Post on 05-Jul-2018
8/16/2019 Piciorul Diabetic 1
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Piciorul diabetic
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• Picior diabetic – infecţia, ulceraţia şi/sau distrucţia
ţesuturilor profunde, asociată cu anomalii neurologice şi cuboală vasculară periferică în diferite grade la nivelulmembrelor inferioare.
• Boală vasculară periferică – prezenţa semnelor
clinice ca absenţa pulsului la pedioase, istoric de claudicaţieintermitentă, durerea în repaus şi/sau anomalii la
investigarea vasculară non-invazivă indicnd alterareacirculaţiei.
Consencul Internaţional privind Piciorul Diabetic, 1999
8/16/2019 Piciorul Diabetic 1
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Factori etiologici în patogenia picioruluidiabetic
Picior diabetic
macroangiopatiemicroangiopatie
traumatism
infecţie
polineuropatie modicăristructurale
sclerozaMonckeberg
osteoartropatia
8/16/2019 Piciorul Diabetic 1
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Combination of:
- lack of sensation
- limited joint mobility
- autonomic dysfunction resulting in dryskin
- repetitive ig pressure
callus formation
Boulton !"# et al. $europat%ic &iabetic 'oot (lcers. N Engl J Med )**+0+1-
increase te foot pressure
plantar ulceration at tesite of ma!imum pressure
8/16/2019 Piciorul Diabetic 1
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"udomotor dysfunction
•
impairment of te sympatetic innervation of cutaneous s#eatglands
$autosympatectomy%
• reduction&loss of s#eating - anidrosis
• primarily on te lo#er e!tremities
• dryness of te skin ' may lead to ssure formation( cracks
2empler P 3ed4. Neuropathies. Nerve ds!unction o! diabetic and other origin . 556
portals of entry formicroorganisms
)nfectious ulcers
7ini8 !9 et al. &iabetic !utonomic $europat%:. "e#in Neurol )**)3+406-;).
8/16/2019 Piciorul Diabetic 1
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*lasicarea Meggitt-+agner apiciorului diabetic
• <rad * fara ulcer, dar cu risc inalt
• <rad ulcer superficial
• <rad ) ulcer adanc, e=tins la tendoane, dar nuimplica osul
• <rad ulcer adanc, implica osul, osteomielita
• <rad + gangrena localizata
• <rad gangrena a intregului picior
8/16/2019 Piciorul Diabetic 1
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UNIVERSITY OF TEXAS CLASSIFICATION OF DIABETIC FOOT
GRADE-0 GRADE-1 GRADE-2 GRADE-3
STAGE-
A
Preulcera!"e #r
$#%ulcera!"e
le%!#& c#'$leel(
e$!)el!al!*e+
Su$er,!c!al #u&+. &#
!&"#l"!&/ e&+#&.
ca$%ule #r #&e
#u&+
$e&era!&/ #
e&+#& #r
ca$%ule
#u&+
$e&era!&/ #
#&e #r #!&
STAGE-B I&,ec!#& I&,ec!#& I&,ec!#& I&,ec!#&
STAGE-C I%c)e'!a I%c)e'!a I%c)e'!a I%c)e'!a
STAGE-
D
I&,ec!#& a&+
I%c)e'!aI&,ec!#& a&+ I%c)e'!a
I&,ec!#& a&+
I%c)e'!a
I&,ec!#& a&+
I%c)e'!a
8/16/2019 Piciorul Diabetic 1
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,a inspectie
*auta oricemodicare osoasacunoscandprincipalelemodicari de lanivelul piciorului.
/iabeticFoot 0lcers1Prevention(/iagnostic and *lasication2345.,ocatiile frecvente ale ulceratiilor
la nivelul piciorului
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6specte ale piciorului diabetic
/eformarile osoasepredispun anumitezone la ulceratii
Figure 7. "tructural deformity. +en combined #it sensoryneuropaty( a structural foot deformity may predispose tediabetic patient to ulceration( infection and subse8uentamputation.
F!/ure 4 Neur#$a)!c ulcera!#& #, )e ,## !& a +!ae!c $a!e&4
8/16/2019 Piciorul Diabetic 1
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Picior Charcot
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9!aminare picior
9!amen vascularperiferic1
• palpare puls arterial;
• examinare circulatie venoasa;
• culoare tegumente
• T° tegumente
9!amen neurologic1
•
Testare sensibilitate
- tactila
- termica - dureroasa
•ROT
/iabetic foot disorders: 6merican *ollege of Foot and 6nkle
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<onele de testare a sensibilitatii
=estareasensibilitatii cu
monolament - lapresiune
/iabeticFoot 0lcers1Prevention( /iagnosticand *lasication
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6lte teste de sensibilitate
intepare
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"ensibilitatea tactila
*u re de bumbac
sau cu vata
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Perceptia vibratiilor
• Cu diapazon
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RECOMANAR!
>. )nspectia piciorului se recomanda la ecare vizitaiar e!aminarea completa anual.
>. =estarea sensibilitatii periferice la bolnavul cu diabetse face anual.
>. "e recomanda un controlul agresiv al glicemieipentru a reduce riscul aparitiei piciorului diabetic.
>. Pacientul trebuie invatat sa-si e!amineze piciorul sisa-l ingrijeasca.
>. =rimite la cirurg( ortoped( dermatolog la aparitiaunei rani( infectii( onicomicoze.