scholarly journals Detection of skin microvascular vasodilation disorders in patients with diabetic foot syndrome during the local heating test

2015 ◽  
Vol 14 (3) ◽  
pp. 27-33 ◽  
Author(s):  
N. A. Zubareva ◽  
S. Y. Podtaev ◽  
A. A. Parshakov
Keyword(s):  
Wavelet Analysis ◽  
Diabetic Foot ◽  
Healthy Subjects ◽  
Local Heating ◽  
Diabetic Polyneuropathy ◽  
Limb Ischemia ◽  
Diabetic Foot Syndrome ◽  
Time Frequency ◽  
Plantar Surface ◽  
Heating Test

Introduction and purpose. The aim of investigation was to evaluate the possibility of using the method of wavelet analysis of skin temperature during the local heating test for the study of the microvascular tone regulation in patients with diabetic foot syndrome (DFS). Materials and methods. The study was performed in 15 healthy subjects and 10 patients with neuro-ischemic form of DFS complicated by trophic ulcers. The temperature of the plantar surface of the hallux was recorded by «Microtest» (Perm, Russia) with temperature resolution 0,002°C. Time-frequency analysis of temperature fluctuations was performed using wavelet analysis. For the reconstruction of the oscillations in endothelial (0.02-0.0095 Hz), neurogenic (0.05-0.02 Hz) and myogenic (0.05-0.14 Hz) frequency ranges we used inverse wavelet transform. Results. In healthy people, indexes of vasodilation (relative changes in the oscillation amplitudes) in the myogenic, neurogenic, and endothelial frequency ranges were 3.04, 4.01 and 2.25 respectively. In patients with DFS the values were significantly lower than in healthy subjects (0.60, 0.67 and 0.51, respectively). Conclusion. In contrast to healthy subjects, the combination of diabetic polyneuropathy with endothelial dysfunction and macroangiopathy in patients with neuro-ischemic form of DFS leads to the progression of mutually aggravating pathological processes and lower limb ischemia. Further implementation of the local heating test at the early stages of diabetic foot is of interest for the prognosis of the disease, evaluating the effectiveness of conservative treatment and endovascular interventions.

scholarly journals Pedographic assessment of the impact of off-the-shelf orthopedic shoes on the load distribution under the feet in patients with a high risk of developing diabetic foot syndrome

2021 ◽  
Vol 23 (5) ◽  
pp. 442-451
Author(s):  
Vadim B. Bregovskiy ◽  
Oleg V. Udovichenko ◽  
Anastasia G. Demina ◽  
Eugenia Aleksandrovna Berseneva ◽  
Irina A. Karpova
Keyword(s):  
High Risk ◽  
Diabetic Foot ◽  
Load Distribution ◽  
Objective Assessment ◽  
Daily Basis ◽  
Diabetic Foot Syndrome ◽  
Lateral Part ◽  
Plantar Surface ◽  
The Impact ◽  
Orthopedic Shoes

BACKGROUND: It is known that the so-called “rocker” outsole helps to reduce the load on the forefoot and toes. Such an outsole is available in ready-made orthopedic shoes of some Russian manufacturers, however, an objective assessment of their impact on the load distribution under the foot during walking has not been carried out.AIMS: To study the pressure distribution inside the off-the-shelf orthopedic shoes“Sursil-Ortho” in comparison with the load inside the shoes used by patients on a daily basis.METHODS: We studied 20 patients (40 feet) with a high risk of diabetic foot syndrome. According to clinical data, a risk regions were determined on the plantar surface of the feet. In-shoe pedography (pedar, novel,Germany) was performed in shoes usually worn by the patients, and in orthopedic shoes“Sursil-Orto”(Moscow). The maximum peak pressure (MPP) was calculated. Criterion of efficiency: MPP in the risk region<200 kPa or reducing it by 25% or more.RESULTS: There was a significant decrease of the median MPP in the forefoot and in the risk region. The percentage of feet with MPP >200 kPa in the risk region decreased from 58% to 30% (p=0,014), in any area of the forefoot — from 63% to 30% (p=0,04). The increase in MPP under the midfoot and hindfoot did not exceed +14% (ns). Tested footwear was effective in 71% of cases. Predictors of the insufficient effect were: higher initial MPP in the risk region, risk region on the hallux or in the lateral part of the forefoot.CONCLUSIONS: Shoes with a rigid rocker outsole significantly reduce the pressure under the forefoot and under the toes during walking. The degree of load reduction varies: the lateral part of the forefoot and 2-5 toes are most unloaded, and the hallux and medial forefoot are slightly less.

