Zespół stopy cukrzycowej to jedno z najgroźniejszych powikłań cukrzycy. W podstawowej klasyfikacji wyróżnia się trzy postaci stopy cukrzycowej: neuropatyczną, naczyniową oraz mieszaną. Czym się różnią poszczególne rodzaje stopy cukrzycowej?
Zespół stopy cukrzycowej objawia się poprzez owrzodzenia zlokalizowane najczęściej na podeszwowej (pięta) lub grzbietowej (główki kości śródstopia, grzbiety palców) części stopy. Owrzodzenie może ulec zakażeniu.
Przyczyną patologicznych zmian, które powstają w przebiegu zespołu stopy cukrzycowej, są uszkodzenia nerwów i więzadeł oraz zaburzenia krążenia. Z tego powodu wyróżnia się dwa podstawowe rodzaje stopy cukrzycowej: stopę neuropatyczną oraz niedokrwienną. Postać trzecia, mieszana, łączy obydwa wymienione czynniki etiologiczne.
Neuropatyczna stopa cukrzycowa – przyczyny i objawy
Polineuropatia obwodowa jest przyczyną 65 proc. przypadków zespołu stopy cukrzycowej. Postać neuropatyczna występuje częściej u pacjentów z cukrzycą typu 1. Chory, u którego doszło do uszkodzenia nerwów, ma zaburzone odczuwanie bodźców dotykowych (wibracje, temperatura, ból). Powoduje to, że pacjent nie odczuwa nadmiernego ucisku powodowanego przez obuwie oraz dolegliwości bólowych stwarzanych przez inne czynniki (np. skaleczenie stopy ostrym przedmiotem).
Polineuropatia prowadzi również do osłabienia mięśni, co skutkuje powstaniem deformacji (szeroka, płaska stopa, palce młoteczkowate). Chory nieprawidłowo ustawia nogę podczas chodzenia, przez co powstają nietypowe obszary ucisku.
Zaburzenia te prowadzą do powstania zmian skórnych takich jak np. modzele, odciski lub otarcia. Wraz z rozwojem choroby zmiany ulegają powiększeniu, w wyniku czego dochodzi do powstania owrzodzeń.
Stopa neuropatyczna jest ciepła i zachowuje naturalną barwę. Skóra często wykazuje oznaki przesuszenia, stopa nie ulega poceniu. Może występować skłonność do drętwienia oraz dolegliwości bólowe takie jak pieczenie, mrowienie, ból o przeszywającym charakterze. Ból nie występuje natomiast podczas chodzenia.
Niedokrwienna stopa cukrzycowa – przyczyny i objawy
Niedokrwienna stopa cukrzycowa wiąże się z zaburzeniami krążenia, do których dochodzi w przebiegu cukrzycy. Naczyniowa stopa cukrzycowa występuje u ok. 15-20 proc. pacjentów, przede wszystkim wśród chorych na cukrzycę typu 2.
W przypadku niedokrwiennej stopy cukrzycowej dochodzi do upośledzenia ukrwienia na skutek zwężenia tętnic. Niedokrwienie stopy powoduje, że procesy gojenia nawet w przypadku drobnych urazów są zaburzone.
Stopa niedokrwienna jest zimna i sina, tętno nie jest wyczuwalne na tętnicy grzbietowej stopy. U chorego występuje chromanie przestankowe, czyli dolegliwości bólowe, które nasilają się podczas wysiłku, a ustępują podczas odpoczynku. Nie występują natomiast zaburzenia czucia temperatury i bólu. Stopa nie ulega deformacji.
Źródła: pulsmedycyny.pl, diabdis.com, mp.pl
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