Diabetic foot syndrome: pathogenesis, diagnosis, modern approaches to therapy

Background. Diabetic foot syndrome is a socially significant late complication of diabetes mellitus. Neuropathic ulcerative defect in diabetic foot syndrome develops on the background of pronounced decrease or absence of peripheral sensitivity, but with preserved main blood flow. Violation or absence of sensitivity leads to the development of foot deformities due to demyelination of motor fibers, as well as the inability to respond to damage due to damage to the sensory component of the peripheral nerve fiber. Autonomic neuropathy makes its significant contribution to the development and aggravation of the process, which is the cause of the development of skin dryness, making it vulnerable to infection. The first successful implementation of a multidisciplinary approach with differentiated treatment of ulcer defects depending on the state of the main blood flow was published in Great Britain in 1986: according to the presented results, healing of neuropathic ulcer defects was achieved in 86% of cases, and ischemic ones in 72%. Currently, significant progress has been made in the study of diabetic foot syndrome. Specific interventions have been outlined to reduce the number of high amputations. The introduction of an interdisciplinary approach to the management of this category of patients has led to a decrease in the number of high lower limb amputations. Factors delaying the healing of chronic wounds in diabetic foot syndrome have been identified.

Results. The publication reflects epidemiologic aspects of the problem, including data on prevalence and lethality. The historical stages of formation of the strategy of complex treatment of patients with this pathology are presented. The questions of pathogenesis of various forms of diabetic foot syndrome are outlined, modern principles of differentiated treatment measures depending on the form of the lesion are given. Types of unloading of the limb involved in the pathological process, indications for the prescription of antimicrobial drugs and the basics of local treatment are discussed.

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