Diabetic foot is a complication of diabetes mellitus, which consists of pathological processes on the patient’s foot.
Diabetic foot is one of the most common complication of diabetes mellitus and in 85-90% of cases is characteristic of type II diabetes. It usually begins to develop after 15-25 years of diabetic experience, in the stage of decompensation and is the most common cause of disability in patients with diabetes.
The development of diabetic foot syndrome is a complex mechanism of various processes occurring throughout the body during diabetes mellitus. So, with a long course of diabetes, especially with frequent decompensations of the process, due to constant jumps in sugar from normal to high levels, gradual destruction of blood vessels throughout the body.
It all starts with small capillaries and ends with a total disruption of the blood supply. Along with this process, similar phenomena occur with nerve endings. The result is a metabolic disorder in tissues, including the surface of the skin.
Diabetes is characterized by dry skin and thickening . This is usually caused by a fungal infection or simple callus. This skin condition leads to frequent cracks in the foot or other injuries, which the patient initially does not notice due to impaired innervation of the area.
Injured skin in healthy people, with sufficient blood supply, heals easily and fairly quickly. And in diabetes, when the blood flow through the vessels is impaired, any injury to the foot (including minor cuts and even bruises) leads to a long-term non-healing process. An infection attaches to the site of injury and the process of inflammation and necrosis (tissue death) begins.
Complaints and changes in an objective examination by a doctor for diabetic foot depend on the form and stage of the disease.
Symptoms depending on the shape of the diabetic foot:
Also, regardless of the form of the disease, changes in the foot depend on the stage of the process :
To diagnose diabetic foot, its stage and form, the following methods are used :
Depending on the stage of the process, patients with diabetic foot may be prescribed conservative treatment or its combination with surgical methods.
Conservative treatment includes:
The following methods are used:
About 50% of all patients with diabetes are at risk
After timely and adequate treatment and following the doctor’s recommendations, the risk of recurrence is no more than 1%.
The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.
Diabetic gangrene is the most severe form of diabetic foot. It develops when, against the background of severe circulatory disorders, an anaerobic infection occurs in the foot and lower leg. This happens very quickly and very often leads to irreversible consequences, including the death of the patient. Today, the main treatment for gangrene is amputation. Additional methods include the use of antibiotics and the removal of intoxication. Therefore, it is very important to promptly treat “diabetic foot” in order to prevent the development of gangrene.
Gymnastics for the feet, massage and self-massage will help reduce pain and restore sensitivity.
1) Pulling socks toward and away from you.
2) Extension and adduction of the feet.
3) Circular rotations of the feet to the right and left.
4) Clenching your toes into “fists” and straightening them out.
When doing massage and self-massage, use kneading rather than rubbing.
Elimination of bad habits - smoking, alcohol, strengthening control over excess weight is necessary for all patients with diabetes.
1. Consult a doctor if even minor inflammation occurs. Even minor inflammation can lead to serious consequences.
Preventive orthopedic shoes may not be necessary for all patients with diabetes, but for those who have various foot deformities. Properly selected shoes can reduce the risk of diabetic foot syndrome by 2-3 times.
2. The width of the shoe should not be less than the width of the foot.
3. The volume should be adjusted using laces or Velcro.
4. Unbending hard sole with roll.
5. The material of the top and lining must be elastic.
6. The shoes must have additional volume to accommodate an orthopedic insole.
7. The leading edge of the heel should be beveled.
8. Thick and soft insole at least 1 cm thick.
9. If there are foot deformities, it is recommended to request the production of an individual pair of insoles, the service life of which is 6-12 months.
2. It is better to buy shoes that are soft, wide, comfortable and fit well on the foot, made from natural materials. It should not cause discomfort when trying it on for the first time, and the foot should not be pinched.
3. If sensitivity is reduced, it is better to use a foot print for fitting (to do this, place the foot on a sheet of thick paper or cardboard, trace and cut out the print). Such an insole must be inserted into the shoes - if it bends at the edges, the shoes will press and cause chafing or calluses.
