Diabetic Foot

diabetic foot treatment abroad

Diabetic Foot is a common complication that individuals with diabetes may experience. Even small problems have the capacity to get worse and have negative effects. Most frequently, nerve damage in the feet is the cause of foot problems, also  called diabetic neuropathy.

Over time, high blood sugar levels in diabetes patients may damage the nerves and blood vessels in their feet. Nerve damage can cause numbness and a lack of sensation in the feet. The patient typically is unaware of foot wounds or ulcers because of this loss of feeling until the skin begins to degenerate and become infected. On the other hand, blood vessel damage can result in poor circulation, which reduces the amount of oxygenated blood that reaches the foot and hinders the healing of wounds.

The department of Diabetic Foot Treatment, belongs to one of the hospitals of our network, directed by Prof. Dalla Paola, boast a 30 years clinical experience, 1.000 surgical procedures a year, 270 surgeries performed in-live at congresses and 115 international publications. According to the statistics, patients can count on a 95 % success rate in avoiding amputations for whom there is no alternative.

The team carries out an intense outpatient activity, aimed at the prevention, therapy and rehabilitation of complications of diabetes in the lower limbs, both in the acute and chronic phases. The multidisciplinary team includes: Diabetic foot surgeons, Cardiologists, Diabetologists, Vascular surgeons, Hemodynamists, Podiatrists, Specialized nurses and Orthopedic technicians.

Services offered:

  • Screening and diagnosis of lower limb complications of diabetes;
  • Study and orthotic correction of biomechanical alterations of the diabetic foot;
  • Conservative treatment of uncomplicated diabetic ulcerative lesions of the lower limbs and foot;
  • Conservative surgery of ulcerative lesions and osteomyelitis in the diabetic foot;
  • Emergency surgery for limb salvage (LIMB SALVAGE);
  • Prophylactic and preventive surgery of Charcot’s neuroarthropathy;
  • Conservative surgery of osteomyelitis in Charcot neuroarthropathy.

Types of Diabetic Foot

There are two main categories for diabetic foot conditions.

  • Diabetic neuropathy

If you have diabetes, you could develop diabetic neuropathy, which is a form of nerve damage. Throughout the body, damaged nerves can result from high blood sugar (glucose). The nerves in the legs and feet are most frequently damaged by diabetic neuropathy. Up to 50% of diabetics may get diabetic neuropathy, a significant consequence of the disease. But with constant blood sugar control and a healthy lifestyle, you may prevent diabetic neuropathy or reduce its progression.

Diabetic neuropathy testing should begin as soon as a person is diagnosed with type 2 diabetes or five years after being diagnosed with type 1 diabetes, according to the American Diabetes Association (ADA). After then, a yearly screening is suggested. 

Diabetic neuropathy mostly comes in four different forms. You can have one type of neuropathy or several different types. Depending on the type you have, and which nerves are impacted, your symptoms will vary. Symptoms typically appear over time. Until significant nerve damage has taken place, you might not notice anything is amiss.

  • Neuroischemic Foot

Neuroischemic foot is a medical condition characterized by decreased blood flow to the foot, which leads to tissue damage and nerve dysfunction. It is caused by a combination of peripheral arterial disease (PAD) and diabetic neuropathy, which results in reduced blood flow and oxygen to the nerves and tissues of the foot. This condition can lead to ulcers, infections, and, in severe cases, gangrene and amputation. Symptoms of neuroischemic foot include pain, numbness, tingling, and a burning sensation in the feet. It is important to seek medical attention and treatment for this condition to prevent further complications.

Causes of Diabetic Foot

Despite the fact that the precise causes of diabetic neuropathy are unknown, a number of factors lead to diabetic neuropathy, such as:

  • Elevated blood sugar (glucose). Excessive blood sugar alters the chemical makeup of nerves, making them less capable of transmitting messages. Moreover, it may harm the blood arteries that supply the nerves with nutrition and oxygen.
  • Metabolic influences. High triglyceride and cholesterol levels are also linked to an increased risk of neuropathy, in addition to glucose levels. Neuropathy is more likely to develop in patients who are overweight or obese.
  • Genetic considerations. Certain hereditary characteristics may predispose some individuals to nerve disease more so than others.

Symptoms of Diabetic Foot

  • Darkened skin over the affected area is one of the symptoms of diabetes-related neuropathy.
  • decreased capacity to feel heat or cold.
  • loss of hair in the region.
  • Numbness.
  • Tingling.
  • Any changes to the skin or toenails, such as cuts, blisters, calluses, or sores, are warning signs that diabetes-related neuropathy may cause foot ulcers.
  • discharge of pus or liquid.
  • unpleasant odor.
  • Pain.
  • Redness.
  • discolouration of the skin.
  • Swelling.

