When blood circulation is insufficient, a wound on the foot may struggle to heal and progress to a deeper lesion. For this reason, if you have a wound that is not healing, a lesion on the toes or signs of poor circulation, an early vascular assessment is important.
What is diabetic foot?
Diabetic foot refers to the changes that can occur in the feet of people with diabetes and that increase the risk of developing wounds, ulcers, infections and other complications.
Diabetes can affect the nerves, reducing sensation. This can mean that small injuries, blisters or wounds go unnoticed. It can also be associated with peripheral arterial disease, which reduces the supply of blood and oxygen to the tissues.
The most common problems include:
- Wounds that do not heal, ulcers on the toes or the sole of the foot
- Calluses and pressure sores
- Changes in the colour of the toes
- Pain in the foot or limb
- Tissue loss, necrosis or gangrene
- Infections
Not all diabetic foot lesions have a vascular cause. That is why it is important to determine whether there is a circulation problem and how significant it is.
Vascular assessment of the diabetic foot
The aim of the vascular assessment is to determine whether blood flow is impaired and which arteries are affected.
The examination begins with a clinical assessment of the foot and limb.
Among other aspects, we assess:
- Condition of the skin
- Arterial pulses
- Characteristics of the wounds and presence or absence of signs of infection
- Presence of necrosis
- Sensation
Depending on the findings, different tests may be carried out to study the circulation.
Arterial Doppler ultrasound
This makes it possible to study the arteries of the limb and detect narrowing or blockages.
It is a non-invasive test that analyses blood flow and locates the different affected segments.
In patients with diabetes, interpreting some tests can be more complex because of arterial calcification. For this reason, in certain situations the study needs to be complemented with other techniques.
CT angiography and other imaging tests
When there is significant arterial disease and revascularisation is being considered, a CT angiography or another imaging test may be needed.
These examinations provide more detail on:
- Location of the blockages
- Extent of the arterial disease
- Condition of the arteries below the knee
- Access and treatment options
- Anatomical characteristics of the limb
In selected cases other diagnostic techniques can be used to assess tissue perfusion.
Foot ischaemia
Ischaemia occurs when the blood supply to the tissues is insufficient.
In the most advanced cases a condition known as chronic limb-threatening ischaemia can develop, in which there is a high risk of tissue loss and amputation if perfusion cannot be improved.
Limb revascularisation
Revascularisation aims to improve the blood supply to the limb through an intervention on the affected arteries.
Depending on the anatomy and the patient’s characteristics, it can be performed with endovascular techniques, open surgery or a combination of both.
Endovascular treatment
Endovascular techniques make it possible to treat certain arterial blockages from inside the blood vessels.
Through a catheter, the affected area can be reached and different procedures performed, such as:
- Balloon angioplasty
- Stent placement in selected cases
- Treatment of complex arterial lesions with different devices
Open surgery
In some patients open surgery may be needed to create a new route through which blood can reach the affected tissues.
One of the techniques used is bypass, which connects an arterial segment above the blockage with another below it, using the patient’s own vein or a vascular prosthesis depending on the characteristics of the case.
Limb salvage and amputation prevention
The goal of treating diabetic foot with severe vascular disease is to preserve the limb whenever possible and to achieve the right conditions for healing.
Revascularisation can be a key element, but it is not the only treatment needed.
In some patients, surgical debridement of the affected tissue, treatment of infection, specialised wound care, offloading of the area and metabolic control will also be required.
In some cases, despite all treatments, a limited amputation may be necessary. When this happens, the aim is to preserve as much length and function of the limb as possible.
A multidisciplinary approach to diabetic foot
Treating diabetic foot often requires the coordinated involvement of different specialists.
Depending on each patient’s needs, these may include:
- Vascular surgery
- Endocrinology
- Podiatry
- Orthopaedic surgery or traumatology
- Infectious diseases
- Rehabilitation
This coordinated approach makes it possible to tackle the disease from different perspectives and can be especially important in complex lesions.
Our goal: preserving the limb
Diabetic foot is a complex problem that requires early identification of the factors that may prevent healing.
At Berkelium Surgical Group we study each case individually, assessing the arterial circulation, the characteristics of the lesion and the patient’s general health.
Our goal is to offer the most suitable strategy for each situation, coordinating vascular treatment where necessary with wound management, infection control and all the other care needed to promote healing, preserve function and reduce the risk of amputation.