4. Lace shoes correctly - parallel, not crosswise.
5. Never wear shoes without socks.
The most qualified care is provided by surgeons in diabetic foot offices and centers. Such offices have been established in many large clinics and medical centers. If it is not possible to go to a specialized diabetic foot office, you need to visit a surgeon or endocrinologist. Only timely seeking medical help will help prevent the most severe forms and outcomes of diabetes complications.
Unfortunately, amputation is resorted to in approximately 15-20% of cases of diabetic foot syndrome. Although in most cases, amputation can be prevented if treatment is started promptly and correctly. First of all, it is necessary to prevent the formation of trophic ulcers. If damage does occur, treatment should be started as early as possible. It is necessary to find out in advance from your endocrinologist about the work of specialized diabetic foot rooms and contact them if problems arise. Conditions such as osteomyelitis (suppuration of bone tissue) and ulcers associated with critical limb ischemia (severe impairment of blood flow to the foot) pose a high risk of amputation.
Antibiotics are indicated for all patients with infected wounds on the foot, but the duration of use, type of antibiotic, dose and method of administration is determined only by the doctor. Broad-spectrum antibiotics are mainly used (acting on several types of microorganisms at once). But to make the right choice, it is still necessary to resort to determining the sensitivity to antibiotics of microbes isolated from the affected tissues.
Due to their properties, ointments can create a favorable environment for the growth of bacteria and impede the outflow of discharge from the wound. Therefore, ointments are not the best remedy for diabetic foot syndrome. The best effect is provided by new generation dressing materials - napkins with increased absorbency, with antimicrobial activity, or collagen sponges for filling wounds. In any case, the choice of dressing and wound treatment should only be made by a doctor.
In folk medicine, blueberries, clove oil, yogurt, burdock leaves, and honey are used to treat “diabetic foot.” However, it must be remembered that the use of compresses is undesirable. In any case, before using any traditional medicine, you should definitely consult your doctor.
Diabetic foot is a serious complication of diabetes mellitus. Statistics show that gangrene of the foot (ulcerative necrotic lesion) is typical for 10% of patients with diabetes. The main cause of leg damage is elevated blood glucose levels. If measures are not taken in a timely manner, everything can even end in death. What causes diabetic foot? What symptoms should you pay attention to? How to treat diabetic foot?
When the disease occurs, the foot is first deformed, then a large number of ulcers appear on it, and the nerves and blood vessels of the legs are affected. Most often, the pathology occurs in those who suffer from high blood pressure, constantly smoke, abuse alcohol, and have heart problems. Also, diabetic foot is typical for people who are overweight and have atherosclerosis.
Most often, diabetic foot is characteristic of people with type 2 diabetes. Depending on the symptoms, neuropathic and ischemic forms of the syndrome are distinguished. The disease is dangerous because in the future everything ends in amputation of the limb.
Note! In diabetes mellitus, local tissue changes are quite dangerous, because a deep form of damage can develop. It is necessary to treat promptly:
It is important to follow the basic rules of hygiene of the lower extremities. Quite often, all the problems described above arise as a result of incorrectly selected shoes, which are narrow and tight. Because of this, sensitivity in the feet may decrease; a person does not always feel that the shoes are pinching, rubbing and injuring.
In medical practice, the ischemic and neuropathic form of diabetic foot is considered. In the ischemic form, blood supply to the extremities is disrupted because large and small vessels are affected. Ischemic syndrome is characterized by the following symptoms:
The neuropathic form is characterized by the fact that it affects the nervous system in the distal parts of the legs. At the same time, the patient’s sensitivity (pain, tactile, heat) decreases, the skin dries out, flat feet develop, and the bones of the feet become deformed. A mixed form is separately diagnosed, in which symptoms occur that are characteristic of the neuropathic and ischemic forms.
Depending on the degree, there are several stages of development of diabetic foot:
Zero stage. The patient's skin peels excessively, the foot is deformed, but no ulcerative lesions are observed.
First stage. A large number of ulcers appear on the surface of the skin.
Second stage. In addition to the skin, fiber, muscle tissue, and tendons are affected, while the bones remain intact.
