Diabetic foot - Causes, symptoms and treatment. MF.

In recent decades, worldwide, a catastrophic increase in the incidence of diabetes has been recorded. This trend is fully traced in the territory of Russia. According to experts, every tenth Russian has a hidden or obvious violation of carbohydrate metabolism. The greatest danger in this disease is the consequences of such disorders in the form of damage to various organs and systems. Diabetes gradually destroys virtually all cells in the body. And the eyes, and the kidneys, and the heart, and the liver, and the brain are equally sensitive to excess glucose in the blood. As a result of prolonged exposure to large concentrations of blood sugar in patients with diabetes develop late complications of the disease. Perhaps, one of the most serious complications is the diabetic foot syndrome.

Causes and signs of diabetic foot

Diabetic foot is a ulcerative-necrotic process or gangrene of the foot. Under the syndrome of diabetic foot also understand the conditions immediately preceding the development of necrosis, which include severe lesions of the peripheral nervous system, blood vessels, bones and joints of the foot.

More than 5% of all diabetic patients experience a severe complication during their lifetime. The greatest risk of diabetic foot syndrome in patients with the following conditions:

* Severe damage to the nervous tissue of the foot
* Damage to the arteries of the extremities
* Deformity of the foot
* Blindness
* Chronic renal failure
* Alcoholism
* Tobacco dependence

The most common syndrome develops in patientsdiabetes mellitus type 2 of older age groups.

In the appearance of the diabetic foot, a greater role may belong to damage to the nerves or vessels. Depending on this, the diabetic foot is classified as neuropathic and ischemic. Perhaps the development of a mixed form of the syndrome.

When examining the lower extremities, one can presumably determine what is the basis of the complication-neuropathy or ischemia. With a neuropathic form, the skin on the foot is dry, there are areas of altered skin in the area of ​​greatest pressure when walking, the foot is deformed, pulsation on the arteries is preserved, ulcerative painless pains, there are practically no complaints in patients. With ischemic form( vascular damage), the skin on the foot is thinned, cyanotic, pulsation on the arteries is not determined, the wounds and cracks are located on the fingers, sharply painful.

Diabetic foot

Of course, only an external examination does not provide complete information about the state of blood vessels and nervous tissue. When referring to a doctor about the diabetic foot syndrome, the patient should be hospitalized for examination and treatment. Patients in the hospital are assessed all kinds of sensitivity( vibration, temperature, pain), determination of tendon reflexes, electroneuromyography, X-ray examination, ultrasound scanning of arteries. After the diagnosis is clarified, the patient is prescribed treatment taking into account individual sensitivity.

Treatment of diabetic foot

Treatment of the diabetic foot of the diabetic foot includes:

* blood sugar normalization
* rest rest
* surgical removal of all dead tissues in the wound area
* antibiotics in the form of tablets or injections
* use of modern dressings

Surgical removal of deadtissues in the wound area with diabetic foot

Treatment of the ischemic form of the diabetic foot includes:

* normalization of sugar and cholesterol in the blood
*smoking cessation
* Treatment of hypertension
* Reduction of excessive blood viscosity( aspirin, heparin)
* Surgical restoration of permeability of vessels
* Antibiotics

Amputation is also a method of treating diabetic foot syndrome. Indications for amputation are purulent melting of the foot bones, a critical decrease in blood supply to tissues.

In Russia, high amputations are most often performed. Operation at the level of the middle or upper third of the thigh is one of the most common. After such interventions, the patient is considered an invalid. Serving yourself in the home, and even more so fully work to become extremely difficult. Therefore, the first place in the fight against the syndrome of the diabetic foot is prevention.

Prevention of diabetic foot syndrome

Treatment of diabetes mellitus, nerve and vascular injuries is considered the best prevention of diabetic foot. The normalization of carbohydrate metabolism is perhaps the most difficult to achieve. Blood sugar and glycated hemoglobin in the patient should not exceed the individual target threshold. Usually, the goal is fasting sugar to 7.5 mM / L, sugar within a day is not more than 10 mM / L, glycated hemoglobin is less than 7.5%.

Treatment of neural tissue damage is performed jointly by an endocrinologist and neurologist. Traditionally used drugs alpha-lipoic acid( Berlition, Tyoktatsid, Oktolipen), vitamins of group B( Milgamma, Kombilipen, Neuromultivit), physiotherapy( magnetotherapy) and therapeutic exercise.

Vessel treatment is performed by an endocrinologist and a surgeon. An important point is the cessation of smoking and the reduction of excess levels of fats in the blood( cholesterol).

In addition, a visit to a specialized diabetic foot cabinet in medical institutions and community-based outpatient monitoring reduces the risk of this complication. In large cities Diabetological centers are usually organized, where patients can be seen in one day by a diabetologist and specialists of other specialties.

An important step in prevention is the training of patients on specialized programs based on the so-called "Schools of Diabetes Mellitus."During classes with patients and their relatives, the rules of foot care and choice of shoes are discussed in detail.

Footwear for patients with foot deformation should be manufactured on an individual basis in orthopedic salons. In other cases, shoes are bought in ordinary stores, observing the following rules:

* shoes are selected strictly according to size
* you can not wear rubber shoes
* heel should not be above 4 cm
* shoes should not be too narrow
* already at the first fitting shoesshould be comfortable

In general, all the rules for selecting shoes are that shoes should not damage and squeeze the foot, and also prevent evaporation of excess moisture. Rubber boots can cause damage to the foot. They can not be worn for more than 30 minutes in a row, and it is better to abandon this material altogether.

The foot care rules are divided into two groups: what to do for prevention and what not to do in any case.

Prohibition rules:
* Do not wear open shoes, wear any shoes "on bare feet"
* Do not walk barefoot
* You can not remove corns yourself with plasters, ointments, razors
* For foot care, metal and sharp objects can not be usedscissors, razors)
* You can not do pedicure in beauty salons
* No wounds and scratches can be treated with alcohol-containing substances( iodine, salicylic alcohol, zelenka).For these purposes, you can use hydrogen peroxide, chlorhexidine, miramistin.

Foot Care Recommendations:
* Before putting on your shoes, touch the inside of the inside of the insole( whether the insole is lying flat or not?)
* Do warm foot baths every day for 10minutes
* After the foot bath should be carefully dried with a towel
* Daily apply a cream with urea or plant extracts on the plantar surface of the foot
* Daily, carefully inspect the foot, process the cracks, at any suspicious changeto the doctor.
* For 5 minutes before going to bed perform a light foot massage, a set of exercises for special gymnastics

Stop during the day is subjected to heavy loads. All our weight falls on its surface. The walking movements are quite monotonous. With diabetes, damage to nerves leads to the fact that a person can not feel pain with minor injuries, rubbing, burns. Obtained wounds will not heal well - after all, patients have reduced blood supply, trophic tissue. An important factor is reduced immunity in diabetes. Bacteria quickly penetrate into the wound and multiply freely in it. As a result, those injuries that without diabetes could pass unnoticed at all, patients with violations of carbohydrate diabetes sometimes even lead to gangrene and amputation. Therefore, patients with diabetes should be extremely responsible for foot care, choice of shoes, supervision by specialists. The fight against metabolic disorders in diabetes mellitus( normalization of blood sugar) is certainly the basis for the prevention of any complications, including diabetic foot syndrome.

Doctor of the endocrinologist Tsvetkova IG