Diabetic neuroarthropathy: Description, Causes, and Risk Factors:
Diabetic neuroarthropathy is increasing in prevalence. All physicians treating diabetic patients should be vigilant in recognizing the early signs of an acute process such as unexplained pain, warmth, edema, or pathologic fracture in a neuropathic foot. Early detection and prompt treatment can prevent joint and osseous destruction, which may result in morbidity and high-level amputation. Patients in the quiescent stage with significant deformity are at high risk for amputation and should be referred to a Diabetic foot clinic for management.
Two competing theories have been proposed to explain the pathogenesis of diabetic neuroarthropathy. The neurovascular theory views this condition as a neurologically-mediated trophic defect resulting in increased osseous blood supply and osteoclastic activity in the absence of injury or repetitive microtrauma.
It is important to diagnose diabetic neuroarthropathy early in the course of the disease so that a foot specialist can prescribe corrective treatment. Untreated, diabetic neuroarthropathy can lead to fracture, dislocation of the bones in the foot, foot deformity, and ulceration and infection, which may require amputation. An MRI of the feet is increasingly becoming the diagnostic procedure of choice.
Keeping your blood sugar levels in your target range, set with your doctor, may help prevent diabetic neuroarthropathy from ever developing. The best way to do this is by checking your blood sugar and adjusting your treatment. It is also important to get to and stay at a healthy weight by exercising and eating healthy foods.
In the mild early stage of this disease, there may only be mild swelling in the foot, however, later on, the foot may develop severe malformations and swell. A red, hot, swollen foot without ulcerations may present.While such a clinical picture may suggest a skin infection called cellulitis, the absence of ulceration, or a history of one, makes this diagnosis less likely. A number of other medical conditions such as gout, deep vein thrombosis, and even malignancy may present with a similar picture.
Diagnostic imaging is indicated primarily to evaluate the extent of bone and joint destruction or to detect osteomyelitis in a patient with a clinical presentation consistent with acute neuroarthropathy.Standard radiographs should be taken at baseline and periodically thereafter to monitor progress. Ruling out osteomyelitis is difficult and may require imaging modalities including In-111 (Indium-111) and Tc-99m(Technetium-99m) HMPAO-labeled leukocyte scans, computerized tomography (CT), and magnetic resonance imaging (MRI). If doubts persist after examination and imaging, then a definitive diagnosis may be obtained by bone biopsy.
Management of diabetic neuroarthropathy should begin at the initial diagnosis of diabetes. The primary care physician needs to be alert for the development of neuroarthropathy — or even its presence at the time of initial diabetes diagnosis — because failure to diagnose diabetic polyneuropathy can lead to serious consequences, including disability and amputation.
Consider any patient with clinical evidence of diabetic peripheral neuropathy to be at risk for foot ulceration, and provide education on foot care. If necessary, refer the patient to Podiatrist. Admit patients for an infected diabetic foot ulcer or gangrene.
Patients with diabetic peripheral neuroarthropathy require more frequent follow-up, with particular attention to foot inspection to reinforce the need for regular self-care. The provision of regular foot examinations and reinforcement of the educational message on foot care have been shown in several studies to significantly reduce rates of ulceration and even amputation.
The primary care physician is responsible for educating patients about the acute and chronic complications of diabetes, including the psychological impact of sexual dysfunction in both men and women. The importance of involving a neurologist (preferably with expertise in peripheral neuropathy) in the treatment of patients with diabetic neuropathy cannot be overemphasized.
NOTE: The above information is an educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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