposure to local heat, in the form of hot water bags or proximity with fire;

a daily examination of shoes is recommended, avoiding nails or loose elements inside them.

These are measures that most times prevent the illness onset, which generally leads to amputation.