DIABETIC FOOT SYNDROME. DIABETIC PERIPHERAL NEUROPATHY

The peculiarities of diagnosis and treatment of diabetic peripheral neuropathy are revealed in this article. Diabetic peripheral neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in patients with diabetes mellitus after the exclusion of other causes. The clinical picture of this complication of diabetes mellitus is variable and depends on the predominance of the damage of another type of nerve fibers. There is a failure to detect temperature changes, vibration, deep sensitivity, pressure and pain. From the point of view of a clinical surgery, in case of diabetic foot syndrome it is expedient to distinguish motor, sensory and autonomic diabetic peripheral neuropathy. Motor diabetic peripheral neuropathy is diagnosed objectively, the patient is found an internal minus foot that has the following diagnostic criteria: hammer-shaped fingers, protrusion of the heads of the metatarsal bones on the sole, atrophy of the interstitial muscles of the back of the foot, increased rotation of the distal foot portions, weakness of the long extensor of the big toe, high arch of the foot, dryness and thinning of the skin of the foot. In sensory diabetic pe-ripheral neuropathy, the patient has a variety of com-plaints, among which the most crucial is the lack of pain sensitivity. Autonomic diabetic peripheral neuropathy causes changes in the foot skin and damage of autonomic regulation of the vascular bed. For diagnostics, the patient's complaints analysis, monofilament test, vibration sensitivity test, thermal sensation test, pain identification scale, tests for motorized diabetic peripheral neuropathy are used. For performance of the preventive measures and medical correction, the patients are divided into four categories of risk for the development of neuropathic ulcers: low risk (category 0), moderate (category 1), high (category 2) and very high (category 3). Diabetic peripheral neuropathy is one of the most important risk factors for the limb loss in patients with diabetes mellitus. Modern approaches to the medicinal treatment of diabetic peripheral neuropathy and the orthopedic correction of anatomical abnormalities in patients with diabetic foot syndrome are sufficiently well-developed and allow a significant reduction in the frequency of amputations associated with neuropathic changes, but the situation is still critical at present.