Third stage. The pathological process spreads to the bones.
Fourth stage. Gangrene begins.
Fifth stage. Extensive gangrenous lesion.
How the disease will manifest depends on the shape of the diabetic foot. If the patient has an ischemic form, pain occurs when the person walks. The patient complains of rapid fatigue in the legs. Quite often, a symptom such as lameness is observed, which is caused by insufficient muscle blood supply in the lower extremities during various physical activities. In advanced cases, the foot turns pale and cold, and strong pulsation is felt. Then ulcers with a black-brown crust form.
How to determine gangrene?
The affected area is dark or black in color, and there is also complex tissue death, followed by necrosis of the affected skin.
First, the doctor carefully examines the skin, checking for dryness, thickening, and whether the fingers are deformed or not. Then tests are prescribed for cholesterol and blood glucose levels. An additional test for sugar in the urine is also taken. X-ray contrast angiography and peripheral CT arteriography are mandatory.
Additionally, osteoarthropathy, x-ray of the foot in two projections, as well as x-ray and ultrasound densitometry are prescribed. If ulcers appear, it is necessary to carry out bacterial culture, with its help the bottom of the ulcerative lesion is studied.
The course of therapy will depend on the form of the disease. If a neuropathic form is diagnosed, it is necessary:
In the ischemic form it is necessary:
Amputation is carried out in case of a purulent inflammatory process that affects the bones of the foot. If the blood supply is completely reduced, a high amputation is performed, in which the entire limb is removed at the level of the hip. After such an amputation, the person remains disabled. The patient cannot care for himself. To prevent such complications, it is necessary to take preventive measures and timely treatment of diabetes.
Thus, diabetic foot occurs in severe cases. It is important to immediately pay attention to the first damage to tissues and muscles. A patient with diabetes must be registered with a doctor and regularly undergo all necessary tests. If the patient's condition worsens, it is necessary to go to the hospital and undergo a course of therapy. Take care of yourself! Watch your health!
The field of study of endocrinology is the medical aspects of the structure and functioning of the endocrine glands (or endocrine glands), the study of the biologically highly active substances they produce - hormones and their effect on the body, as well as diseases arising in connection with disruption of the activity of these glands or the production of hormones. Endocrinology is closely related to almost all areas of clinical medicine, since hormones control the most important processes occurring in the body: growth, maturation, reproduction, metabolism, proper functioning of organs and systems.
Modern directions in endocrinology are neuroendocrinology, which studies the relationship between the nervous and endocrine regulation of the body, and gynecological endocrinology, which deals with the correction of hormonal disorders in the female body.
The endocrine system combines anatomically unrelated endocrine glands: pineal gland, pituitary gland, parathyroid glands, thyroid gland, thymus gland, pancreas, adrenal glands, gonads. Most diseases of the endocrine glands cause severe disruption of vital functions, not excluding death, if you do not consult an endocrinologist in time.
The most pressing problems of modern endocrinology are the prevention, diagnosis and treatment of diseases of the thyroid gland (diffuse toxic goiter, thyroiditis, hypothyroidism, thyroid cysts), diabetes mellitus, diseases of the hypothalamic-pituitary system (acromegaly, gigantism, hypothalamic syndrome, diabetes insipidus, lactation problems, prolactinoma), diseases of the adrenal glands (adrenal insufficiency, adrenal tumors), dysfunction of the gonads (endocrine infertility). Today, thanks to the knowledge and practical experience accumulated by endocrinology, it is possible to significantly improve the quality of life of patients with endocrine pathology.
Deteriorating environmental conditions, stress, unbalanced nutrition, and family history often cause disturbances in the functioning of the endocrine glands and lead to the development of endocrine diseases. Diseases of the endocrine system, as a rule, are long-term and severe. Therefore, it is important to prevent their occurrence in time, identify them as early as possible, or prevent the development of their complications.
