DISABILITY ON DIABETES MAINLY TO DIABETIC FOOT |
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Diabetes mellitus is a progressive multi-system disease that affects 5% of the population in the United States. Approximately 25% of diabetic patients will eventually present to a physician's office with a problem involving the foot. Foot disorders manifest in many ways ranging from a mild corn or callus to limb-threatening infection. Neuropathy, infection, and angiopathy are the main features of diabetic foot pathology. Charcot's joints and osteearthropathy may lead to complications because of the osseous pathology. Diabetic foot problems may result in disability. Seventy-five percent of all patients admitted because of diabetes mellitus have evidence of neuropathy. Symptoms of diabetic neuropathy may include pain, loss of temperature sensation, paresthesia, weakness, and breakdown of skin. Distal metatarsal narrowing, characterized as "peppermint sticks," may also occur. An individual with diabetic neuropathy and coexisting ischemia with periodic capillary blood flow blockage will experience less sensation than a normal individual. The absence of discomfort enables these individuals to tolerate a tight shoe for many hours, which can lead to necrosis and possible ulceration. Vascular disease is a major cause of morbidity and mortality among diabetic patients. Thorough dermatologic examination of the patient's lower extremity includes checking for corns and calluses, ulceration, intertriginous maceration, and nail pathology. Often, pathological conditions are hidden: Debridement of a callus may reveal an ulcer. The orthopedic examination of the diabetic foot should include evaluation of digital deformities, such as contracted digits, bunions, deformed or prominent metatarsal, and osteoarthropathy. TESTS IN EVALUATING DISABILITY IN DIABETES: DIAGNOSTIC STUDIES: Neuropathies make nerves more vulnerable to minor repetitive trauma, leading to peripheral nerve entrapments. Sensory nerves are affected more than motor nerves. NERVE CONDUCTION STUDIES: Neuropathy may be accompanied by loss of pain and temperature sensation. DISABILITY DUE TO VASCULAR COMPLICATIONS: Neuropathic edema may result from microvascular disturbance following autonomic denervation; treatment with epinephrine is indicated in rare instances. When autonomic dysfunction is associated with neuropathy and vasculopathy, edema of the foot may exacerbate pain, swelling, and progressive gait difficulty. Patients with ischemic vascular disease generally have dry, scaly feet with soft tissue atrophy, hair loss, and fissures on the heels and bony prominence. Dorsal pedis and posterior tibial pulses are reduced and venous filling time prolonged. The ischemic foot is cold and may contain painful neuropathic ulcers or gangrenous ischemic ulcers. TREATMENT OF DIABETIC FOOT
Surgery
Patients need to pay close attention to their feet and be aware of any potential problems. Physicians should also be aware of the need to examine their patients' feet. Successful treatment of the diabetic foot requires control of diabetes, as that may diminish complications and improve quality of life. |