Stellenwert von mikrozirkulatorischen Untersuchungsmethoden bei Patienten mit diabetischem Fuß-Syndrom

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Lawall ◽  
Amann ◽  
Rottmann ◽  
Angelkort
Keyword(s):  
Diabetic Foot ◽  
Reactive Hyperemia ◽  
Diabetic Polyneuropathy ◽  
Capillary Density ◽  
Diagnostic Methods ◽  
Diabetic Foot Syndrome ◽  
Type I ◽  
Additional Information ◽  
Type Ii Diabetics

Background: Diabetic foot syndrome (DFS) is a frequent complication of long-standing diabetes mellitus, occurring in 10 to 30 percent of all diabetics with a vital risk for the affected limb and high mortality rates. Macroangiopathy, diabetic polyneuropathy and infections are trigger factors for DFS. Recent results imply a pathogenic role of functional and structural microcirculatory changes. The exact role of microangiopathy and the value of microcirculatory diagnostic methods in DFS have not yet been defined. Patients and methods: 78 patients with DFS (28 type I, 50 type II diabetics, mean age 63 years) were evaluated with video capillary microscopy, transcutaneous partial oxygen tension (tcpO2) measurement and laser Doppler fluxmetry (LDF) at the forefoot of the affected leg at admission and after revascularisation. Mean hospital stay was 28 ± 11.7 days. Patients were stratified according to the etiology of DFS in patients with neuropathic lesions, macroangiopathic ulcers and mixed neuropathic-angiopathic lesions. Results: All groups had impaired microcirculation, and significant differences between groups were found in respect to capillary density. Reactive hyperemia, LDF pattern and tcpO2 did not differ significantly. Microcirculatory examinations did not yield additional information to clinical and Doppler sonographic results. Conclusion: In clinical practice, the role of microcirculation evaluation techniques for diabetic foot syndrome is limited.

Reduced microvascular reactivity in patients with diabetic neuropathy

2021 ◽  
pp. 1-12
Author(s):  
K.A. Krasulina ◽  
P.A. Glazkova ◽  
A.A. Glazkov ◽  
D.A. Kulikov ◽  
D.A. Rogatkin ◽  
...  
Keyword(s):  
Local Heating ◽  
Diabetic Polyneuropathy ◽  
Compensatory Mechanisms ◽  
General Group ◽  
Doppler Flowmetry ◽  
Microvascular Reactivity ◽  
Structural Disorders ◽  
Patients With Diabetes ◽  
Michigan Neuropathy Screening Instrument ◽  
Heating Test

BACKGROUND: Neurogenic regulation is involved in the development of microcirculation response to local heating. We suggest that microvascular reactivity can be used to estimate the severity of diabetic polyneuropathy (DPN). OBJECTIVE: To evaluate the prospects for using the parameters of skin microvascular reactivity to determine the severity of DPN. METHODS: 26 patients with diabetes mellitus were included in the study (patients with retinopathy (n = 15), and without retinopathy (n = 11)). The severity of DPN was assessed using Michigan Neuropathy Screening Instrument (MNSI) and Norfolk QOL-DN (NQOLDN). Skin microcirculation was measured by laser Doppler flowmetry with local heating test. RESULTS: There were revealed moderate negative correlations between microvascular reactivity and the severity of DPN (for MNSI (Rs = –0.430), for NQOLDN (Rs = –0.396)). In patients with retinopathy, correlations were stronger than in the general group (for MNSI (Rs = –0.770) and NQOLDN (Rs = –0.636)). No such correlations were found in patients without retinopathy. CONCLUSION: Correlation of the microvascular reactivity and DPN was revealed in patients with registered structural disorders in microvessels (retinopathy). The lack of such correlation in patients without retinopathy may be explained by the intact compensatory mechanisms of microvessels without severe disorders.

scholarly journals Diabetic foot syndrome: importance of calf muscles MR spectroscopy in the assessment of limb ischemia and effect of revascularization

2017 ◽  
Vol 63 (4) ◽  
pp. 236-241
Author(s):  
Andrea Němcová ◽  
Michal Dubský ◽  
Alexandra Jirkovská ◽  
Petr Šedivý ◽  
Miloslav Drobný ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Mr Spectroscopy ◽  
Limb Ischemia ◽  
Diabetic Foot Syndrome ◽  
Calf Muscles

scholarly journals The Role of Physical Therapy in the Combined Treatment of Patients with Lower Extremities Diabetic Angiopathies

2021 ◽  
Vol 20 (2) ◽  
pp. 80-87
Author(s):  
Denis V. Frolov
Keyword(s):  
Diabetes Mellitus ◽  
Physical Therapy ◽  
High Mortality ◽  
Physical Training ◽  
Diabetic Foot ◽  
Vascular Complications ◽  
Lower Extremities ◽  
Diabetic Polyneuropathy ◽  
Diabetic Foot Syndrome ◽  
Diabetic Angiopathies

One of the most disabling complications of diabetes mellitus is angiopathy of the lower extremities. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with vascular complications of diabetes mellitus, which significantly aggravate the course of the disease and contribute to high mortality. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with the diabetes mellitus vascular complications that significantly aggravate the course of the disease and contribute to high mortality. Despite the improvement in the results of pharmacotherapy of diabetes mellitus, the problem of treating its vascular complications is far from being solved. Traditionally, therapeutic physical training is used among the methods of non-drug treatment of diabetes mellitus and its complications. As a method of pathogenetic focus on many risk factors for the development of diabetes and its complications, physical therapy exercises contribute to the correction of the syndrome of hypodynamia, obesity, and muscle atrophy. At the same time, there is insufficient data on how exercise therapy affects the quality of life of patients, functional characteristics of walking and objective indicators of blood flow in the lower extremities. This review identifies the main approaches to the application, advantages and disadvantages of individual methods of therapeutic physical training in the correction of functional disorders in patients with lower extremities diabetic angiopathies. We can currently talk about the proven safety of the physical therapy use in patients with diabetic angiopathies. Meanwhile, the scientific data on the high efficiency of this method is still insufficient.

