NEUROPATHY IN DIABETES_mechanisms and consequences

Posted by e-Medical PPT Wednesday, August 22, 2012
Mechanisms of  diabetic foot 
Loss of pain sensation
Unrecognized trauma
Loss of joint position sense
Abnormal foot posture
Wasting of small intrinsic muscles
Foot deformity
Intrinsic deformity:Clawing of toes,Flattening of arch
Abnormal pressure loading
Callus formation
Connective tissue change:Nonenzymatic glycation of collagen and keratin,Tissue breakdown
Angiopathy:Decreased blood flow,Delayed healing
Autonomic neuropathy: Decreased sweating,Dry fissures/cracks
Opening of AV channels:Shunting of nutrients and oxygen from tissues

Risk factors for ulceration
Neuropathy
Vasculopathy
Previous ulceration
Elevated foot pressure
Foot callus
Foot deformities:
   Charcot foot, hammer toes

Charcot neuropathy
An arthroneuropathy = bone + joint involvement due to sensory + autonomic neuropathy
HOT SWOLLEN FOOT
D/D: osteomyelitis
Pain is preserved
Continued weight bearing worsens condition
Motor involvement: ligament stretching, spontaneous dislocations
Autonomic involvement: high blood flow
Increased osteoclastic activity
Reduced bone density

What should be done ?
  • Detect neuropathy early
  • Correct neuropathy early
  • Correct footwear
  • Correct vascular status
  • Prevent diabetic foot
  • Prevent amputations
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