Calluses, dry cracked skin, bone deformities, improper pressure distribution, pressure points, and wounds: when several of these changes occur together, this is referred to as diabetic foot syndrome. The calluses that are usually present at the beginning cause small, unnoticed injuries with bleeding beneath the skin surface. Eventually, small skin cracks develop, allowing bacteria to enter and leading to a spreading infection.

Causes of diabetic foot injuries
The main cause of diabetic foot injuries is ill-fitting footwear. Other causes include injuries from walking barefoot, burns (e.g., from hot water bottles), skin damage due to athlete’s foot, and foreign objects inside the shoe. People without diabetes immediately feel such injuries and will relieve the affected area by avoiding pressure or remove foreign objects right away. The injury usually heals within a few days. In contrast, people with diabetes often do not notice these injuries immediately due to frequently occurring nerve damage.

Diabetics with nerve damage do not feel injuries to their feet
People without diabetes will take off a new pair of shoes as soon as they notice a blister forming. However, people with diabetes and nerve damage may not feel a blister, and a deep wound extending to the bone can develop. They often only notice the wound in the evening when they see their socks soaked with blood.

Nerve damage can also change the shape of the feet. Toes may become claw-like and rub against the shoes. Shoes that fit well for years can suddenly cause wounds (ulcerations).

Once a wound has developed, the risk of infection—especially in poorly controlled diabetes—is high, because elevated blood sugar levels weaken the body’s natural defenses. An infection can undo weeks of wound healing.

Chronic wounds on the feet can develop
If a wound does not heal within six weeks despite supportive measures, or if it does not show clear, continuous improvement, it is considered a chronic wound.

Accurate, standardized assessment is essential for the diagnosis and treatment of a chronic wound, including measurement and detailed description of the wound.

Diagnosis also includes taking a wound swab from deeper areas of the wound to identify possible bacteria.

Circulatory disorders are often also present and can significantly impair or even prevent healing. As a result, even a very small injury can develop into a chronic diabetic foot ulcer that may ultimately lead to amputation.

For this reason, prevention and proper foot care are the most important measures in the treatment of diabetic foot syndrome.

Categorized under: Diabetes and foot disorders (diabetic foot syndrome)