Diabetes complications

Charcot foot in diabetes mellitus: treatment of complications and diabetic osteoarthropathy

Diabetes mellitus is a disease in which many human organs are affected. The disease has many syndromes and signs that speak about the existing complications. One of the characteristic signs is Charcot's foot.

In diabetes, the immune system does not exercise control over the damaged immune system and organs. Patients often note the rapid development of foot problems.

A diabetic foot is a pathology that can lead to serious complications. In identifying diabetes, you must continue to carefully monitor the condition of the legs and the changes that occur.

What is a Charcot foot

Diabetic osteoarthropathy of the foot is expressed in disorders of the structure of the lower extremities that appear with an increase in blood sugar. With insufficient control of diabetes, the sensitivity of the nerves is reduced and the bleeding in the vessels of the legs is reduced.

Thus, there is a risk of injury to the limbs and the appearance of infections.

With diabetes mellitus, the nervous system is often affected, and a person cannot fully feel his limbs. Disturbed sebum secretion process, as well as sweating. This situation contributes to the emergence of pressure on:

  1. bones,
  2. skin,
  3. foot joints.

The pressure appears during the movement of the limbs, which leads to skin defects. Ulcer and Charcot's syndrome may appear. The latter is expressed in the appearance of wounds on the legs, damage to bones and joints.

In this case, healing occurs slowly, microbes often spread. When the case is neglected, diabetic gangrene appears in diabetes mellitus, which is fraught with amputation of the limb. Infection is life threatening because it can get into the blood.

Charcot's syndrome is called the defeat of all tissues of the lower extremities.

This is due to a prolonged increase in the level of sugar in the circulatory system.

Disease factors

People with diabetes and inadequate control of the disease are at risk of injury to their feet. If the leg nerves are damaged, the patient may not feel the extremities.

The person in this case cannot determine where his fingers and legs are when moving. If the nerves are healthy, then during movement the person feels that the feet are in a tense state.

In diabetes, the patient cannot feel foot injuries, such as blisters, cuts, and scratches. With pathological wear of the foot, calluses and corns often appear.

Insufficient control of the disease leads to deterioration of the arteries and atherosclerosis.

Foot injury increases the risk of significant changes in the foot. One of the common problems is considered to be a non-healing ulcer. Her appearance can provoke:

  • constant pressure on the legs,
  • secondary damage
  • wound or puncture
  • a foreign object that has hit the shoes
  • the appearance of infection.

Damage to the skin of the nails or legs with a fungal infection can cause a significant spread of infection. You should immediately consult a doctor and begin treatment.

Forms of the disease

Depending on the cause of the diabetic foot syndrome, there may be several forms of the disease.

Neuropathic form is the most common. Nervous tissue is highly sensitive to a variety of factors that damage it. Thus, it is subject to pathology. There is a violation of the innervation of the tissues of the legs, then their structure and function deteriorate.

Often there are ulcers between the fingers and on the soles of the feet. In these areas, the foot is subjected to the greatest pressure. Disorders of the osteo-ligament apparatus also occur.

Neuropathy in diabetes mellitus can be:

  1. painful
  2. painless.

The course of the disease of this form is not manifested by painful symptoms. The person does not feel the appearance of ulcers, discomfort and damage. Often a diabetic complains of leg numbness. Pain form is characterized by such manifestations:

  • tingling lower limbs
  • heat in the legs
  • goosebumps
  • pain in rest,
  • presence of pulse on the legs with the appearance of neuropathy.

The development of this form of the disease occurs in atherosclerotic lesions of the arteries of the legs. The following symptoms appear:

  1. cold skin on the feet, often pale and bluish,
  2. pink skin color appears during reactive dilation of capillaries,
  3. appearance of tongue on fingers
  4. heel pain
  5. the inability to probe the pulse on the foot,
  6. limp if walking has severe pain in the lower leg.

Mixed form consists of neuropathic and ischemic forms. On average, ailment affects up to 15% of people with diabetes.

Manifestations of the disease

Diabetic osteoarthropathy is fraught with permanent dislocations, injuries and deterioration of the general condition of the legs. Charcot's foot is characterized by the complete loss of its functions.

With this pathology can be the following symptoms:

  • pain due to stretching and congestion of the feet,
  • development of infection
  • redness of the skin, confirming the presence of a virus,
  • swollen legs
  • increased skin temperature due to infection,
  • load of feet, calluses while wearing uncomfortable shoes,
  • purulent content that flows from wounds,
  • lameness, difficulty walking,
  • ingrown nail plate
  • the presence of fungus,
  • chills and fever, as a result of infection,
  • severe pain in the legs and their numbness.

As a rule, on the legs appear:

  1. blisters and blisters
  2. nail ingrowth
  3. growths on the sole of the foot,
  4. bursitis on the thumbs,
  5. fungal infection
  6. skin cracks
  7. draining the skin
  8. curvature of the fingers.

