[Column] Reducing the Risk of Amputation in Diabetic Foot Through Early Detection

Diabetic foot (diabetic foot necrosis) is a representative complication that occurs in diabetes patients, where wounds or ulcers on the foot progress to tissue necrosis. In Korea, it is estimated that there are about 6.05 million diabetes patients aged 30 and over, and among them, 15 to 25% experience diabetic foot. The main causes of diabetic foot are peripheral neuropathy and vascular damage resulting from hyperglycemia.

Min Kyu Kim, Orthopedic Specialist, SMG Yonsei Hospital. [Photo courtesy of Yonsei Hospital]

When nerves are damaged, sensation in the feet becomes dull, making it difficult to notice minor wounds. Additionally, impaired blood flow delays wound healing, leading to infection and necrosis. In the early stages, symptoms such as tingling, numbness, dry skin, and minor wounds or ulcers may appear. As the condition progresses, the toes or feet may turn black and pain becomes severe. If treatment is delayed, amputation of the foot may become necessary.

Prolonged high blood sugar levels damage both blood vessels and nerves. As a result, sensation in the feet diminishes and blood flow becomes insufficient, drastically reducing the ability of wounds to heal. Even small blisters or wounds may go unnoticed because there is no pain, making it easy for them to be neglected. During this time, bacterial infection can spread, leading to tissue necrosis. Although the wound may look simple on the surface, in many cases, the damage extends to the subcutaneous tissue or muscle layer.

Diabetic foot is a "race against time." Once necrosis progresses, it is difficult to reverse, and it develops quickly, so early detection is of utmost importance. Diabetes patients should visit the hospital immediately if they notice even minor wounds or blisters on their feet. If symptoms such as swelling, odor, or redness around the ulcer occur, prompt antibiotic treatment and wound care are necessary. If tissue damage has already progressed, surgical removal of necrotic tissue or procedures to restore blood flow may be required.

If impaired blood flow is the main cause of diabetic foot, vascular recanalization procedures are effective. This is a treatment method that opens blocked blood vessels to promote proper blood circulation, playing a crucial role in saving the peripheral vessels of diabetic foot patients. The procedure works by opening closed arterioles, restoring blood flow to wounds on the toes or feet, overcoming tissue hypoxia, and sufficiently supplying immune cells to assist with wound healing. Unlike amputation, this minimally invasive method preserves the limb while treating only the affected area. The procedure is performed by making a small hole of less than 2mm in the leg artery and inserting micro-medical devices such as a catheter, balloon, or stent.

For diabetic foot, "continuous management" is more important than complete cure. Many problems can be prevented simply by checking the condition of the feet daily and washing them with lukewarm water before thoroughly drying them. If any unusual changes occur, such as discoloration, swelling, fluid leakage, or odor, it is important not to self-diagnose but to seek medical attention.

Additionally, the better blood sugar is controlled, the lower the risk of nerve damage and impaired blood flow. Therefore, consistent medication and regular check-ups are essential. Patients with a long history of diabetes or those who have previously undergone ulcer treatment are classified as high-risk. In these cases, it is advisable to visit an orthopedic or diabetic foot specialist clinic every 3 to 6 months to check the condition of the feet.

Kim Mingyu, Orthopedic Specialist at SMG Yonsei Hospital

This content was produced with the assistance of AI translation services.