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Diabetes mellitus is a chronic, systemic disease that affects every organ in the body and affects millions of people worldwide. Among its many complications, one of the most serious is damage to the lower extremities, a condition that, if not treated promptly, can even lead to amputation.

It is a metabolic disorder that affects the body’s utilization of sugar, fats and proteins. Diabetes affects every system, but its main manifestations are summarized in the characteristic “triad” of complications:

1. Neuropathy: destruction of the nerves, resulting in loss of sensation. 
2. Vascular disease: damage to the vessels and reduced blood circulation. 
3. Reduced resistance to infections:  vulnerability to microbial complications and delayed healing trauma. 

The combination of these factors, along with joint damage (neuropathic arthropathy), causes muscle weakness and deformity of the foot. This leads to the development of a neuropathic ulcer, which, due to the loss of pain, often goes unnoticed, resulting in infection of the bone (osteomyelitis) and, in advanced stages, amputation. 

According to statistics

Diabetes sufferers have a 25 times greater risk of amputation, compared to people without diabetes.
Diabetes mellitus is the leading cause of lower limb amputation worldwide; each year, approximately one million people lose one or both legs due to the disease and concomitant vascular disease. 

How does diabetes cause damage to the lower extremities?

Diabetes affects multiple parts and functions of the foot: 

1. Loss of sensation: The sensory nerves are destroyed, resulting in the patient not feeling pain, pressure, heat or injury. Thus, small wounds can go unnoticed and become infected. 
2. Sweat glands are destroyed: Damage to the sweat glands causes dryness, dehydration, cracks and ulcers. 
3. Hair loss: It destroys the hairs of the limb that make up great sensory antennae 
4. Muscle atrophy: The leg muscles weaken, reducing the support of the bones and joints. 
5. It causes narrowing and blockage in small and medium-sized arteries, especially below the knee (characteristic) and this entails poor circulation, poor blood flow and intermittent lameness-inability to walk.  
6. Calluses and hyperkeratosis: The thickening of the skin creates “calluses”, which function like nails and cause ulcers. 
7. Nail hyperplasia: The nails become hard, yellow, with fungal infections and are a hotbed of microbes. 
8. Distortion of the architecture – shape of the foot: The alteration of the anatomy leads to the projection of the bones under the skin and easier injuries. 
9. Diabetic ulcer:  The most common and dangerous complication, which can lead to osteomyelitis and amputation. 

Conclusion: All of the above make the diabetic foot extremely vulnerable to injuries, infections and ulcers, which without proper care can lead to partial or total amputation.  

The importance of prevention

Prevention is the most powerful weapon against diabetic foot.
Early diagnosis, patient education and regular monitoring by specialized health professionals can prevent the formation of ulcers and serious complications. 

Info: The first “Diabetic Foot Clinic” was founded at the Athens Medical Center by Vascular Surgeon Mr. Koustas and consists of a team of 14 specialties. It is the most experienced and specialized in Greece. Its technological equipment “Diabetic Foot Clinic” at Athens Medical Center is state of the art.