The Diabetic Foot

Diabetes mellitus can damage the nerves of the lower limbs over time (peripheral neuropathy). This condition results in reduced sensitivity in the feet, increasing the risk of not recognizing foot lesions early, especially in their initial stages. In such cases, lesions can worsen rapidly, become infected, and in some cases lead to the amputation of a toe, part of the foot, or in more severe cases, the lower limb.

Diabetes can also cause damage to the blood vessels of the lower limbs (peripheral vasculopathy). Vascular insufficiency can promote the development of foot ulcers and, more importantly, interfere with their healing. The presence of vascular damage with inadequate perfusion, especially with concomitant infection, can also lead to the amputation of a toe, part of the foot, or in more severe cases, the lower limb if not promptly addressed.

Risk Factors

Risk factors for foot ulcers in people with diabetes include:

• Peripheral neuropathy (reduced tactile, thermal, and pain sensitivity in the feet)
• Peripheral vasculopathy (reduced arterial circulation in the lower limbs)
• Inadequate footwear with a risk of injury from shoe friction or pressure
• Deformities affecting the toes, foot, or ankle

When to See a Doctor for Diabetic Foot

All individuals with diabetes should undergo regular specialized screening for lower limb complications and assess the risk of ulcers within an appropriate prevention pathway.

In some situations, it is necessary to promptly seek medical attention, especially in the presence of:

• Redness, blisters, or lesions on the foot or ankle
• Any type of foot pain
• Difficulty walking
• Changes in skin color on part or all of the foot
• Swelling of the foot or ankle
• Fever associated with a lesion, redness of the skin, or swelling of the foot

Interventions at the Diabetic Foot Center

• Diagnosis and treatment of diabetes
• Screening and diagnosis of lower limb complications of diabetes
• Conservative treatment of uncomplicated diabetic foot ulcers
• Simple and advanced wound dressings
• Curative surgery for ulcerative lesions
• Curative surgery for osteomyelitis
• Emergency surgery for limb salvage
• Treatment of Charcot neuro-osteoarthropathy

The center manages diabetic foot pathology by offering a multidisciplinary approach (diabetologist, interventional radiologist, vascular surgeon, cardiologist) with innovative instrumentation and methodologies. In addition to performing all necessary diagnostic tests, ambulatory and, if appropriate, inpatient diabetic foot surgeries are conducted.

These interventions can promote faster wound healing and prevent deterioration. Moreover, through the use of new tissue bioengineering technologies, reconstructive plastic surgery can be performed to restore extensive tissue loss.

When Surgical Intervention Is Necessary

Surgery is often a curative solution, aiming to use minimally invasive and increasingly conservative techniques. Surgical intervention is often necessary to avoid minor and major amputations and promote faster healing. Types of surgical interventions performed include:

• Simple ulcer removal (ulcerectomy)
• Removal of infected bone areas (sequestrectomy)
• Excision of non-vital tissues (e.g., areas of necrosis or gangrene)
• Implantation of synthetic dermal substitutes to cover large and deep tissue losses
• Implantation of autologous or heterologous skin.