Contacting an endocrinologist is necessary if:
To diagnose endocrine pathology, a comprehensive examination is used, including a study of the patient’s medical history, tests for the content of various hormones, ultrasound of the glands, and magnetic resonance imaging. Based on the data obtained, the issue of further conservative or surgical treatment is decided.
Treatment of endocrine diseases is aimed at correcting hormonal disorders, achieving stable remission of the pathological process and restoring the patient’s normal quality of life.
In the Medical Directory of Diseases on the “Beauty and Medicine” website you will become familiar with the characteristic features of endocrine diseases. On the “Beauty and Medicine” website you will receive all the necessary information about existing methods of prevention and treatment of endocrine diseases and medical centers engaged in endocrinological practice.
Diabetic foot symptoms and clinical manifestations are caused by pathological processes characteristic of this syndrome (neuro-, angio- and osteoarthropathy). Statistics show that this complication of diabetes is more common among patients with type 2 diabetes. Depending on the shape of the diabetic foot, certain signs of the disease may predominate in patients, developing gradually, in accordance with the stages of development.
About 50% of patients come to the doctor with an advanced form. Which in turn complicates treatment and can lead to amputation of limbs.
Without consulting a doctor on time, the chances of death double and the cost of treatment triples.
The neuropathic form of diabetic foot syndrome manifests itself as aching and burning pain, mainly at night. The patient complains of numbness and cramps in the calf muscles, which disappear or disappear completely when walking.
Chronic sensory neuropathy affects all types of sensitivity:
With this form, painless injuries to the feet are possible.
Motor neuropathy is characterized by the development of paralysis of the foot muscles, which can cause the foot to become deformed, which will change the gait for the worse. Calluses form in areas of greatest pressure. Also, the neuropathic form of diabetic foot, due to autonomic neuropathy, is characterized by dry, thin skin and impaired sweating function (anhidrosis).
Under such conditions, cracks often form, which are the “entrance door” for infection and, as a consequence, the development of non-healing wounds. If ulcers form in this form of the syndrome, they are round and painless, usually located in the center of calluses, calluses on the sole (at points of excess pressure) or on the tops of the toes. The tissue at the bottom of the wound is usually pink, the pulsation in the arteries of the feet is expressive. Often purulent processes occur:
The ischemic form is characterized by pain, which, as a rule, manifests itself during physical activity, however, with stages 3 and 4 of arterial circulatory failure, pain also occurs in a state of complete rest.
Also observed in diabetic angiopathy of the lower extremities, absence of pulse in the arteries of the feet, the appearance of intermittent claudication. The feet are cold, pale in color, and often swollen. Under such conditions, tissue nutrition deteriorates and local immunity decreases. The resulting ulcers have jagged edges and are painful.
It should also be noted that as a result of the effects of neuro- and angiopathy, atrophy and deformation of the nail plates develop in patients with diabetes. These changes, in turn, contribute to fungal nail infections.
Diabetic osteoarthropathy, which develops as a result of neuropathy, brings with it changes in bone structures and ligamentous apparatus, resulting in the development of the so-called Charcot foot and, as a consequence, pathological fractures and dislocations, as well as increased formation of corns.
Thus, clinical manifestations develop in accordance with the pathological processes and stages of development of the syndrome according to the accepted classifications of DFS. It should be noted that initial changes in the condition of the skin and deterioration in the sensitivity of nerve endings are symptoms of diabetic feet (stage 0) and require increased attention and appropriate treatment in order to prevent ulcerative forms of the syndrome.
Diabetic foot, or diabetic foot syndrome, is the most common complication of diabetes mellitus, occurring 15-20 years after the onset of the disease at the onset of decompensation.
In 90% of cases, diabetic foot syndrome is diagnosed with type 2 diabetes mellitus. The disease is an ulcerative-necrotic lesion of the skin, soft tissues, and in severe cases, the bone tissue of the foot. In its final stage, diabetic foot leads to gangrene of the limb, which kills two thirds of patients with type 2 diabetes.
