El pie diabético

El pie diabético está considerado como un pie de alto riesgo, está demostrado que si aplicáramos una adecuada y correcta educación sanitaria a todos los profesionales de la salud y al propio paciente, se podrían evitar en la mayoría de los casos las tan temidas amputaciones. En el presente trabajo hacemos referencia de las características más importantes de la diabetes, pie diabético y a la actuación profesional del podólogo frente a estos pacientes.

Tratamientos provisionales y definitivos en el pie de riesgo

Los autores presentan varios casos de pacientes diabéticos con lesiones en el pie, a los que se les aplican diferentes alternativas de tratamientos ortopodológicos.

"Pied de Charcot": un diagnostic à ne pas manquer [Charcot osteoarthropathy: don't miss it!].

Charcot neuropathic osteoarthropathy (CNO) is a destructive process affecting the bone and joint structure of diabetic patients and resulting from peripheral neuropathy. It is a limb threatening condition resulting in dramatic deformities associated with severe morbi-mortality. The diagnosis is mostly made by the observation of inflammatory signs and higlight the importance of prompt foot evaluation. Imaging studies may help confirm the diagnosis and the severity of the condition but lack of specificity. The goal of the treatment is to maintain or achieve structural stability of the foot and ankle to prevent further deformity and plantar dislocation. The scientific evidences aren't strong enough to recommend bisphosphonates or acute surgical treatment. Surgery is unanimusly recommended to prevent secondary ulceration.

La importancia de la cirugía en la resolución de un proceso ulceroso en el pie diabético

Las lesiones necróticas son actualmente una de las primeras causas de amputación del pie diabético, lo que conlleva un gran coste personal, económico y social. Este artículo muestra que existe la alternativa de llevar a cabo un tratamiento quirúrgico ante una úlcera de grado 3, realizando una cirugía curativa para ayudar a cicatrizar la misma.

La infermeria d'atenció primària en l'atenció als problemes del peu en la diabetis tipus 2 a Catalunya

Aquesta tesi pretén respondre a la pregunta: Què pot fer la infermeria d'atenció primària i què és el què fa, en els problemes del peu en persones amb diabetis tipus 2 a Catalunya?. L'estat del tema exposa la importància de les complicacions en el peu i la possibilitat de reduir-les amb un paper rellevant de la infermeria d'atenció primària. La investigació s'ha centrat en conèixer de què disposa, les activitats que desenvolupa, i què li manca a la infermeria per desenvolupar el seu potencial. Els resultats observats són representatius i mostren clares desigualtats assistencials entre centres, regions sanitàries i tipus de gestió. Suggerint que en l'atenció primària convé organitzar i coordinar l'atenció als problemes del peu en la diabetis, millorar la formació i la capacitació infermera en el tema, fomentar i optimitzar la presència de professionals especialitzats, i potenciar l'educació en diabetis i la promoció de la salut.

Prevalência de doença arterial obstrutiva periférica (DAOP) e alterações sensoriais em pacientes diabéticos tipo 2: impacto da DAOP sobre a qualidade de vida, nível de atividade física e composição corporal

Diabetes Mellitus (DM) affected approximately 171 million people in the world in the year 2000 as described by the World Health Organization (WHO). Because DM is a multisystem disease it can cause several complications especially those related to the cardiovascular system. The Peripheral Arterial Disease (PAD) of the lower limbs and the Diabetic Distal Symmetric Polyneuropathy (DDSP) can affect the DM patient causing consequences as the diabetic foot and eventually amputations. The main objective of this study was to determine the prevalence of PAD and sensorial impairment in 73 type 2 DM (DM2) patients and also assess the impact of PAD on quality of life, level of physical activity and body composition. For clinical assessment it was used: the ankle-brachial index (ABI); quantitative sensorial test for tactile sensibility (ST), pain (SD), vibration (SV); Achilles tendon reflex (RA); quality of life questionnaire (SF-36); modified Baecke physical activity questionnaire and bioelectric impedance. Prevalence of PAD in the studied population was 13.7%. ABI was inversely correlated to age (p=0,03; rhô= -0,26), diabetes duration (p=0,02; rhô= -0,28) and blood pressure (p= 0,0007; rhô= -0,33). There were lower scores for physical health summary on the SF-36 in DM2 patients; however, the presence of PAD predominantly mild did not significantly impact quality of life, body composition or physical activity level assessed by questionnaire. Fourteen patients (19.2%) present bilateral and symmetrical alterations in two or more sensorial tests compatible to DPN diagnosis. Abnormalities in ST, SD and SV were present in 27.3%, 24.6% and 8.2%; respectively. There was association of results from ST abnormalities with RA and mainly with SD, suggesting the importance of 10g monofilament use in DM2 routine assessment. In conclusion, the prevalence of PAD in subclinical DM2 was slightly higher compared to the general population and in agreement to previously published data in DM patients. The PAD severity was predominantly mild and still without repercussion on quality of life and body composition. Our study demonstrated a significant prevalence of both PAD and DPN in DM2 without previous diagnosis of these complications and indicates the necessity of early preventive and therapeutic interventions for this population

