Das diabetische Fußsyndrom

Abstract

The diabetic foot syndrome (DFS) has a great socio-economic impact due to the increasing prevalence of diabetes mellitus. This disease complex is responsible for most non trauma-related limb amputations. The diabetic foot syndrome is classified into a neuropathic, an ischemic and a mixed type. The main pathogenetic mechanism is sensomotoric neuropathy. A frequently simultaneously existing reduced joint mobility as well as a peripheral arterial occlusive disease (PAD) amplify the common pathogenic pathway.

The symptoms of the patients correspond to those of the sensory neuropathy (tingling paresthesia, burning pain, and hyperaesthesia) and are typically exacerbated at night.

In the course of the diagnostic work-up, risk factors of a diabetic foot syndrome are to be elicited in the patient’s history. Clinical examination can determine the severity of neuropathy as well as the presence of a PAD.

The therapeutic approach is primarily aimed to prevent limb amputation. The main therapeutic actions consist of wound debridement, consequent off-loading, treatment of infection, stage-appropriate local wound care, revascularisation, metabolic control as well as patient education. Treatment should therefore always be carried out in a multidisciplinary setting, with a special role being played by the physician due to regular patient examination.

Reduction of limb amputation rate can only be achieved by adherence to these particular treatment protocols.

Aufgrund der steigenden Prävalenz des Diabetes mellitus (DM) in der Bevölkerung kommt auch dem diabetischen Fußsyndrom als einer der häufigsten Langzeitkomplikationen des DM eine stetig wachsende Bedeutung zu. Das diabetische Fußsyndrom muss als Systemerkrankung gesehen und entsprechend interdisziplinär therapiert werden. Nur wenn diese Behandlungsstrategie konsequent eingehalten und die Behandlungserfolge regelmäßig kontrolliert werden, kann eine Senkung der Amputationsrate und damit der Morbidität und Mortalität erreicht werden.

Schlüsselworter

Sensomotorische Neuropathie - Systemerkrankung - periphere arterielle Verschlusskrankheit (pAVK) - Neuropathie-Defizit-Score - Diabetische Neuroosteoarthropathie (DNOAP)

Key words

sensorimotor neuropathy - systemic disease - peripheral arterial occlusive disease - neuropathy-deficit-score - diabetic neuro-osteoarthropathy

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