The stage of decompensation of diabetes mellitus is characterized by high blood sugar levels, as well as sharp jumps in its level. This has a destructive effect on nerves and blood vessels; first, the microvasculature vessels are affected, and then the large ones. Violations of innervation and blood supply lead to insufficient tissue trophism. The foot is the part of the body that experiences increased stress and is often injured, especially in diabetes, since the skin in diabetes is dry, and hyperkeratoses often appear on the skin of the foot. As a result of reduced innervation, the patient does not notice minor injuries - bruises, abrasions, cuts, cracks. But in conditions of impaired blood circulation, the protective function of tissues is reduced, and any minor injury can lead to a long-term non-healing wound, which, when infected, turns into an ulcer.
In 1991, the First International Symposium on Diabetic Foot Syndrome was held, where a classification of this disease was developed, taking into account the predominant lesion, which was adopted as the basis by the world medical community. According to this classification, the following types of diabetic foot are distinguished:
The most common form is neuropathic foot, the second most common form is the mixed form, ischemic foot is the rarest manifestation of diabetic foot syndrome. Depending on the type, the approach to the treatment of diabetic foot and the prognosis of the disease depend.
Symptoms of diabetic foot have their own characteristics, depending on the form of the disease.
The manifestations of diabetic foot syndrome also depend on the stage of the disease. The clinic uses the Wagner classification of diabetic foot:
The diagnosis of diabetic foot syndrome is not difficult due to a history of diabetes and the characteristic clinical picture of the disease. For treatment, it is important to establish the form and stage of the process, for which a neurological examination, a detailed study of the blood flow (angiography, Doppler ultrasound, Doppler sonography, etc.), a blood test, radiography of the feet, and a bacteriological study of the contents of the ulcer are carried out.
The approach to treating diabetic foot depends on the type of disease, however, in any form of the disease, the main thing is to compensate for diabetes mellitus and lower blood sugar levels as the elimination of the main damaging factor.
In the ischemic form, treatment of diabetic foot consists of restoring blood flow in the limb, for which both therapeutic and surgical methods are used. Medications are prescribed that improve blood circulation and relieve swelling, as well as antibacterial agents. Among the surgical methods used are percutaneous transluminal angioplasty (an operation in which blood flow in the vessels is restored without cutting the skin, through a puncture in the artery); thrombarterectomy or distal vein bypass. A gentle regime is created for the injured limb, local treatment of ulcers with antiseptics is carried out.
Treatment of diabetic foot in neuropathic and mixed forms also consists of local treatment of ulcers, general antibacterial therapy and improvement of foot trophism, but special attention is paid to restoring normal innervation, for which drugs that improve metabolism are used. Smoking cessation is important in the treatment of diabetic foot, since tobacco has a negative effect on the microvascular bed, and in the case of smoking, most interventions may be ineffective or have only a short-term effect.
For a patient with diabetic foot disease, folk remedies during treatment can be recommended as auxiliary ones, since with long-term use traditional medicines can have a good effect. Another advantage of their use is their gentle action that does not cause harm.
To treat diabetic foot with folk remedies, various medicinal substances of natural origin are usually used in the form of baths, lotions and compresses. Decoctions and infusions of medicinal herbs are widely used - chamomile, sage, eucalyptus, celandine. Wound healing pastes are made based on herbs or bee products, which are applied under a bandage for a period of several minutes to several hours.
However, it should be said that when serious stages of the disease develop, you should not rely on folk remedies, since in this case, treatment of diabetic foot requires active medical intervention and emergency medical care.
Diabetic foot syndrome is a complex set of anatomical and functional changes that occurs in various forms in 30-80% of patients with diabetes. Lower limb amputations in this group of patients occur 15 times more often than in the rest of the population. According to a number of authors, from 50 to 70% of the total number of all lower limb amputations performed are among patients with diabetes mellitus. In 1993, about 12,000 lower limb amputations at various levels were performed in the Russian Federation in patients with diabetes mellitus.
