Diabetic foot
Description:
Diabetic foot (English diabetic foot) — the combined concept combining group of late complications of a diabetes mellitus at which pathological changes of feet of the patient in a look develop is purulent - necrotic processes, ulcers and bone and joint defeats, arising against the background of specific changes of peripheral nerves, vessels, skin and soft tissues, bones and joints. In some cases the concept "diabetic foot" as an independent nosological form is not used, and the diseases (abscess, phlegmon, gangrene, etc.) making it are specified.
The syndrome of diabetic foot is the main reason for amputations of extremities at a diabetes mellitus. About 8-10% of patients with a diabetes mellitus are struck, and 40-50% from them can be carried in risk groups. 10 times more often the syndrome of diabetic foot develops at persons with the second type of a diabetes mellitus. At least, at 47% of patients treatment begins after possible. The amputations of extremities increasing mortality of patients twice and increasing the further cost of treatment and rehabilitation of patients by 3 times are result. Improvement of tactics of diagnosis, medical examination, treatment of patients allow to reduce the frequency of amputations at patients by 43-85%.
The syndrome of diabetic foot develops at most of patients with a diabetes mellitus of 1 type by 7-10 years from an onset of the illness, at patients with a diabetes mellitus 2 types can take place since the beginning of a disease. To 85% of cases it is presented by ulcers of feet of different weight. Comes to light at 4 — 10% of total number of patients with a diabetes mellitus.
Symptoms of Diabetic foot:
- Neyropatichesky form. It is shown by destructive process on foot against the background of a diabetic polyneuropathy.
- Neuroischemic form. Takes place against the background of a diabetic angiopatiya
- Osteoartropatichesky form
1. Acute stage
X-ray - the negative period
X-ray - the positive period
2. Subacute stage
3. Chronic stage
On existence of complications:
Chronic critical ischemia of an extremity
Ulcer, localization, degree according to Wagner (1-5)
Menkeberg's syndrome
Pathological change
Deformation of foot
Reasons of Diabetic foot:
About 40-50% of patients with a diabetes mellitus concern to risk groups. Criteria of reference of the patient in risk group on a syndrome of diabetic foot are:
- phenomena of peripheral neuropathy,
- lack of pulse on arteries of feet,
- deformation of foot,
- the expressed foot giperkeratoza,
- existence of ulcers, is purulent - necrotic processes, amputations in the anamnesis.
It is accepted to allocate three risk groups:
I. Sensitivity is kept in all points, a pulsation on foot arteries good. Are inspected annually.
II. Sensitivity is reduced, there is no distal pulse, there are deformations. Are inspected time in ½ years.
III. In the anamnesis — ulcers and/or amputations on foot, considerable neuropathy. Are inspected time in 3 months.
Treatment of Diabetic foot:
Therapy of diabetic foot includes basic (obligatory for all patients) and additional (applied according to indications) actions.
Treat basic:
- prevention of polyneuropathy: control of glucose, pressure, lipidemia;
- podiatrichesky care of foot;
- training of patients and their family at Diabetic Foot school;
- unloading of foot.
To additional:
antimicrobic therapy;
treatment of a pain syndrome;
treatment of neuropathy;
medical unloading and immobilization of foot;
treatment of an angiopatiya;
topical treatment of ulcers and wounds.
Operational treatment:
Opening of abscesses, phlegmons, necretomies
Operations for recovery of an arterial blood-groove to foot — angioplasty and stenting of arteries of the lower extremities, autovenozny shunting, endarterectomy
Amputations