Parâmetros da marcha em portadores de diabetes mellitus

O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação, predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chave: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e pré-balanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques.

Parâmetros espaço temporais da marcha e inter-relação com equilíbrio e força muscular isométrica de tornozelos em diabéticos com neuropatia periférica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Parâmetros da marcha, pressões plantares e equilíbrio corporal de diabéticos neuropatas e vasculopatas, com o uso de palmilhas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Potencial imunogênico dos curativos bioativos: aspectos imunhematológicos e leucoplaquetários

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Diabetes mellitus e complicações em idosos residentes em municípios de médio porte no Estado de São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo comparativo das representações sociais sobre diabetes mellitus e pé diabético

The study aimed to investigate social representations of the terms diabetes and diabetic foot in different populations. Participants were divided into groups: diabetics (GD); non- diabetics (GN); and non-diabetic healthcare professionals (GP). Personal data were collected, and subjects answered two questions that were expected to evoke five words that came to mind when they thought of diabetes and then diabetic foot. The evoked material was analyzed with the software Ensemble de Programmes Permettant l'Analyse dês Èvocations. A total of 161 subjects participated, including GD (n = 72) with a mean age of 56.12 ± 5.49 years; GN (n = 38) with a mean age of 54.29 ± 7.91 years; and GP (n = 51) with 34.95 ± 7.52 years. The term diabetes evoked 297 words in GD, 172 in GN, and 235 words in GP. The term diabetic foot evoked 180 words in GD, 90 in GN, and 236 in GP. The groups proved to be anxious for more information, thus confirming the need for awareness-raising and educational programs on diabetes, covering comprehensive issues concerning the disease.

Implementation of physiotherapeutic shares in the prevention of diabetes complications in a Family Health Strategy

Introduction In the Family Health Strategy (FHS), the treatment of Diabetes Mellitus (DM) includes education and lifestyle change strategies. Physiotherapists have a key role in this health setting. Objectives To implement actions of evaluation and guidelines for patients with type 2 DM who attend a Family Health Strategy (FHS), regarding diabetic foot and the practice of regular physical exercise in the control and prevention of the complications of Diabetes Mellitus. Methods 17 individuals from an FHS were evaluated, with the following procedures: clinical and anthropometric parameters, inspection, a questionnaire on diabetic neuropathy, tests of vibratory and tactile sensitivity, muscle function, range of motion, functional analysis, questions about exercise practice and guidance regarding controlling blood glucose and foot care. Results Deformities, dry skin, calluses, dehydration, ulceration, cracking and brittle nails were found. Peripheral neuropathy was not observed; tactile sensitivity was altered in the heel region and the vibratory sense was absent in 5% of individuals. A decrease in functionality of ankle movements was verified. Of the participants, 76% were sedentary, 24% knew about the benefits of practicing regular exercise, 25% had undergone a medical evaluation prior to performing physical exercise and, of these, 25% were supervised by a qualified professional. Discussion The implementation of physiotherapy actions in diabetics from an FHS was important for highlighting the presence of risk factors for diabetic complications. Conclusions Individuals attending the FHS need more information and programs for the prevention of diabetic complications.