Diabetes mellitus (DM) & foot issues seems a synonym for diabetics, because most people with diabetes recognize that at some point there's likely to experience a gangrenous foot. Compared with non-diabetic, people with diabetes more often had gangrenous foot, an estimated 17 times more often. In large clinics in the United States every two of 6 action is diabetic foot amputation. Therefore it is understandable, diabetic foot is not a medical issue, but also the economic issues for patients & hospitals.
Diabetic foot issues are complicated by the various treatments that often takes time, & not always successfully, to give encouragement to us that all efforts ought to be made to prevent the occurrence of diabetic foot. The idea that all people with diabetes have poor leg circulation is not true. Most have a standard circulation, patients-patients who are comparatively young age. The older the age, the less nice circulation of the foot.
Foot disorders CLASSIFICATION
Abnormalities of the foot in diabetes may be caused by infection / septic, neuropat, ischemic or a mix of all. Distinguishing the causes is necessary to adjust the treatment steps to be taken. At a young age seems to ischemia has not been lots of factors played a role. The rest, in elderly age is more often found the reason for the combination, ischemia & infection so that the prognosis would be worse. It is positive that the amputation of elderly age is always caused by diabetes mellitus.
Opinion that the state of hyperglycemia resulted in basically grown bacteria was not true. It seems that the growth factor plays hipoksemi germs. Poor tissue oxygenation due to ischemia reduces the ability of immune response so that the bacteria basically grow the network. Without the factor of ischemia & neuropathy, foot infections in diabetics are not much different from the infection in non-diabetic.
� Because infection
� Because of neuropathy
Diabetic neuropathy disifati by sensory disturbances, in the sense of loss of superficial perception. In addition to reduced vibration sense is lost. Also found weak inherent foot muscles, causing dorsal dislocation of the thumb. This deformity due weight will be concentrated on the thumb so that over time will form callus. Cracked callus is breeding grounds for bacteria that usually stafilokok which gradually formed an indolent ulcer. Infection may penetrate in to the bone & there was osteomyelitis. The same method can be on the tarsal joints & provide a unique & deformity known as Charcot arthropathy.
� vascular obstruction in diabetes is always at the age of information, usually over 50 years & more often in boys. More related to age factor of the period of diabetes. The presence of neuropathy is more ease of gangrene. Ischemic foot usually appears dry, atrophic, hairless accompanied by abnormalities in the nail. Dorsalis pedis artery & posterior tibial artery is usually difficult to be touched, even sometimes not palpable. As lots of as 3% of patients-diabetics with intermittent claudicatio typical complaints. Osilometri examination is helpful to find disorders of blood circulation in the legs.
Ischemia in the legs give you different clinical picture, ie rest pain (rest pain) & gangrene. At rest leg pain felt chilled & looked pink. Feeling like a burning pain on the whole leg & is usually worse at night. Gangrene is always starts at my toes. Usually painless, purplefish color to black & then dry. If accompanied by infection, gangrene in to wet & smelled peculiar.
TREATMENT
General
Absolute bed rest on each diabetic foot disorders. By running put pressure on the ulcer area, & permit the destruction of tissue that prevents healing fibroblasts. In addition, any pressure on the wound to provide pain & ischemia in the surrounding area so that healing becomes difficult.
� Rest
� Insulin
Each infection destabilize diabetes, hyperglycemia may exacerbate the infection otherwise. Therefore, fundamentally foot disorders, with infection requires strict control of blood glucose. Patients with infectious disorders ought to be diverted to the historicallyin the past received insulin when oral medications. always lead to infection of increased insulin needs is not unusual even twice-daily injections must dirobah to times a day. In contrast to note that the wound healing reduces the necessity for insulin injections so that the dosage ought to be reduced.
� Antibiotics
Any injury to the leg requiring antibiotics, however, does not mean giving antibiotics indiscriminately. Germ cultures absolutely must be done to get the appropriate type of antibiotic. From experience, every infection produces multiple germ culture. From of the research at New England Deaconess Hospital are always present in three groups of bacteria, namely: kokki gram positive, gram negative & kokki anerob group.
