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The foot is one of the most vulnerable areas of the body in people with diabetes, so much so that it is considered the true "Achilles' heel" of this condition. Diabetic foot is a serious complication of diabetes mellitus. But how can diabetes affect the extremities of the body?
Diabetes is a major risk factor for vascular disease, and in particular can impair peripheral circulation, especially in the lower limbs. Due to their anatomical location at the periphery of the vascular and nervous system and their continuous functional load, the feet are particularly exposed to the consequences of these changes. This makes them vulnerable to ischaemia, ulceration and infection, which are some of the root causes of diabetic foot.
The symptoms of diabetic foot are often vague, especially at the beginning. Patients may feel tingling in the extremities or pain when walking, and in the case of ischaemia and neuropathy, ulcers may also appear. The vascular changes that occur as a result of diabetes and the metabolic damage caused to the nerves can impair foot movement. As a direct consequence of this, deformities may appear on the foot: the toes become claw-like, the plantar arch becomes accentuated, and metatarsal heads become more prominent.
In case of severe infection or tissue necrosis, surgical debridment of the foot can be performed, although it is not the only option. Tissues affected by the lesion are removed for cleaning purposes. In fact, much research has shown the importance of plantar support and biomechanics in the genesis of this pathology, as well as with regard to healing and the development of recurrences. Foot deformities caused by an alteration in the structure and function of the tissues of the foot result in incorrect plantar support, with areas of overload and parts of the foot that are subject to repeated rubbing, increasing the risk of ulcers.
Ulcers, infections and other clinical manifestations of diabetic foot can be prevented by paying special attention to hygiene; in some cases, appropriate footwear and socks (e.g. seamless, breathable, custom-made) should also be selected. First and foremost, it is essential to inspect the feet daily, paying particular attention to the spaces between the toes. Feet should be washed with water that is not too hot, and with soaps with a neutral pH, and should then be thoroughly dried, including between the toes. When cutting the toenails of diabetic patients with neuropathy or vascular risk, even in cases where diabetic foot has not yet been diagnosed, it is good practice to consult qualified professionals (podiatrists).
Choosing appropriate footwear is crucial for the prevention of diabetic foot complications. It is often necessary to resort to custom-made orthopaedic shoes or shoes purchased with the assistance of a specialised orthopaedic technician or podiatrist. The choice should be made after sufficient walking tests, in order to ensure the correct fit and comfort of the shoe.
