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Diagnosis of diabetic foot

 
, medical expert
Last reviewed: 04.07.2025
 
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Early diagnosis of initial signs of damage to the peripheral nervous system, vascular system, soft tissues and bone structures of the lower extremities is aimed at preventing amputations in patients with diabetes mellitus.

To conduct an initial diagnostic search, a general clinical examination and a minimal set of instrumental diagnostic methods are often sufficient to help determine the state of peripheral innervation and main arterial blood flow.

Mandatory examination methods in outpatient settings:

  • collection of complaints and anamnesis;
  • examination and palpation of the lower limbs;
  • determination of pain, tactile, temperature and vibration sensitivity;
  • determination of LPI;
  • bacteriological examination of wound exudate and ulcer tissues with determination of the microbial spectrum and sensitivity of microorganisms to antibacterial agents;
  • general clinical and biochemical blood tests;
  • coagulogram;
  • X-ray of the foot in the presence of an ulcerative defect, swelling, hyperemia.

The diagnostic search should begin with the clarification of the patient's complaints and collection of anamnesis. It is necessary to pay attention to such complaints as leg pain, its nature and connection with physical activity, coldness of the feet and paresthesia, swelling of the lower extremities, subjective manifestations of decompensation of carbohydrate metabolism, increased body temperature, the presence of ulcerative defects and deformations of the feet and ankle joints. When collecting anamnesis, special attention should be paid to the duration and nature of the course of the underlying disease, the presence of ulcerative defects of the feet and shins in the past, possible concomitant diseases that affect the development of diabetic foot syndrome. The patient's family history and current living conditions are important. Already on the basis of complaints and anamnesis, it is possible to form a first impression of whether the patient is at risk for developing diabetic foot syndrome.

The most common complaints associated with diabetic foot syndrome are:

  • numbness of fingers and feet;
  • pain (usually moderate, but causes a feeling of anxiety and fear in the patient);
  • weakness and fatigue in the legs;
  • cramps in the calf muscles;
  • paresthesia;
  • change in the shape of the feet.

The next stage of the diagnostic search is an examination of the patient's lower limbs in a well-lit room. It is necessary to examine not only the dorsal but also the plantar surface of the feet, interdigital spaces. Examination and palpation of the lower limbs will allow the doctor to form an idea of the presence of deformations and their nature, color, turgor and temperature of the skin, the presence of ulcerative defects, their size, localization and condition of the surrounding tissues, pulsation of the peripheral arteries.

To assess the severity of distal pelineuropathy, various types of sensitivity are examined. For this purpose, the following tools are used:

  • to assess tactile sensitivity - a monofilament weighing 10 g;
  • to assess vibration sensitivity - a graduated tuning fork;
  • To assess temperature sensitivity - two glass test tubes filled with warm and cold water, or a cylinder made of two materials with a constant temperature difference ("type-therm").

The absence of pulsation in the arteries of the feet during palpation dictates the need for ultrasound Doppler with measurement of the ABI using a portable Doppler device and a sphygmomanometer. The cuff of the manometer is applied to the middle third of the shin. The Doppler sensor is installed at the projection point of the posterior tibial artery or dorsalis pedis artery. Systolic blood pressure is measured in one of the listed arteries. Then, using the standard method, systolic blood pressure is measured in the brachial artery. ABI is calculated as the ratio of systolic blood pressure in the artery of the lower limb to systolic blood pressure in the brachial artery. Normally, ABI is 0.8-1. A decrease in this indicator below 0.8 indicates that the patient has obliterating disease of the arteries of the lower limbs. An increase in ABI to 1.2 and above indicates severe diabetic neuropathy and Monkeberg's mediocalcinosis.

Evaluation of the condition of the bone structures of the foot and detection of signs of diabetic osteoarthropathy are based on radiography of the feet and ankle joints. For greater information, radiography of the feet is performed in two projections: direct and lateral.

Mandatory examination methods in a specialized hospital:

  • collection of complaints and anamnesis;
  • inspection and palpation of the lower extremities
  • determination of pain, tactile, temperature and vibration sensitivity;
  • determination of LPI;
  • bacteriological examination of wound exudate and ulcer tissue with determination of the microbial spectrum and sensitivity of microorganisms to antibacterial agents;
  • determination of the size and depth of the ulcer defect;
  • duplex scanning of arteries to determine the degree and extent of occlusive lesions (when choosing a method of vascular reconstruction - radiocontrast angiography);
  • transcutaneous determination of tissue oxygen saturation (oximetry) to detect ischemia and its severity;
  • X-ray, computed tomography and/or magnetic resonance imaging (MRI) of the bone structures of the lower extremities to identify signs of osteomyelitis, the presence of a deep infectious process in the tissues of the foot;
  • general clinical and biochemical blood tests (lipid spectrum, total protein, albumin, creatinine, potassium, alkaline phosphatase, ionized calcium, bone isoenzyme alkaline phosphatase) to determine the severity of the atherosclerotic process, diabetic nephropathy, bone resorption and osteosynthesis;
  • coagulogram,
  • assessment of the condition of the fundus.

To determine the severity of diabetic foot syndrome, it is important to fully assess the depth of the ulcer defect, the presence of cavities, and the condition of the surrounding tissues. To do this, it is necessary to measure the area and depth of the trophic ulcer, conduct a bacteriological study of the wound discharge and soft tissues. The material for the study should be taken not from the surface of the ulcer defect, but from the depth of the affected tissues.

To conduct a qualified study, the rules for collecting and transporting material must be carefully followed.

The presence of bone structure lesions in patients with various clinical forms of diabetic foot syndrome determines the relevance of conducting an examination aimed at verifying the genesis of bone pathology and determining the tactics of its treatment. For this purpose, in addition to traditional radiography, it is possible to conduct MRI, CT, osteoscintigraphy.

Severe foot deformity in patients with diabetic osteoarthropathy leads to the formation of atypical areas of excessive load pressure on the plantar surface. Identification of areas is of great importance for the development of measures to prevent recurrence of ulcerative defects. The method of computer pedobarographim allows one to correctly select orthopedic devices and evaluate the effectiveness of their use.

Differential diagnosis of diabetic foot syndrome

Differential diagnostics is usually carried out between ischemic and angiopathic ulcers. Non-diabetic ulcers have an atypical localization, not associated with areas of excess pressure on the foot. In addition to diabetes mellitus, neuroosteoarthropathy occurs in some systemic diseases: tertiary syphilis, syringomyelia, leprosy.

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