Tactics of managing a patient with diabetic foot syndrome

Diabetic Foot Syndrome (DFS) − a specific symptom complex of foot lesions in diabetes mellitus (DM), the basis of the pathogenesis of which is diabetic micro-, macroangiopathy, peripheral neuropathy of the lower extremities and osteoarthropathy.

These processes develop in parallel, mutually burdening each other, with the addition of severe purulent-necrotic lesions, which are characterized by a special composition of the microflora and a course against the background of deep metabolic disorders and immunosuppression.

Find out in the article on estet-portal.com about the latest recommendations regarding the diagnosis and treatment of patients with diabetic foot syndrome.

• Assessing the risk of developing diabetic foot syndrome
• Frequency of diabetic foot syndrome risk assessment
• Measures that are prohibited in the treatment of diabetic Assessing the risk of developing diabetic foot syndrome When examining a patient with diabetes, it is recommended to remove shoes, socks, bandages and examine both feet for the presence of such risk factors for developing diabetic foot:
neuropathy;

lower limb ischemia;

ulcers; corns;

presence of inflammation, deformity;
gangrene;
Charcot arthropathy.
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It is also recommended for these patients to have

annual ankle-brachial index to assess the state of the peripheral arteries. Individuals with diabetes may have false positive results due to arterial calcification.

Diabetes mellitus in young patients: features of management

To assess the risk of developing diabetic foot syndrome in the clinic, it is recommended to use the following risk stratification:

1. Low risk: no risk factors except callus;

2. Moderate risk: Presence of deformity, neuropathy, or signs of limb ischemia.

3. High Risk:

history of ulcer or amputation; patient receiving renal replacement therapy;

combination of neuropathy and non-critical limb ischemia; combination of neuropathy with callus and/or deformity

;
Combination of non-critical limb ischemia with callus and/or deformity.
• Frequency of risk assessment for diabetic foot syndrome
• Recommended intervals for assessing the risk of developing DFS:
Annually for low-risk individuals;

Every 3-6 months for those at moderate risk;

Every 1-2 months for high-risk individuals; Every 1-2 weeks for high-risk and critically ill patients.

1.  
 

The

threatening conditions in the presence of diabetic foot syndrome

ulcer with existing limb ischemia;

gangrene of the foot or individual fingers.

• Development of new forms of insulin preparations for the treatment of diabetes mellitus
• If the patient has an ulcer, the physician should evaluate and record the data in the medical history.  It is recommended to use a
standardized system for documenting the severity of a foot ulcer

, e.g.

SINBAD (Site, Ischaemia, Neuropathy, Bacterial Infection, Area and Depth).

Measures that are prohibited in the treatment of diabetic foot

Due to possible complications, it is not recommended to use the following methods: in the treatment of diabetic foot syndrome

electrostimulation therapy;

platelet-rich plasma (PRP therapy); dalteparin and regenerative matrices; growth factors (G-CSF, EGF, PDGF, TGF-.beta.);

hyperbaric oxygen therapy.
• If there is a suspicion of an infection in a diabetic foot, it is recommended to take a tissue / bone sample and send it for microbiological analysis.
• It is recommended to 
x-ray the affected foot(s)
•  of the patient to determine the extent of the lesion. In the presence of an infection of a diabetic ulcer, it is necessary to
rule out osteomyelitis
• .

When a foot ulcer infection is confirmed, it is recommended to

start antibiotic therapy as soon as possible in patients with DFS

. It is recommended to start the 1st line of therapy with oral forms of antibacterial drugs, if the severity of the condition does not require a parenteral form of administration.

 

When prescribing parenteral (intravenous) antibiotic therapy, it is recommended to evaluate after 48 hours and if the patient's condition improves − switch to oral form.

It must also be remembered that a foot or ankle fracture in a person with diabetes can lead to

Charcot's arthropathyTo confirm this complication,

radiography of the affected foot and ankle

is performed. If the x-ray shows no changes, it is recommended to

perform an MRI.

Drug therapy for diabetic complications

As a treatment for this pathology, a non-removable individual unloading bandage

can be used. If a bandage is not appropriate in the treatment of the patient, it is recommended that a

removable unloading bandage be considered. However,, bisphosphonates are prohibited for the treatment of patients with acute Charcot arthropathy.

Patients who have deformity due to previous Charcot arthropathy are at high risk of developing an ulcer.

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