The diabetic foot: general considerations
When we speak about the diabetic foot we are referring to a summary of pathologies which have an impact on the foot as a result of the Diabetes Mellitus which the patient suffers. Diabetes is a chronic disease which affects to a vast number of people causing them a series of serious complications and a high percentage of mortality. The causes may be hereditary, the diets which help obesity, the sedentary lifestyle as well as the age. All these factors make doctors to be suspicious that the increase of diabetes will be exponential in the next years. We can define the diabetic foot as a neuropathic disorder determined by the hyperglycemia with some risk of ischemic affection and which can cause a traumatism. Such traumatism (injury or ulceration) may cause more trouble if an infection is produced. Neuropathy is a chronic and tardive complication of diabetes which affects to the systema nervosum autonomicum and peripheral. By a multiple overall of disorders. There are two kinds of neuropathy:
- Vascular or focal origin, such as simple or multiple neuropathy, radiculopathy, plexopathia and cranial neuropathy. There are some symptoms such as pain, anesthesia, anhidrosis, extremities proximal debility, etc.
- Methabolic or diffuse origin. It takes in the distal symmetric sensorimotor polyneuropathy and the autonomic neuropathy. There are some symptoms such as the deep sensibility and also of reflexes.
In those diabetic patients it’s important to have a sensibility control as frequently as each case will require. In this sensibility control we will assess the perception level to pain, to the taction, to the body temperature, to the pressure and to the vibration. It’s also important the reflex control and a vascular examination which includes a control by doppler, pulse palpations and a skin examination (staining, temperature, aspect). The most frequent complications of the diabetic foot are the Charcot’s arthopathy and the neuropathic ulcer. Such ulcers are mainly caused by the alteration of sensibility, low glycemic control, tobacco, alcohol, etc.
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