damage to the arteries of the lower extremities
The last factor, as a rule, is concomitant with respect to the first two. Based on the predominance of neuropathic changes or peripheral blood flow disorders, two main clinical forms of diabetic foot syndrome are distinguished:
Fig. 5 Neuropathic form of diabetic foot with trophic infected ulcer
In the neuropathic form, there is damage to the somatic and autonomic nervous systems when the arterial segments of the lower extremities are intact. Neuropathy can lead to the following three types of foot lesions:
osteoarthropathy (with subsequent development of Charcot's joint)
The ischemic form develops as a consequence of atherosclerotic damage to the arteries of the lower extremities, which leads to disruption of the main blood flow. In this case, neuropathic changes may also occur. However, a decrease or complete absence of pulsation in the arteries of the feet and legs, cold extremities upon palpation, pain symptoms, as well as the characteristic localization of ulcerative defects such as acral necrosis make it possible to differentiate neuropathic and mixed (neuro-ischemic) forms of foot damage.
The neuropathic defect occurs in areas of the foot that experience the greatest pressure, especially often on the plantar surface and in the interdigital spaces. Long-term sensorimotor neuropathy leads to deformation of the foot, which contributes to the redistribution and excessive increase in pressure on its individual areas, for example, in the area of the projection of the heads of the metatarsal bones. In these places, thickening of the skin and the formation of hyperkeratoses with a fairly high density are noted. Constant pressure on these areas leads to inflammatory autolysis of the underlying soft tissues and the formation of an ulcerative defect. In this case, the patient may not notice the changes occurring due to reduced pain sensitivity.
Timely and adequately carried out conservative therapy for non-iropathic infected forms of foot lesions allows one to avoid surgical intervention in 95% of cases. Treatment for neuropathic foot infection includes the following main components:
1. Optimizing Metabolic Control
In most cases, patients with foot ulcers experience severe hyperglycemia. To ensure conditions conducive to healing, it is important to achieve a state of compensation of carbohydrate metabolism. For IDDM, the insulin therapy regimen is intensified. The body's need for insulin can increase significantly due to the presence of an infectious-inflammatory process and high temperature, therefore this requires a corresponding increase in the dose of administered insulin. Therefore, the guideline for the optimal amount of the drug is not the ratio of the insulin dose and the patient’s body weight, but the glycemic indicators.
Dry, thin skin of a neuropathic foot with a loss of integrity has reduced barrier properties against the penetration of microorganisms located on its surface. If there is an infection of the soft tissues of the foot, antibiotic therapy is necessary. The drugs of choice may be:
The type, dose of the drug and duration of treatment are determined based on the data of a bacteriological study of the microflora of the wound discharge, the severity of the process and the rate of healing of the ulcer.
Complete rest and offloading of the foot can lead to healing within weeks of even years-old ulcers. In this case, both a wheelchair, crutches, and special unloading shoes can be used.
Local treatment of the wound includes removing necrotic tissue, treating the edges of the ulcer and ensuring asepticity of the wound surface and surrounding areas of the foot.
If there are areas of hyperkeratosis, it is necessary to remove them in a timely manner using a scalpel with a shortened blade. This procedure is performed by specially trained medical personnel. In some cases, after removal of the callus, an ulcerative defect is discovered.
If there is a violation of the integrity of the skin without involving the underlying soft tissues, then it is enough for the patient to follow the recommended regime of unloading the limb or affected area and carry out local treatment of the ulcerative surface with antiseptics (solution of furacillin, dioxidine). If signs of ulcer infection or involvement of subcutaneous fat and muscle tissue in the pathological process are detected, antibacterial therapy must be prescribed.
Bone changes are manifested by osteoporosis, osteolysis, hyperostosis. Initial changes in the bones may not be apparent on X-ray examination. In this regard, for early diagnosis of changes in the osseous-ligamentous apparatus, the method of ultrasound bone scanning is used. Destructive changes can progress over several months and lead to severe foot deformity.
Patients with fractures or an already formed Charcot joint are recommended to completely unload the affected limb until the bones are completely consolidated, and subsequently wear individual orthopedic shoes. In the presence of severe hyperostosis, the patient may experience long-healing, recurrent ulcers. In such cases, hyperostosis is removed.
