Diabetic Foot: Clinic

DIABÉTICS

The International Working Group on the Diabetic Foot (IDFCG), defines the diabetic foot ulcer (PDU) as a depth wound that affects even the dermis located below the ankle in a patient with diabetes. UPDs are the result of multiple factors among which neuropathy and peripheral arterial disease (EAP) are the main underlying causes. In the presence of these factors, even moderate ischemia can cause ulcers and affect healing. Diabetic foot ulcers are classified as purely neuropathic, purely ischemic or a combination of both, i.e. neuroischemic. The estimated current prevalence of each is 35 per cent, 15 per cent and 50 per cent, respectively.

Neuropathic ulcer

Defined as the existence of ulceration at a pressure point or foot deformation, presents three prevalent locations: first and fifth metatarsian in its acratic zones, and calcáneo at its later end.

They are rounded ulcerations, perulcerous silence and painless.

There is an alteration of sensitivity.

Neuro-Ischemic Ulcer

Initially dry necrosis and usually latero-digital location, which usually progress quickly to wet and supurative if there is over-infection.

Generally the warm pulses are abolished and there is a prior associated neuropathy. They tend to be dodorous although it depends on the degree of coexisting neuropathy.

Infected Diabetic Foot

Clinically it is possible to distinguish three forms, which may occur successively, but also simultaneously: superficial cellulite, necrotizing infection and osteomyelitis.

• Surface cellulite: in a percentage higher than 90%-95% is caused by a single positive gram pathogen germ, which is usually aureus staph or streptococcus. It may take a self-limited course, or progress to more extensive forms depending on the prevalence of predisposing factors.
• Necrotizing infection: affects soft tissues, and is polymicrobial. When abscessed, the process can be extended to plant compartments
• Osteomyelitis: its most frequent location is on 1, 2 and 5 fingers, and can cause symptomatic treatment, but it is not rare that the symptoms and inflammatory signs are missing, and it is often difficult to establish their differential diagnosis with non-septic arthropathy. In this sense, bone externalization at the base of an ulceration has a predictive value of 90%.

Neuropathy

Clinically manifested by spontaneous fractures that are asymptomatic.

Radiologically it is objective peristic reaction and osteolysis.

In its most advanced or final phase it leads to a global arthropathy (Charcot), which is defined by the existence of the planting subluxation of the tarso, the loss of the medial concavity of the foot caused by the displacement of the calcáneo-astragaline joint, associated or not to the tarsometatarsal luxation.

It presents an early non-infectious phase, with erythema and edema, without radiological changes.

It has a high prevalence of associated ulcer.

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