DIABETES
Diabetes
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A chronic illness affecting more and more people , podiatrist have an important role.
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The foot is the main site of complications caused by this disease since 90% of diabetic patients hospitalized are there to treat a foot pathology.
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Diabetes can lead to neuropathic (loss of sensitivity), arteriopathic (poor circulation of arterial blood) and serious podiatric complications .
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Care by a podiatrist allows the gradation of podiatric risk, curative care, patient education, evaluation of footwear and the implementation of orthotic treatment (insoles) if necessary.
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In France, 10 to 15% of diabetic patients still have to undergo amputation today when all therapeutic interventions have failed to stop the devastating effects of this disease.
In Mauritius the number of amputations is disproportionate.
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It is therefore crucial to continue individual prevention efforts , which offer the best chance of optimizing patients' quality of life, alongside basic research into the disease itself.
For further ...
1
GRADE 0
no sensory neuropathy
GRADE 1
isolated sensory neuropathy
Gradations
GRADE 3
history of ulceration or amputation
2
GRADE 2
Sensory neuropathy associated with arteriopathy of the lower limbs and/or foot deformity.
General complications of diabetes
The metabolic changes caused by diabetes broadly generate three types of major complications:
Neurological complications Damage to the peripheral nerves causes sensory and motor deficits which mainly affect the nerves of the lower limbs (leg), with a predominance distally: the lesion of the nerve is all the more serious the closer you are to the extremities.
Infectious complications The diabetic patient's immune system is weakened. Diabetics are more likely to contract bacterial infections and are also more vulnerable to skin and nail fungus. In addition, the metabolic alterations observed reduce the effectiveness of antibiotic and antimycotic treatments in these patients.
Vascular complications: Cholesterol deposits lead to progressive obstruction of the large arterial trunks (macroangiopathy) as well as an alteration of small vessels (microangiopathy). These two phenomena cause arteritis predominantly in the lower limbs as well as impaired healing. Skin lesions heal poorly, creating entry points for germs responsible for infectious pathologies.
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Repercussions of its complications on the feet
Almost all of the pathologies encountered in the diabetic foot are caused by neurological damage. This mainly leads to:
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- sensory-motor impairments
- neuro-vegetative damage
- osteoarticular and skin damage
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Osteoarticular consequences
Diabetic arthropathies can lead to deformities such as collapse of the arch of the foot (Charcot foot), but also areas of osteoporosis, bone lysis and ossification.
Skin consequences
The different bone deformations will modify the shape of the foot and the uniformity of its plantar supports. We will see the appearance of pathological support when walking with the formation of horny areas (hyperkeratosis) next to the areas of greatest pressure. The lack of sensitivity to pain often present at this stage of the disease, as well as the lack of prevention, are often responsible for the transformation of these calluses into plantar perforating pain (MPP). In the absence of rapid treatment, these skin lesions become chronic because healing does not occur and osteitis (skeletal damage) is often to be feared. The blisters which may appear following a conflict with the shoe, although seemingly trivial, must be treated quickly in good aseptic conditions because they are a source of infection with the dramatic consequences that we know in a context of diabetes.