Diabetic foot - specific anatomical and functional changes in the tissues of the foot caused by metabolic disorders in patients with decompensated diabetes http://januvia-sitagliptin.net/. Symptoms of diabetic foot are pain in the legs, hyperkeratoses and skin cracks, deformation distal limb defects and ulcerative necrosis of soft tissues, in severe cases - gangrene of the foot or lower leg. Diagnosis of diabetic foot syndrome includes external inspection, determination of different kinds of sensitivity, Doppler ultrasonography and angiography, X-ray stop, microbiological research content ulcers, etc. The treatment of diabetic foot requires an integrated approach:.. Normalization of glycemia, the unloading of the affected limb, local treatment of ulcers, of antibiotic therapy; in severe injuries - surgical methods are used.
Under the diabetic foot syndrome in endocrinology understand the complex microcirculatory and neurotrophic disturbances in the distal lower extremities, resulting in the development of ulcerative necrotic processes of the skin and soft tissues, bone and joint injuries. Changes characterizing diabetic foot, usually develop within 15-20 years after the onset of diabetes. This complication occurs in 10% of patients, 40-50% of patients with diabetes are at risk. At least 90% of the diabetic foot is associated with type 2 diabetes.
The organization is currently helping patients with diabetic foot is far from perfect: almost half of the cases the treatment is started in the late stages, which leads to the need for amputation, disability of patients, an increase in mortality.
The main pathogenetic links of diabetic foot syndrome are angiopathy, neuropathy and infection.
Long nekorrigiruemaya hyperglycemia in diabetes causes specific changes in blood vessels (macroangiopathy and diabetic microangiopathy), as well as the peripheral nerves (diabetic neuropathy). Angiopathy lead to a decrease in elasticity and permeability of blood vessels, increase blood viscosity, which is accompanied by a violation of the normal innervation and trophic tissue, loss of sensitivity of nerve endings.
Increased glycosylation of proteins causes a decrease in joint mobility, which entails the simultaneous deformation of bones of the limbs and disruption of normal biomechanical load on the foot (diabetic osteoarthropathy, Charcot foot). Against the background of the altered blood circulation, reduced sensitivity and protective functions of tissues, any, even a slight foot injury (minor injury, abrasions, cracks, mikroporezy) leads to the formation of nonhealing venous ulcers. Ulcerative defects feet often become infected by staphylococci, colibacteria, streptococci, anaerobic microflora. Bacterial hyaluronidase loosens the surrounding tissues, facilitating the spread of infection and necrotic changes, which cover the subcutaneous fat, muscle, bone and ligaments. When infected ulcers increases the risk of an abscess, cellulitis and gangrene of the limb.
Despite the fact that the potential risk of developing diabetic foot there in all patients with diabetes at increased risk include those with peripheral polyneuropathy, atherosclerosis, hyperlipidemia, coronary artery disease, hypertension, alcohol abuse and smoking.
In diabetes risk of deep lesions increase the local tissue changes - so-called stop small problems: ingrown nails, fungal nail infections, fungal infections of the skin, corns and calluses, cracked heels, poor hygiene legs. The cause of these defects can be picked wrong shoes (too narrow or close). Reduced sensitivity of limbs does not allow the patient to feel that shoes are too pressing, rubbing and injure the foot.
In the debut of ischemic form of diabetic foot syndrome is manifested by pain in the legs when walking, fast leg fatigue, intermittent claudication, followed by developing resistant foot swelling. The foot is pale and cold to the touch, ripple on the arteries of the foot is weakened or absent. Against the background of pale skin often seen areas of hyperpigmentation.
Typically the presence of calluses, long-term healing of cracks on the fingers, heels, lateral surface I and V metatarsophalangeal joint, ankle. In their place further develop painful sores, the bottom of which is covered with scab black-brown color. Copious exudation atypical (dry skin necrosis).
During the ischemic form of diabetic foot are 4 stages: the first stage of a patient can safely walk about 1 km; the second - about 200 m; third - less than 200 m, in some cases, pain occurs at rest; fourth stage is characterized by critical ischemia and necrosis of the toes, resulting in gangrene of the foot or lower leg.
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