[Diabetic foot syndrome]

Abstract

PATHOGENETIC FACTORS: The decisive factors for the etiology of the diabetic foot syndrome (DFS) are diabetic neuropathy, macroangiopathy and the combination of neuropathy with macroangiopathy. If ischemia prevails, macroangiopathy decisively deteriorates the prognosis and leads, together with local infection, to amputation in almost all cases of DFS. Triggering factors are exogenous trauma by tight shoes, foreign bodies and insufficient foot care combined with a foot deformity, which develops in the context of osteoarthropathy. Pathogenetic factors include the increased collagen deposition and network by advanced glycosylation endproducts, the loss of adipose tissue and the occurrence of edema, which destroy the compensating balance between preventive and damaging factors.

Therapy: Regular routine inspections by the physician and the patient for hyperkeratosis, fungal infection, skin lesions, control of footwear and foot deformities are as indispensable as the examination of the neurologic and angiologic status. Treatment requires the know-how of a specialized center in collaboration of different medical disciplines, e. g., the diabetologist, the angiologist, the orthopedic and vascular surgeon, the interventional radiologist and assistance by the podiatrist, the orthopedic technician and expert diabetic counseling. Whereas the neuropathic lesion almost always heals under local therapy and pressure release, ischemic lesions demand revascularization. A superimposed infection calls for microbial and resistance testing, since up to six different agents including anaerobic bacteria can be found. This situation needs systemic antibiotic therapy and local treatment.

Prophylaxis: The amputation rate can be considerably reduced by these measures. Even more important is structured teaching of the patient, which can reduce amputation by 60-70%, which underlines the importance of prophylaxis in DFS. Teaching to the patient must comprise daily inspection of the feet, correct hygiene of the feet and adequate footwear.