scholarly journals Interdisciplinary approach to the management of the neuropathic form of diabetic foot syndrome. The role of the orthopedist

2020 ◽  
Vol 5 (4) ◽  
pp. 22-27
Author(s):  
A. K. Volkovoy ◽  
V. N. Obolensky ◽  
V. G. Protsko ◽  
E. Yu. Komelyagina ◽  
S. V. Gorokhov ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Chronic Wound ◽  
Interdisciplinary Approach ◽  
Diabetic Foot Syndrome ◽  
Plantar Surface

The article presents the experience of an interdisciplinary approach to the management of diabetic foot syndrome using the example of treating a patient with a neuropathic form, which manifests itself as a chronic wound of the foot plantar surface.

scholarly journals Application of metabolic therapy in pathogenetic treatment of patientes with diabetic foot syndrome

2018 ◽  
Vol 23 (4) ◽  
pp. 356-361
Author(s):  
A.V. Garnitskaya
Keyword(s):  
Diabetic Foot ◽  
Diabetic Polyneuropathy ◽  
Polyol Pathway ◽  
Diabetic Foot Syndrome ◽  
Early Application ◽  
Nerve Growth ◽  
Metabolic Therapy ◽  
Reductase Inhibitors ◽  
Chronic Hyperglycemia ◽  
Stimulation Of Nerve

According to modern recommendations concerning the treatment of diabetic foot syndrome, it is necessary along with intensive control of carbohydrate and lipid metabolism, to use the strategy of early application of agents that promote pathogenetic correction of diabetic polyneuropathy and angiopathy, the main links in the development of lesions of lower extremity tissues. Means of metabolic therapy can counteract the influence of such pathogenetic factors as chronic hyperglycemia, activation of the polyol pathway, oxidative stress, glycation of structural, transport and receptor proteins, disruption of nerve growth and regeneration. Timely administration of alpha-lipoic acid, aldose reductase inhibitors, B-group vitamins, antithrombotics, prevention of glycation and stimulation of nerve growth factors can slow or prevent the passage of SDS into a purulent-necrotic form, reducing the risk of trophic ulceration and amputation.

scholarly journals Pathogenetic substantiation of infusion therapy using modern methods of visualization in diabetic foot syndrome

2012 ◽  
Vol 93 (2) ◽  
pp. 344-346
Author(s):  
L A Akhmetyanov ◽  
R I Fatykhov ◽  
I V Klyushkin ◽  
A E Kolesnikov ◽  
V V Naumov
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Comprehensive Evaluation ◽  
Local Treatment ◽  
Treatment Algorithm ◽  
Limb Ischemia ◽  
Diabetic Foot Syndrome ◽  
Venous Stasis ◽  
Individual Treatment ◽  
Infusion Therapy

Aim. To propose a pathogenetically substantiated infusion therapy based on the results of a comprehensive evaluation of lower limb ischemia in diabetic foot syndrome. Methods. Energetic Doppler sonography of the blood vessels of the lower extremities in its distal part and electrothermometry in 32 patients with diabetic foot syndrome and critical limb ischemia was conducted in addition to the general clinical imaging studies (radiography, ultrasonography in the «gray scale» mode). Considering the obtained data the treatment strategy in these patients (conservative or surgical) was determined together with a physician-endocrinologist. Results. Presented is an example of tactics formation for conservative infusion therapy of a patient with diabetes mellitus, which is complicated by the diabetic foot syndrome with critical limb ischemia. Compiled was an individual treatment algorithm. At the initial stage crystalloid solutions (slow drip, followed by urination stimulation) were administered. Next prescribed were vitamins from group B (cyanocobalamin 0.25 mg and pyridoxine 50 mg) in order to regulate the metabolism of key neuromediators and amino acids. The complex of treatment included the nonsteroidal anti-inflammatory drug diclofenac (25 mg). This was followed by administration of dextran solutions (reopolyglukine), in combination with an antiplatelet solution (pentoxifylline). At the final stage of therapy administered was prostaglandin E1 (alprostadil, 3-4 infusions per course). Local treatment: osmotic agents were applied to the right foot as semi-alcohol compresses to relieve swelling, improve microcirculation and promote closure of the fistulas. After the conducted treatment noted was an improvement in general condition, pain symptoms subsided, the fistula closed, the soft tissue on the foot had no signs of inflammation. Recovery of the parameters of microcirculation signify the relief of arterial and venous stasis. Conclusion. This treatment scheme will make it possible to improve the course of the disease, reduce the time of treatment and disability of patients, will also improve their quality of life.

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