There are four stages in the development of the disease in diabetes:

  • in the first stage, the joints are destroyed. There are injuries to the joints, small bone fractures and dislocations. This stage is characterized by swelling of the foot, redness of the skin, and an increase in temperature. A person does not feel pain at this time,
  • in the second stage, the arches are compacted, the foot is deformed,
  • in the third stage, the deformation becomes noticeable. There may be spontaneous fractures and dislocations. The toes begin to buckle and the functions of the foot are disrupted,
  • wounds appear in the third stage, which leads to infection.

Charcot's joint is a progressive arthropathy that occurs when pain sensitivity is impaired due to various diseases, most often diabetes. The consequences are:

  1. joint deflection
  2. articular effusion,
  3. deformation,
  4. instability

Diagnostics

If diabetic osteoarthropathy is suspected, it is important to consult a doctor in time. If possible, it is better to visit a specialized medical facility.

To make a correct diagnosis, it is necessary to carefully study the clinical picture and X-ray examination, which will show the specific stage of development of the disease. The difficulty of determining the disease is reduced to the fact that the symptoms may resemble:

  1. phlegmon of the foot,
  2. thrombophlebitis,
  3. lymphostasis and other diseases.

The most difficult is the differential diagnosis in the case of the Charcot foot is in the acute stage. In such a situation, deferred treatment may cost a person a loss of a limb.

It is possible to treat a diabetic foot with the help of surgery or using classical methods. Conservative therapy involves, above all, basic treatment. At this stage you need:

  • compensate for diabetes
  • control pressure
  • normalize blood glucose levels.

If the doctor has established the presence of Charcot's foot in diabetes, then treatment should include antimicrobial therapy with antibiotics. To stop the pain also use tools such as Analgin or Ibuprofen.

In addition, the patient needs to undergo several therapeutic measures that are aimed at restoring nervous sensitivity and improving blood circulation in the area of ​​the feet. Also, the doctor may prescribe antiseptic drugs.

In addition to X-ray, magnetic resonance imaging is also used. In some cases, shown skeletal scintigraphy of the foot.

All of these diagnostic measures help determine the level of inflammatory changes, the presence of microfractures and the degree of blood flow in the affected areas. If necessary, biochemical markers of bone decay are evaluated.

Also, tissue remodeling markers are taken into account, as they show the activity of the bone enzyme. This information may be useful in the postoperative period, which follows after limb amputation.

In order to determine the cause of bone destruction, you need to take a blood test for osteomyelitis.

Treatment

First of all, it is necessary to understand that the treatment will provide the maximum result if a person visits a doctor in time. People diagnosed with diabetes should have a regular assessment of the condition of their feet.

Anyone can learn the proper examination if he asks for help from a qualified doctor. As a result, a person must form a habit of constantly inspecting his lower limbs, in particular, his feet.

As soon as any changes, even minor ones, are revealed in the structure, it is necessary to immediately consult a doctor. In addition, it is important to take into account what is most often accompanied by Charcot's disease - Marie, namely, pain in the foot due to atrophy of nerve endings. It may seem to a person that this damage is minor, however, the harm is serious.

If ulcers appear on the foot, they should be investigated with the establishment of depth. In certain ulcers, restoration with orthopedic insoles is indicated. These insoles significantly reduce the degree of pressure when walking. If this measure is not enough, then apply immobilization, which prevents a strong effect on the skin.

Surgery can be scheduled if the ulcer has spread to the level of the dermis. When fixing the fact of infection, the doctor prescribes the use of antibiotics. In some cases, plantar ulcers spread to the bony protrusions. In this case, there is a need for surgery to eliminate these ulcers.

An example is the metatarsal bone, which can be removed with an ulcer placed in the front of the foot.

Skeleton foot restoration

When a diabetic foot appears, the treatment focuses on the elimination of ulcers and abscesses. A surgical intervention may be prescribed as a recovery measure if correction of foot deformity is needed.

Neutralization of resection of arthrodesis and bone structures, which causes an increase in pressure on the plantar surface, is performed. Thus, an unhealed ulcer appears.

To use such techniques, it is necessary to achieve stopping the inflammatory process and the absence of osteolysis. If these conditions are not observed, there is a possibility that the operation will provoke new foci of destruction.

Before surgery, you need to strengthen the bones with the help of certain means. Restoration of the foot is necessary when it is severely deformed, which makes the use of orthopedic shoes ineffective.

Prevention

First of all, you need to constantly inspect the foot. At the first manifestations of skin lesions or deformities, refer to the endocrinologist.

It is necessary to abandon the scissors that cut their nails. It is best to use a nail file. Narrow shoes should be disposed of, as feet are rubbed easily and calluses form.

It is important to protect the feet from the effects of different temperatures. If a wound is found, it should be treated with 3% hydrogen peroxide solution or Chlorhexidine with dressing. In this situation, you can not use tools that have a tanning effect. These tools include:

  • Zelenka,
  • iodine,
  • potassium permanganate.

Care must be taken to keep the skin dry. You can use creams, for example, Balsamed or Callusan. The video in this article describes the forms of the diabetic foot.

Watch the video: Diabetic Charcot Foot Deformity. Diabetic Neuropathy and foot. Diabetes Complications (November 2019).

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