Picior diabetic infecia, ulceraia i/sau distrucia

esuturilor profunde, asociat cu anomalii neurologice i

cu boal vascular periferic n diferite grade la nivelul
membrelor inferioare.

Boal vascular periferic prezena semnelor
clinice ca absena pulsului la pedioase, istoric de
claudicaie intermitent, durerea n repaus i/sau
anomalii la investigarea vascular non-invaziv indicnd
alterarea circulaiei.

Consencul Internaional privind Piciorul Diabetic, 1999
Factori etiologici n patogenia
piciorului diabetic
Picior diabetic
macroangiopatie
microangiopatie
traumatism
infecie
polineuropatie
modificri
structurale
scleroza
Monckeberg
osteoartropatia
Combination of:
- lack of sensation
- limited joint mobility
- autonomic dysfunction resulting in dry skin
- repetitive high pressure
callus formation
Boulton AJM et al. Neuropathic Diabetic Foot Ulcers. N Engl J Med 2004;351:48-55
increase the foot pressure
plantar ulceration at the site
of maximum pressure
Sudomotor dysfunction
impairment of the sympathetic innervation of cutaneous sweat glands
autosympathectomy
reduction/loss of sweating - anhidrosis
primarily on the lower extremities
dryness of the skin may lead to fissure formation, cracks
Kempler P (ed). Neuropathies. Nerve dysfunction of diabetic and other origin. 1996
portals of entry for microorganisms
Infectious ulcers
Vinik AI et al. Diabetic Autonomic Neuropathy. Semin Neurol 2003;23(4):365-372.
Clasificarea Meggitt-Wagner
Grad 0 fara ulcer, dar cu risc inalt
Grad 1 ulcer superficial
Grad 2 ulcer adanc, extins la tendoane, dar nu
implica osul
Grad 3 ulcer adanc, implica osul, osteomielita
Grad 4 gangrena localizata
Grad 5 gangrena a intregului picior
Multiple stenosis on arteries of
both inferior limbs
Treatment Total contact cast