Diabetes is a complex metabolic disease, which usually lasts for decades, and affects vessels and nerves, therefore the whole body since there is no tissue or organ that is not nourished and oxygenated by the blood vessels or does not receive orders and react through the neural pathways.

“Indeed, as time goes on and the medical community’s knowledge of diabetes increases we are seeing its effect on many organs of the body. Recently, the directive was given by the international bodies for the treatment of diabetes mellitus, (ADA/EASD), to add to the annual control of the patient with diabetes and the hearing control, (in addition to the cardiac, ophthalmological, dental, foot control and laboratory control)”, report Ms. Ekaterini Trikkalinou MD, Msc in Diabetic Foot, Phd(c) Diabetic Pathologist, Head of Diabetic Foot Practice at Metropolitan Hospital Diabetes Center, Mr. Andreas Melidonis MD Msc PhD, Pathologist diabetologist, Director of Diabetes Center Metropolitan Hospital and n Mr. Chrysanthi MitsiuPodiatrist of the Metropolitan Hospital Diabetes Center and continue:

Of course, all of the above are recommended in order to completely avoid or at least manage the complications of diabetes, that is, diseases or conditions caused by the chronic course of diabetes, especially when it is unregulated and which concern:

• The heart
• The vessels
• The nerves
• The kidneys
• The eyes
• The lower limbs ie the legs
• The periodontium (the area in the gums around the tooth)
• Hearing

But also other less known effects on tissues, mechanisms and functions of the body such as:

• The skin
• Defense mechanisms
• The blood-brain barrier in the brain
• The chain of reactions by which the body avoids oxidation and premature aging.

Underlying causes of diabetic foot

One of the most difficult complications to manage is the so-called “diabetic foot”. But what is the diabetic foot? Is it the patient’s lower extremity with diabetes? Does every diabetic patient have a “diabetic” foot? Of course not! “By ‘diabetic foot’ we mean a set of images, deformities and conditions that usually involve the ‘end of the foot’, i.e. the foot below the ankle.

In the development of this complication, the duration of diabetes, its regulation, previous injuries and/or deformities of the foot play an important role, but two other complications of diabetes: diabetic vasculopathy and diabetic neuropathy have a primary role in the creation of the diabetic foot. That is, the defective (poor blood supply due to the narrowed vessels) and disorders in nerve function (neuropathic pain, loss of sensation, disturbances in balance, perception of space, etc.). Diabetic foot problems concern both type 1 or insulin-dependent diabetes and type 2 or non-insulin-dependent diabetes.

The great fear and the reason for the increasing preoccupation with the diabetic foot is the development of an ulcer (i.e. a wound), which does not close in the expected time in the patient with diabetes, takes time, becomes infected and a significant percentage, without the necessary and specialized care, can to lead to amputation sometimes of a different height, to the foot, the shin or even the thigh. Ulcers can be due either to insufficient blood supply to the foot, mainly at its extreme points, for example at the toes (ischemic ulcers) or to faulty nerve function so the ulcers develop in pressure points (neuropathic ulcers), or a combination of both conditions (neuroischemic ulcers)”, they point out.

85% of amputations are preceded by a chronic ulcer of the lower extremities. And 80%-90% of ulcers are caused by improper footwear. More than one million amputations on diabetic patients are performed worldwide each year, one every 30 seconds!
According to 2011 data from the international organization IWGDF (International Working Group of Diabetic Foot), an amputation is performed every 20 seconds!

While according to AJ Boulton, 19%-34% of the diabetic population will develop a lower extremity ulcer at some point in their lives.
Therefore vigilance, foot care and prevention of ulcers also means prevention of amputations.

“It is necessary to observe the feet daily. We look for deformities, callous wounds, changes in color in the texture of the skin, blisters, hematomas, the color and texture of the nails. When we detect a problem or damage, we seek help from a diabetologist specialized in the diabetic foot,” they add.

Charcot arthropathy: A hidden danger

One of the very serious deformities is that caused by neuropathic arthropathy, (charcot arthropathy), which destroys the architecture of the foot very often without the patient having pain due to the neuropathy. In charcot arthropathy, protrusions are created from bony parts and the conditions for the development of an ulcer on these points, where increased pressures appear.

“Any damage should be assessed by a diabetologist specializing in the diabetic foot with the help of a team of health therapists (podiatrists, nurses, health visitors, orthopedic vasculists, vascular surgeons, general surgeons, orthotists) and treated promptly and appropriately in order to give the best possible chance of recovery and limb rescue.

The patient with diabetes is not the average patient. It has particularities that only diabetes therapists know and which, if not given sufficient attention and specialized care, make the already very difficult cure difficult and reduce the chances of saving the limb”, they emphasize and conclude:

In conclusion:

• Diabetes is a complex metabolic disease.
• The complications of diabetes are numerous and require frequent scheduled checks for all body systems.
• A very serious complication is the diabetic foot. A thorough examination of the lower extremities, screening for diabetic neuropathy and vasculopathy, and frequent special function tests of the lower extremities are required.
• Any damage to the lower limbs of people suffering from diabetes needs a diabetologist specialized in the foot in principle, but also a medical health team (foot therapists, specialized nurses) to solve the complex medical problem. In this context, at the Diabetes Center of the Metropolitan Hospital, the diabetic foot team operates in an exemplary and responsible manner.
• With the most modern imaging methods for diagnosis and control of deformities and pathological conditions of the feet of people with diabetes.

Mr. Aikaterini Trikkalinou MD, Msc in Diabetic Foot, Phd(c) Pathologist Diabetologist