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ISSN 0210-5187 (Electronic)

2003, Number 4

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Med Cutan Iber Lat Am 2003; 31 (4)

Diabetic Foot

Conde TA, De la Torre C, García DI

Language: Spanish
References: 37
Page: 221-232
PDF size: 292.60 Kb.


ABSTRACT

Diabetes mellitus is a frequent illness in Spain (2-3%), and diabetic foot is an important complication that leads to amputation in some cases.
Pathogenesis: there are three main factors: vascular alteration (ischemia), autonomic and periferic (motor-sensitive) neuropathy and infection. Ulcerations in these patients are more frequently neuropathic, but they must be differentiated from ischemic type.
Diagnosis: ischemia can be diagnosed by clinical manifestations and tests as venous filling time, claudicometry, ankle-arm index or Doppler. We will explore different sensibilities to look for neuropathy, and the use of Semmes-Wenstein monofilament is specially important. Finally, infection can be diagnosed with clinical signs and cultures, and osseous infection should be evaluated with probing to bone, RX and isotopic studies.
Treatment: patient education is useful, explaining some rules to follow daily. Ischemia will usually need arterial reconstruction (when possible).
Neuropathic lesions will be treated with debridement, pressure relief, draining, wound dressings and symptomatic care.
Lastly, antibiotics will be chosen for infection depending on its gravity, recurrence, and the possibility of osteomyelitis.


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