Special
It seems worse the higher the state of infection of gram-negative bacterial species. When extreme infection found any type of gram-negative Proteus, & Pseudomonas enterokokus, the prognosis is usually poor. Because of infection in diabetes there is an inclination to deteriorate quickly, antibiotic treatment ought to be started immediately. The existence of gas gangrene ought to be suspected of germ anerob. At the foot of a worsening infection, antibiotics ought to be selected (while waiting for culture results) was an intravenous administration. groups are thought about nice combination is a mix of aminoglycoside, ampicillin & clindamycin or a cephalosporin & chloramphenicol.
� debridement
Debridement means using knives, scissors & tweezers to remove as much necrotic tissue. Not only remove but also open network of pathways for drainage of pus to be nice. After cleaning, the wound can be compressed with Betadine solution (dilution two times) or 1% neomycin solution. Both are excellent solution to the festering wound. At the festering wound ought to be done three times a day. Let's not soak the feet to gangrene, because warm water can increase the metabolic needs of tissues thereby worsening ischemia.
Words amputation is always scary for everyone with diabetes, therefore always dilcaitkan with the mind could not walk anymore. By itself this is not always true, amputation of toes, by itself does not interfere with the activities of the road. Action amputation in diabetes can be on your toes, transmetatarsal, below the knee & above the knee. Some things require to be thought about in performing an amputation, including amputation ought to be done in areas where circulation is still nice for the wound healed. Do not do the amputation of the infection because healing usually fail.
� Amputation
Chiropody
In most patients with diabetic foot disorders are usually looking for help doctors after state of the foot is bad. Based on prevention is much more either of the treatment, it is proper foot care ought to get primary attention. The best way to prevention is to teach people to know things related to the occurrence of foot disorders, in addition to foot examination by a physician. Either way Rumah-Sakit/amputasi likelihood of entry will be much reduced.
Some things to think about as a preventive measure, either by doctors or patients. It is recommended that the doctors always take in to account:
From several clinical studies found the frequency of foot examination by a physician in internal medicine clinic & diabetes clinic ranged from only 19% of visitors compared with for example blood pressure checks reached 76.9% of patients. So it is clear that attention to patients although a doctor for foot care was minimal.
Swelling of the feet is essential to find the cause, because in patients with diabetic neuropathy, a gentle infection that is sometimes not accompanied by pain. Charcot joint is never resemble degenerative arthritis. By radiological examination, the diagnosis can be enforced.
one) The foot
three) Leather foot / nail
Not infrequently the patient is accompanied by infection of the nail / skin. Narrow shoes often give blisters on the skin that can become the source of the foot to gangrene. Require to discover a thickening of the skin, callus, fissures or ulceration.
They recommend that you use a wide shoes, do the taper.
three) The situation shoes
Pulsation pulse foot must always be touched, the posterior tibial artery. Use of Doppler ultrasound recorder much help find abnormalities of the arteries in the legs. It is recommended for method examination in patients with advanced age.
two) Palpation of the foot pulse
Require to palpation temperature comparisons left & right leg. Even between the leg calf & thigh to select the degree of blood supply to the peripheral.
two) Palpate foot temperature
6) Status of sensory-motor foot
Neurological examination is important one time again simple to do. Vibration tests left & right foot, checking reflexes, they recommend this examination is done routinely. It seems not difficult if at all diabetics ought to be given schooling / information - information relating to the occurrence of diabetic foot.
one. Check your feet every day. Research abnormalities that occur such as scuffed by shoes, infection of the foot / nail.
three. the nail to be shortened. Trim nails straight line basis so as not to give the wound at the corner of the nail.
three. Feet ought to be cleaned every day & immediately dried. It is better if after dried rubbed with an oily material such as oil cream for the feet is not dry. Never soak feet in warm water / hot, because temperature changes in tissue metabolism imposes foot.
two. Wear shoes that are broad, not pointed & ladies do with high shoes.
two. Modify your socks every day. Do not use socks that are tight / elastic, preferably wool socks. in ladies are encouraged to not wear stockings.
Some general advice can be given to patients is this:
SUMMARY
Diabetic foot is a nice issue to patients, physicians as well as economic. Of the causes of diabetic foot disorders, ischemia & infection factors most often present in particular in advanced age. Not infrequently the patient come to the foot doctor in a state that has been so bad that amputation is a last resort. Therefore, foot care is the best way to prevent the occurrence of diabetic foot. Foot care includes observation of each day by patients, examination by a doctor at each visit & the prevention of the use of narrow shoes.
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