Chromanie przestankowe, czyli silny ból w kończynie pojawiający się podczas marszu i ustępujący w spoczynku, to charakterystyczne zaburzenie chodu będące symptomem rozwoju niedokrwiennej stopy cukrzycowej. Powstaje w wyniku zwężenia naczyń krwionośnych, do którego dochodzi w przebiegu cukrzycy.
Jednym z najcięższych powikłań nieleczonej lub niewłaściwie kontrolowanej cukrzycy jest zespół stopy cukrzycowej. Występuje u ok. 5-10 proc. diabetyków. Rozróżnia się dwa typy stopy cukrzycowej – niedokrwienną i neuropatyczną. W początkowej fazie rozwoju niedokrwiennej stopy cukrzycowej można zauważyć m.in. oziębienie i bladość kończyn oraz zaburzenia chodu, w tym właśnie chromanie przestankowe.
Objawy chromania przestankowego
Chromanie przestankowe objawia się bólem, który występuje podczas chodzenia. W przeważającej liczbie przypadków jest zlokalizowany w obrębie łydki. Może jednak objąć także stopę, a w rzadkich przypadkach występuje w udzie, biodrze lub pośladku. U niektórych pacjentów zamiast bólu lub jako objaw towarzyszący występuje drętwienie stopy.
Dolegliwości bólowe są tak uciążliwe, że wymuszają przerwanie aktywności. W stanie spoczynku ból samoistnie ustępuje, jednak nawraca wraz ze wznowieniem wysiłku. Nasilenie objawów czy dystans, który można przebyć bez bólu, mogą ulec zmianie w zależności od ogólnego stanu zdrowia pacjenta. W niektórych przypadkach chorzy doświadczają okresów pogorszenia. Inni pacjenci mogą natomiast przez cały czas doświadczać takiego samego natężenia symptomów.
Chromanie przestankowe skutkiem upośledzenia krążenia w przebiegu cukrzycy
Występująca w cukrzycy przewlekła hiperglikemia prowadzi do patologicznych zmian w naczyniach krwionośnych, m.in. zwężenia lub niedrożności tętnic. Konsekwencją zmniejszonego przepływu krwi jest niedotlenienie kończyn dolnych, w tym także stóp. Tkanki nie otrzymują wystarczającej ilości składników odżywczych. Jednocześnie wskutek niedostatecznego przepływu krwi gromadzą się w nich szkodliwe produkty przemiany materii.
Tymczasem podczas wysiłku takiego jak chodzenie czy bieganie mięśnie przejawiają zwiększone zapotrzebowanie na tlen. Ponadto w trakcie aktywności fizycznej następuje wzmożona produkcja beztlenowych produktów przemiany materii. Odkładanie się metabolitów prowadzi do zakwaszania mięśni. Skutkuje to podrażnieniem receptorów bólowych. Następstwem jest właśnie chromanie przestankowe.
Chromanie przestankowe objawem poprzedzającym owrzodzenia
Chromanie przestankowe to jeden z wczesnych objawów zaburzeń ukrwienia. Może przejść w ciężkie niedokrwienie z dolegliwościami bólowymi w stanie spoczynku, które nasilają się nocą. Przewlekłe niedotlenienie prowadzi m.in. do cieńczenia i przesuszania skóry. Staje się ona szczególnie podatna na urazy. Pęknięcie naskórka może doprowadzić do rozwoju przewlekłych owrzodzeń.
Rany trudno się goją ze względu na niedostateczne odżywienie tkanek i są podatne na zakażenia. Następstwem nieleczonego zespołu stopy cukrzycowej może być nawet amputacja kończyn dolnych. Z tego powodu wykrycie wczesnych objawów ZSC, takich jak zaburzenia chodu, jest kluczowe, ponieważ pozwala na wdrożenie działań profilaktycznych i uniknięcie powstania owrzodzeń.
Źródła: „Chirurgia”, red. W. Noszczyk, t. 2, Warszawa 2005, str. 558-559.
E. Drela, G. Mielczarz, „Zespół stopy cukrzycowej niedokrwiennej – od epidemiologii do diagnostyki”, w: „Pielęgniarstwo Chirurgiczne i Angiologiczne”, 2017; 11 (3): 73–77.
Przeczytaj także: Zespół stopy cukrzycowej – jak powstaje?
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