The accumulation of fluid in the tissues of the lower extremities associated with neuropathy requires the exclusion of other causes of edema, namely heart failure or nephropathy. The causes of neuropathic edema have not been fully elucidated, but it can be assumed that they are a consequence of disturbances in the autonomic nervous system, the formation of many arteriovenous shunts and a violation of hydrodynamic pressure in the microcirculatory bed.
The most effective treatment is the administration of sympathomimetics, such as ephedrine (30 mg every 8 hours). Ephedrine has a fairly rapid effect, which consists in reducing peripheral blood flow and increasing sodium excretion. Along with the peripheral, ephedrine can also have a central regulatory effect on water-salt metabolism.
The ischemic form is characterized by pain symptoms, usually pain at rest. In this case, some relief occurs when the patient changes his body position, for example, by giving an elevated position to the head end of the bed or hanging his legs from the bed. In order to relieve pain symptoms, lumbar sympathectomy is sometimes performed, but no improvement in the hemodynamics of the lower extremities is observed.
1. Use of conservative methods of therapy (see above).
a) percutaneous transluminal angioplasty;
c) distal bypass with vein in situ.
In case of extensive purulent-necrotic lesions, amputation is performed, and the most favorable in terms of post-amputation rehabilitation are amputations at the level of the lower third of the leg. Issues of post-amputation rehabilitation are resolved by orthopedic surgeons. In the future, prosthetics and the selection of orthopedic shoes are important.
As mentioned above, factors such as neuropathy, ischemia, foot deformity and the presence of edema play a leading role in the development of changes in the lower extremities. When assessing the condition of the legs, it is important to determine in each specific case what place this or that factor occupies in the development of lesions and, in accordance with this, determine the tactics of further treatment.
It is the simplest and most effective method for identifying foot lesions. It is important to pay attention to the following signs:
deformities: hammertoes, hook toes, hallux valgus, hallux varus, protruding heads of the metatarsal bones of the foot, Charcot arthropathy
edema: bilateral - neuropathic, as a result of cardiac or renal failure; unilateral - with an infected lesion or Charcot arthropathy
condition of nails: atrophic with neuropathy and ischemia, discoloration in the presence of fungal infection
hyperkeratoses: especially pronounced in areas of the foot that experience excess pressure due to neuropathy, for example, in the area of the projection of the heads of the metatarsal bones
ulcerative lesions: in neuropathic forms - on the sole, in ischemic forms - they form in the form of acral necrosis
pulsation: pulsation on the dorsal and posterior tibial arteries of the foot is reduced or absent on both limbs in the ischemic form and normal in the neuropathic form
skin condition: dry, thin skin with neuropathy.
1. Study of vibration sensitivity, which is carried out using a biothesiometer or a graduated tuning fork (Fig. 7).
Fig.7 Study of vibration sensitivity using a tuning fork in a patient with diabetes mellitus.
To assess the state of arterial blood flow, the ankle-brachial index is measured using a Doppler device. Systolic pressure is measured in the arteries of the legs and brachial artery. The ratio of systolic pressure in the arteries of the lower extremities to the systolic pressure in the brachial artery is the ankle-brachial index. Normally it is 1.0 or higher. Index values below 0.6 are considered critical in terms of the state of peripheral blood flow; cases in which ankle-brachial index values are below 0.3 are considered unfavorable prognostically.
1. Screening of patients with diabetes mellitus in terms of identifying diabetic foot syndrome consists of timely identification of individuals who have an increased risk of developing ulcerative lesions of the lower extremities. These risk factors include:
peripheral vascular damage
history of leg lesions
weakening or loss of vision
diabetic nephropathy, especially in end-stage chronic renal failure
lack of outside help (the patient lives separately from family and friends)
excessive alcohol consumption
Damage to the lower extremities often develops in overweight men.
Currently, the most effective form of organizing specialized medical care for patients with diabetes is the organization of training, which provides a real opportunity to achieve optimal control of the disease, as the most important factor in the prevention of late complications. Structured training programs include a section on proper foot care. Compliance with these rules can significantly reduce the risk of developing leg lesions.