Complications of Diabetic Foot

Diabetes increases the likelihood of acquiring several illnesses, including cardiovascular disease, foot ulcers, hypertension, nephropathy, neuropathy, and retinopathy. Usually, with the right management, these issues can be avoided.

Peripheral neuropathy

Peripheral distal symmetric neuropathy is another name for this type of neuropathy. It is the kind of diabetic neuropathy that is most prevalent. First it affects the legs and feet, then the hands and arms. Peripheral neuropathy may affect a single nerve (mononeuropathy), many nerves in various locations (multiple mononeuropathy), or a large number of nerves (polyneuropathy). One instance of mononeuropathy is carpal tunnel syndrome. Polyneuropathy affects the majority of patients with peripheral neuropathy.

Peripheral neuropathy’s warning signs and symptoms, which can include the following:

numbness or less sensitivity to pain or temperature changes.

sense of tingling or burning

cramping or sharp pains

weakened muscles.

extreme touch sensitivity: for some, the weight of a bedsheet can be excruciating.

serious foot issues Peripheral neuropathy is the main cause of:

Diabetic ulcers

An open sore or wound on a diabetic person’s foot, usually on the plantar area, or bottom of the foot, is known as a diabetic foot ulcer.

Peripheral neuropathy patients experience diabetic foot ulcers at a rate of about 7% annually. A person might not become aware of the ulcers until they are severe as a result of poor circulation and nerve damage. Insufficient blood flow might also slow healing. If ulcers are not treated, the foot may suffer damages and develop an infection.

There are various kinds of ulcers associated with diabetes, including:

  • Neuropathic ulcers occur in areas with peripheral diabetic neuropathy, but no ischemia brought on by peripheral artery disease.
  • Ischemic ulcers occur when peripheral artery disease is present without diabetic peripheral neuropathy being included.
  • Neuroischemic ulcers occur in cases where the patient has peripheral neuropathy as well as ischemia brought on by peripheral artery disease.

Arriving at the correct diagnosis and identifying the cause of a diabetic ulcer is critical since it affects the treatment plan.

Charcot Foot

Charcot Foot Is a rare but devastating condition that may affect individuals with peripheral neuropathy, particularly those with diabetes mellitus. The soft tissues, joints, and bones of the ankle or foot are all impacted by Charcot. The joints in the ankle or foot might dislocate when the bones deteriorate and become fragile and brittle. The joints in the foot collapse and the foot eventually becomes misshapen if the problem is not discovered in its initial stages. Pressure sores can appear on the ankle or foot as a result of a malformed foot. An infection and possibly an amputation might result from an exposed wound with a deformed foot.

Peripheral neuropathy patients can develop Charcot foot. With this disorder, the nerves in the feet and lower legs have suffered injury. Sensation in the feet is lost as a result of the damage.


Charcot foot cause is unknown, according to research. However, there are some well-known situations that foster the ideal environment for it to arise. Unrecognized sprains or injuries are one commonly recognized cause. Due to the person’s peripheral neuropathy, they are unable to sense pain or other sensations, so an injury may go undetected. A broken bone in the ankle or foot should be properly treated to prevent further deformity, foot sores, and infection. Following organ transplantation, Charcot foot has also been observed in diabetic patients. (This is because anti-rejection medications, which may cause bone loss and fractures as a side effect, are used.)

A rocker-bottom foot deformity is when the midfoot is affected by Charcot foot, the arch collapses rounding the bottom of the foot. The toes may begin to bend under like claws, or the ankle may become malformed and unstable, depending on where the bone broke.

  • Lack of sensation:

If a person with diabetes has lost sensitivity in their feet, it means they might not feel a foot injury. It can make it harder for them to sense pain, heat, and cold. For instance, someone can be unaware that they have a stone inside their shoes and walk on it all day.

  • Abnormal foot shape: 

People who have diabetes who wear tight shoes for a long period of time may have changes in the shape of their feet.

  • Gangrene

There is a chance that gangrene could happen when an individual gets an infected wound in one of his feet as a consequence of peripheral neuropathy.

You could require surgery for removing the infected tissue and antibiotic to cure any underlying infection if gangrene does manifest.

 In extreme circumstances, it may be necessary to perform an amputation of the toe or the foot.

  • Heart and blood circulation problems

People with diabetic polyneuropathy often experience cardiovascular autonomic neuropathy (CAN), a condition that affects the heart and blood circulation and can be potentially serious. CAN arises when the peripheral nerves are damaged, interrupting the automatic functions that govern heartbeat and blood circulation. 

