Diabetic foot is one of the complications of diabetes mellitus, on the whole this complication is considered as a syndrome, accompanied by a whole group of different manifestations affecting the peripheral nervous system, the joints of the foot, bones and blood vessels. Diabetic foot, the symptoms of which have the form of ulcerative necrotic lesion, otherwise referred to as gangrene of the foot and develops on average in 5-10% of patients with diabetes.
Diabetes mellitus itself is a severe disease, and the development of complications in it, no matter how cynical or rude it may sound - is only a matter of time. Meanwhile, there is the possibility of a certain shift in the timing of their offensive, whether in the greater or lesser direction. In particular, we are talking about the patient's approach to the treatment of diabetes. That is, if there is general irresponsibility to one's own state of health, a periodic disregard for the treatment itself and negligence in it, the complications, including the diabetic foot syndrome, will not be long in coming.
As a cause provoking the emergence and subsequent, rather rapid, the development of complications, there is an elevated blood sugar level, which, as is clear, manifests itself in chronic form with diabetes. buy januvia online
Certain complications of diabetes (for example, infections and skin lesions), if we consider them in general, manifest themselves within a few months from the moment of debut of this disease. Nevertheless, almost any complications of diabetes do not occur until 10, and even 15 years after the appearance of diabetes, and only if there are no adequate measures of treatment.
In general, the complications of diabetes mellitus develop imperceptibly, moreover, they may not even affect the overall well-being of patients. When it comes to already manifested complications, then it becomes difficult to cope with them. In general, such complications are characterized by their own unfavorable development. Summarizing the general complications of the disease we are considering, we can add that the more strictly the patient himself refers to the need to control the blood sugar level, so, accordingly, the risk of development for him is defined in terms of complications of diabetes (at least early complications).
Returning to the main disease of interest to us and the complication at the same time, in fact, to the diabetic foot, in which foot tissues are affected, it should be noted that it is a rather terrible addition to the course of diabetes. Diabetic foot is accompanied by deformation of the feet and the appearance of ulcerative lesions on them, which is caused by the defeat of the nerves and vessels of the legs on the basis of the underlying disease.
As the accompanying factors leading to an increase in the number of patients with this pathology, it is possible to identify arterial hypertension in patients, an increase in the overall duration of diabetes by increasing the life expectancy of patients, smoking, alcoholism, coronary heart disease, atherosclerosis, obesity.
In general, the diabetic foot syndrome develops in patients with type II diabetes, corresponding to the older age group - approximately 10 times more often than in type I diabetes, in patients with the urgency of these criteria, this pathology is diagnosed. Depending on what kind of leg lesion is topical in diabetes, vascular or nervous, the ischemic or neuropathic form of the syndrome is isolated.
The syndrome of the diabetic foot is the main cause, which subsequently provokes amputation of the affected limb in diabetes mellitus. As already mentioned, on average, this pathology is detected in 5-10%, while about 50% of patients from this number are at risk with regard to the issue of amputation. Remarkably, in about 48% of cases, the treatment of diabetic foot begins later than it is still possible. Further, with limb amputation, the doubling of mortality remains topical, an increase in the cost of general treatment and the rehabilitation required after this is a separate issue.
The risk of developing deep forms of lesion increases due to the actual local changes in tissues, which are considered to be small stop problems. Such problems include fungal nail lesions, ingrown nails, cracks in heels, calluses, fungal infections, burrs, as well as inadequate hygiene of the lower extremities. The reason for such defects is the wrong selection of shoes, which becomes too tight or too narrow for the patient. Against this background, the overall sensitivity of the lower limbs is reduced, because of which the patient does not fully feel that the shoes are too tight, traumatizing or rubbing the feet.
Based on the prevailing pathological component, the ischemic or neuropathic form of the complication is distinguished. It can also be mixed - in this case it is a combination of both forms, in which the diabetic form is neuroischemic. Ischemic events account for about 10% of cases of morbidity, for neuropathic - about 60-70% and about 20-30% of cases - for mixed.
The ischemic form of the diabetic foot is accompanied by a violation in the extremity of the blood supply, which occurs due to the destruction of small and large vessels in them. Manifestations of ischemic syndrome are accompanied by severe edema of the legs, pain in the legs, skin pigmentation on the legs, intermittent claudication and rapid fatigue of the legs.
The onset of the disease is characterized by the appearance of pain during walking, in general, the legs are quickly tired. Also there is such a symptom as intermittent claudication - lameness on the background of painful sensations, provoked by insufficiency of the muscular blood supply of the lower extremities during physical activity. In the future, on the background of the listed symptoms, there is edema of the foot. The foot itself becomes pale and cold (as determined by palpation). In the arteries of the foot, pulsation is either manifested in a weakened form, or completely absent. When examining the pale skin, you can see areas of hyperpigmentation - that is, areas in which individual areas of the skin differ from the rest of the skin in a general examination.
A typical manifestation of the diabetic foot in this form is the presence of cracks and calluses, which do not heal for a long time. They appear on the ankles and in the region of metatarsophalangeal joints (I and V, their lateral surfaces). Further on the location of these formations, painful ulcers appear, their bottom is covered with a black-brown scab (a crust, usually present on the wound surface during its healing).
This form of the disease in its own course manifests itself in four main stages. Determine them based on the distance the patient passes through certain distances. Thus, the absence of pain when overcoming a distance of 1 km determines the compliance of the first stage of the disease. Overcoming the distance of 200 meters determines for the patient the second stage, less than 200 - the third stage. If we are talking about the fourth stage, then there is already a critical form of the manifestation of the disease, in which necrosis (necrosis) of the fingers on the feet develops, which, in turn, develops gangrene of the foot or gangrene of the shin.
With gangrene, the area affected by the pathological process becomes either very dark or black, this is accompanied by a complex tissue death, in this case with the concomitant necrosis of the affected area of the body.
This form of the disease is accompanied by the development of the pathological process in those parts of the foot that are most affected by the pressure. In particular, we are talking about the interphalangeal areas of the fingers, as well as the thumb, etc. In such areas, corns are formed, areas of excessive hyperkeratosis (thickening of the skin) are present, and an ulcer is formed under them. Neuropathic ulcer is accompanied by a general dry skin, while it is warm. Also on the foot appear deep cracks and scrapes, painful ulcers appear, they have swollen and red edges.
Sharko joint (osteoarthropathy) - one of the forms of diabetic foot of this type, is accompanied by the development of destructive processes in the defeat of the osteoarticular apparatus. It manifests itself as a disease such as osteoporosis. Also there are spontaneous fractures, joints are subject to deformation and swelling (mainly affects the knee joint).
Neuropathic edema is accompanied by an accumulation of interstitial fluid in the subcutaneous tissues, against which a pathological process with an accompanying change in the feet becomes even more serious.
Various forms of this type of disease are accompanied by the preservation of pulsations in the arteries, sensitivity and reflexes in the affected area are reduced. Yazvenno-necrotic formations are manifested in a painless form, characteristic is the abundance of fluid (exudate) released from them. Ulcers are concentrated in those areas where the load manifests itself in the most pronounced form (in particular, it concerns soles, fingers). Deformation of the foot develops according to a specific pattern of manifestation, in particular, these are hammer-shaped fingers, hook-shaped fingers, etc.