Causes

The primary causes of diabetes-related foot complications include:

Peripheral Neuropathy: Nerve damage caused by high blood sugar levels can result in reduced or absent sensation, particularly in the feet, allowing injuries to go unnoticed.

Peripheral Artery Disease (PAD): PAD reduces blood flow to the lower extremities, delaying wound healing and increasing the risk of infection and tissue breakdown.

Additional contributing factors include:

• Poorly controlled blood glucose levels
• Wearing ill-fitting footwear
• Improper foot hygiene
• Smoking (which further impairs circulation)
• Lack of regular foot exams

Types

People with diabetes are at increased risk for a range of foot complications, including:

• Diabetic Foot Ulcers: Open wounds, commonly found on pressure points, that are slow to heal and prone to infection
• Infections: Including cellulitis, abscesses, and osteomyelitis (infection of the bone)
• Calluses and Corns: Can lead to skin breakdown or pressure ulcers
• Fungal Infections: Such as athlete’s foot and toenail fungus
• Ingrown Toenails: May lead to localized infection
• Structural Changes: Such as hammertoes, bunions, and Charcot foot

Approximately 15% of patients with diabetes will develop a foot ulcer in their lifetime. Early identification and treatment significantly reduce the risk of progression to amputation.

Prevention

Preventing foot complications in individuals with diabetes relies on both systemic and local measures:

• Glycemic Control: Maintaining optimal blood glucose levels is the most effective way to reduce the risk of neuropathy and vascular disease.
• Daily Foot Inspection: Patients should examine their feet daily, including between the toes and the soles, using a mirror if needed.
• Proper Footwear: Wearing supportive, well-fitting shoes and avoiding walking barefoot can help prevent injury.
• Routine Foot Care: Includes washing and moisturizing the feet daily, avoiding hot water or heating pads, and careful nail trimming.
• Regular Medical Exams: A visual foot check at each clinic visit, with annual sensory and vascular testing by a podiatrist or vascular specialist.
• Smoking Cessation: Smoking significantly reduces blood flow to the feet and worsens PAD.
• Patients should avoid self-treatment of corns, calluses, or foot lesions and should not use over-the-counter chemical treatments or soak their feet in hot water.

Diagnosis

Diagnosis begins with a comprehensive foot examination that includes:

• Assessment of foot structure and skin integrity
• Testing for neuropathy using monofilament, vibration, or pinprick tools
• Evaluation of blood flow using palpation of pedal pulses or Doppler ultrasound
• Examination of any ulcers or wounds for depth, signs of infection, and drainage
• Imaging studies (X-ray, MRI) if osteomyelitis or deep tissue involvement is suspected
• Wound culture or tissue biopsy if infection is present

Accurate staging of ulcers and vascular status is essential for developing a treatment plan.

Treatment Options

Medical Management

• Wound Care: Debridement, dressings, infection control, and offloading with specialized footwear or orthotics.
• Antibiotics: Oral or intravenous medications may be prescribed for infected ulcers.
• Glycemic Optimization: Adjustments in diabetes medications or insulin regimens to support healing.

Endovascular Interventions

• Angioplasty: A balloon catheter is used to open narrowed leg arteries and restore blood flow.
• Stenting: Placement of a metal scaffold to keep arteries open after angioplasty.
• Atherectomy: Mechanical removal of arterial plaque to improve perfusion in affected limbs.

Surgical Procedures

• Surgical Debridement: Removal of infected or necrotic tissue.
• Bypass Surgery: Grafting to reroute blood flow around blocked arteries in severe PAD.
• Amputation: Reserved for non-salvageable limbs where infection or gangrene is advanced.

Why RIVEA

RIVEA Vascular Institute specializes in the diagnosis and treatment of diabetic foot complications, with a focus on early intervention and limb preservation.

We offer:

Hybrid Operating Room: Allows for immediate transition from diagnostic imaging to intervention in a single session, reducing time to treatment.

Expertise in Limb Salvage: Our team is experienced in performing complex endovascular procedures to restore blood flow and promote healing.

Advanced Imaging Capabilities: Including duplex ultrasound, CT angiography, and cone-beam CT for accurate diagnosis and treatment planning.

Multidisciplinary Care: Collaboration with endocrinologists, wound care specialists, and podiatrists ensures comprehensive management.

Minimally Invasive Treatments: That lower the risk of infection, reduce recovery time, and are suitable even for high-risk patients.