Symptoms of the diabetic foot

Clinical features of the neuropathic and ischemic forms of the diabetic foot syndrome are shown in the table.

To address the issue of the need for antibiotic therapy, timely recognition of systemic and local signs of wound infection plays a significant role.

Systemic signs of a wounded infection:

• fever;
• intoxication;
• leukocytosis.

Local signs of wound infection

• with acute wounds:
  • hyperemia;
  • edema;
  • pain,
  • local hyperthermia;
  • purulent exudate;
• with chronic wounds:
  • soreness in the wound and surrounding tissues;
  • bleeding granulation tissue;
  • unpleasant odor;
  • increased wound size;
  • copious exudation;
  • delayed healing;
  • atypical color of granulation tissue;
  • the formation of cavities at the bottom of the wound.

Clinical signs of osteoarthropathy:

• Acute stage:
  • hyperemia;
  • hyperthermia (difference more than 2 ° C with thermometry);
  • swelling;
  • pain (about 50% of patients);
  • the changes are asymmetric, usually one-sided;
  • on the roentgenogram, it is possible to detect fractures, dislocations of small bones and joints of the foot;
• Chronic stage:
  • deformation of the foot up to the collapse of the arch of the foot;
  • changes on the chest X-ray;
  • possibly the formation of ulcers in places of excessive pressure.

Clinical features of the neuropathic and ischemic forms of the diabetic foot syndrome.

Symptom	Neuropathic form	Ischemic form
Average age	Under 40 years old	Older than 55 years
Duration of diabetes mellitus	More than 5 years	1-3 years
Other late complications of diabetes mellitus	Occur often	May not be expressed
Cardiovascular diseases	Microangiopathy may not be	Arterial hypertension, hypercholesterolemia, ischemic heart disease
Bad habits	More often alcohol abuse	Smoking more often
Ulcers of the foot in the anamnesis	Often	Rarely
Condition ulcers	Usually painless. Hyperkeratosis of the surrounding tissue	Painful dry necrosis in the form of a scab. Hyperkeratoses of the surrounding tissue are not characteristic (but possibly the deposition of fibrin in the form of a "halo"). The skin around the ulcer is thinned, hyperemic (even in the absence of infection)
Localization of ulcers	In areas of increased pressure (often caused by deformation of the feet) - more often on the sole, in interdigital spaces	In the "acral" zones of the foot - more often on the fingers, heels ("acral" necrosis)
Condition of the legs	The skin is pink, warm, dry. Pulsation on the arteries is preserved, veins are full-blooded. At night, severe pain and paresthesia (restless legs syndrome) can be disturbing.	Skin pale or cyanotic, cold, wet. Pulsation on the arteries is reduced or absent. Intermittent claudication or pain at rest, removable lowering of the legs
Sensitivity	Violation of the vibration, pain and temperature sensitivity (by the type of "socks" and "gloves"), as well as the weakening of the knee and heel reflexes, muscle atrophy	A marked violation of sensitivity is often absent
Bony changes	Deformities of foot and osteoarthropathies occur more often	Bone changes rarely develop

[1], [2], [3], [4], [5], [6],