of belonging; due to acral malnutrition, muscle atrophy, flexor and extensor loss of normal balance of traction tension, so that subsidence caused by the
bone joints between the toes bending, forming arched feet, hammer toes, foot deformities such as chicken feet toe. The clinical manifestations of diabetic
foot:
(1) the general performance of the foot: Due to neuropathy, limb skin dry without sweat; extremities tingling, burning, numbness, feeling sluggish or loss,
showing sock-like change, foot batting sense of belonging; because acral malnutrition, muscle atrophy, loss of normal flexor and extensor balance of traction
tension, so that the bone joints between the toes of subsidence caused by bending, forming arched feet, hammer toes, chicken feet and other foot deformities
toe. When a patient's bone and joint and soft tissue strain occurs when the patient continues to walk prone to cause bone and joint and ligament damage,
causing multiple fractures and ligament rupture, the formation of Charcot joints (Charcot). X-ray bone destruction over there, and some small bone fragments
from the periosteum of gangrene caused by sequestrum affect healing.
(2) ischemia mainly: Common skin malnutrition muscular atrophy, dry skin elasticity is poor, relying on hair from the skin temperature decreased, there is
pigmentation, acral arterial pulse weakened or disappeared, vascular stenosis at vascular murmur can be heard. The most typical symptom is intermittent
claudication, rest pain, squatting difficult to stand. When patients have damaged or spontaneous limb skin blisters after infection, the formation of ulcers,
gangrene or necrosis.
(3), diabetic foot ulcers can be classified according to the nature of neurological disease ulcers, ischemic ulcers and mixed ulcers. Neurogenic ulcer:
Neuropathy played a major role in the etiology of the blood circulation good. This foot is usually warm, numb, dry, the pain is not obvious, the foot
arteries fluctuation good. And have enough nerve lesions can have two consequences: nervous ulcer (mainly occurred in the foot) and neural arthropathy
(Charcot joints). Ischemia-induced foot ulcers, non-neurological disease, is rare. Nerve - the same time, these patients with ischemic ulcers are peripheral
neuropathy and peripheral vascular disease. Dorsalis pedis artery fluctuations disappear. The foot is cool these patients, and may be accompanied by rest
pain, foot ulcers and gangrene the edge of the Department.
Foot ulcers more common in the former site of foot, and often repeated was caused by mechanical stress, due to peripheral neuropathy caused by the
disappearance of protective sensation, the patient can not feel the pressure of this abnormal change, can not take some protective measures in place after
the ulcer concurrent infection, difficult to heal ulcers and ultimately gangrene.
Treatment of diabetic foot:
(1) to focus on prevention, try to avoid foot injury, such as wearing loose fit of the shoes and socks so as to avoid wear and tear the skin; such as poor
eyesight, do not self-cut nails; feet with warm water to avoid burns and so on.
(2) General treatment: In addition to strict control of blood sugar, improve whole body health levels, to eliminate some known risk factors for vascular
disease, such as the treatment of high blood pressure, lower blood fat, quit smoking and so on.
(3) removal of edema: As long as there is edema, all of the ulcers are difficult to heal, this has nothing to do with the causes of ulcers. Can be used
diuretics or ACE-I treatment.
(4) infection in treatment: a foot infection patients, especially those with osteomyelitis and deep abscess, and they should in the monitoring of blood
glucose, based on intensive insulin therapy in order to reach or near-normal blood glucose level. According to the results of bacterial cultures and drug
susceptibility testing to choose suitable antibiotics. Superficial infection of the organization may be granted partial debridement and broad-spectrum
antibiotics, such as cephalosporin Gac Linda ADM (clindamycin can be a very good access to organizations, including the difficult to access the diabetic
foot); should not be singled Enzymes using cephalosporins or quinolones as antibacterial spectrum of these drugs does not include anaerobic bacteria and some
G + bacteria. Oral treatment can last for several weeks. Deep infection of these antibiotics are available, but it should begin from the intravenous
administration, but also require surgical drainage, including the removal of infected bone tissue, and amputation.
(5) surgical treatment: refractory ulcers can be surgically treated. When the diabetic foot infection or gangrene affecting the foot most of the post and the
central, the surgeon must choose to major amputation in patients with conservative treatment, or as much as possible.