The most significant concern with CAN is that it could cause an abnormal heart rhythm (arrhythmia), leading to cardiac arrest where the heart stops beating entirely. 

The two primary visible symptoms of CAN are difficulty exercising for more than a brief period and low blood pressure, which can cause dizziness or faintness upon standing up.

  • Blisters

Diabetes poses an increased risk of developing blisters due to several factors. Firstly, diabetic neuropathy can make it difficult for individuals to perceive when their shoes are ill-fitting and alter their gait, increasing the likelihood of blisters. Another condition that may arise in people with diabetes is known as Bullosis Diabeticorum, where blisters spontaneously form without explanation. The cause of this condition is unknown to doctors. Infected blisters can be particularly problematic, causing pain and escalating the risk of infection that could spread throughout the body.

Autonomic neuropathy

The autonomic nervous system plays a crucial role in regulating blood pressure, heart rate, sweating, eyes, bladder, digestive system, and sex organs. Diabetes can have an impact on the nerves in any of these areas. This form of diabetic polyneuropathy can result in various symptoms, including Persistent nausea and vomiting.

Diarrhea, constipation

Irregular sweating

Sexual dysfunction

Digestive issues.

Low blood pressure

Impaired pain perception


Proximal neuropathy (diabetic polyradiculopathy)

Proximal neuropathy, often referred to by a variety of other names, is a very uncommon form of diabetic neuropathy that affects roughly 1% of people with type 2 diabetes. It typically affects elderly folks and can happen to people with newly discovered or under control diabetes.

The primary symptom is nerve pain, which can begin in the upper thigh of one leg and spread to the hip and lower back. About 35% of people with proximal neuropathy also report weight loss, and about 18% also experience weakness in the area affected in addition to the pain. Proximal neuropathy can very rarely affect the arm.

As the condition worsens over time, the pain can spread to the upper and lower parts of both legs. Symptoms usually subside after a few months, but patients may be left with long-term disability, such as foot drop and recurrence of symptoms.

Diabetic neuropathy symptoms may resemble those of other medical conditions or problems. For a diagnosis, always see your doctor.

Mononeuropathy (focal neuropathy)

In diabetic neuropathy, a single nerve is affected at a time, and the symptoms may vary based on the affected nerve. For instance, thoracic nerves in the chest may be impacted, causing chest wall numbness and pain that resembles angina, heart attack, or appendicitis.

Several other forms of focal neuropathy may result in the following symptoms:

    • Thigh pain.
    • Intense pain in the pelvis or lower back.
    • Discomfort in the chest, flank, or stomach.
    • Dull pain behind the eyes.
    • Inability to concentrate the eyes.
    • Double vision.
    • Paralysis of one side of the face.
  • Hearing difficulties.

Diagnostics for Diabetic Foot

To diagnose diabetic neuropathy, your healthcare provider typically conducts a physical exam, reviews your medical history, and scrutinizes your symptoms. 

During the physical exam, your provider assesses your muscle tone, muscle strength, and tendon reflexes. Additionally, your sensitivity to touch, pain, temperature, and vibration is also checked. Your healthcare provider may also recommend specific tests to help diagnose diabetic neuropathy, including:

  • Filament testing, where a soft nylon fiber is brushed over your skin to check your touch sensitivity.
  • Sensory testing, which is a non-invasive test to determine how your nerves respond to temperature changes and vibration.
  • Nerve conduction testing, which measures how fast electrical signals travel through your arms and legs’ nerves.
  • Electromyography, which is often done together with nerve conduction studies to measure electrical discharges in your muscles.
  • Autonomic testing, which involves special tests to assess your blood pressure changes in different positions and whether your sweating is within the normal range.
  • Ultrasound to assess the functionality of various parts of the urinary tract.
  • Skin biopsies to evaluate the innervation of cutaneous nerves.
  • Nerve and muscle biopsies to evaluate the tissue’s histopathology.

Treatment of Diabetic Foot

Treatment options for the Diabetic Foot may include:

  • Taking care of the wound.
  • Draining the ulcer of any fluid or pus.
  • removing or removing dead or infected tissue (called debridement).
  • Special bandages and ointments are used to absorb excess fluid, protect the wound, and aid in its healing.
  • Using a wheelchair or crutches to relieve pressure on the affected foot (called offloading).
  • Antibiotics, either oral or intravenous, are prescribed to manage and eliminate infection.
  • Your healthcare provider may recommend hospitalization depending on the severity of the infection. Amputation is sometimes required to prevent infection from spreading to other parts of the body.