Zusammenfassung
Die Diagnostik des diabetischen Fußes muss interdisziplinär erfolgen. Hier gehen Diabetologie, Angiologie und Neurologie Hand in Hand. Neben der Beschreibung des Status des Lokalbefundes ist die Evaluation einer begleitenden Neuropathie ebenso wichtig wie der Gefäßstatus, sodass vor allen invasiven Maßnahmen eine entsprechende Gefäßrekonstruktion erfolgt. Dritte Komponente im Rahmen der diagnostischen Sicherung ist der Status der Infektsituation, da der nicht adäquat behandelte Infekt ein hohes Risikopotential für eine nachfolgende Major-Amputation beinhaltet. Sofern die Diagnostik bereits auf diese drei Hauptaspekte des diabetischen Fußes fokussiert ist, ergeben sich Vorteile für die Therapieplanung und für das Outcome des Patienten.
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Literatur
Literatur zu Kap. 3.1
Abouaesha F, Van Schie CH, Armstrong DG, Boulton AJ (2004) Plantar soft-tissue thickness predicts high peak plantarpressure in the diabetic foot. J Am Podiatr Med Assoc 94:39–42
Alazraki N, Dalinka MK, Berquist TH et al. (2000) Imagingdiagnosis of osteomyelitis in patients with diabetesmellitus. American College of Radiology.ACR AppropriatenessCriteria. Radiology 215: S303–S310
Armstrong DG, Lavery LA (1998) Diabetic foot ulcers: prevention, diagnosis and classification. AmFam Physician 57:1325–1328
Balsells M, Viade J, Millan M et al. (1997) Prevalence of osteomyelitisin non-healing diabetic foot ulcers: usefulness ofradiologic and scintigraphic findings. Diabetes Res ClinPract 38: 123–127
Boulton AJ, Kirsner RS, Vileikyte L (2004) Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med 351:48–55
Canade A, Savino G, Porcelli A et al. (2003) Diagnostic imagingof the diabetic foot. What the clinician expects to knowfrom the radiologist. Rays 28: 433–442
Cotroneo AR, Citterio F, Cina A, Di Stasi C (1997) The role ofinterventional radiology in the treatment of the diabeticfoot. Rays 22: 612–637
Deanfield JE, Daggett PR, Harrison MJG (1980) The role ofautonomic neuropathy in diabetic foot ulceration.J NeurolSci 47: 203–210
Fleiss DJ (1998) Elevated peak plantar pressures in patientswho have Charcot arthropathy. J Bone Joint Surg Am 80:185–3
Grimm A, Kastenbauer T, Sauseng S, Sokol G, Irsigler K (2004) Progression and distribution of plantar pressurein Type 2 diabetic patients. Diabetes NutrMetab 17:108–113
Jude EB, Boulton AJ (2001) Update on Charcot neuroarthropathy. CurrDiab Rep 1: 228–232
Lipsky BA (2008) New developments in diagnosing and treatingdiabetic foot infections. Diabetes Metab Res Rev 24Suppl 1:S66–S71
Lobmann R (2011) Das DiabetischeFussyndrom. Der Internist52: 539–548
Lobmann R, Kayser R, Kasten G et al. (2001) Effects of preventativefootwear on foot pressure as determined by pedobarographyin diabetic patients: a prospective study. Diabet Med 18: 314–319
Mayser P, Hensel J, Thoma W et al. (2004) Prevalence of fungalfoot infections in patients with diabetes mellitus type 1- underestimation of moccasin-type tinea. ExpClinEndocrinol Diabetes 112: 264–268
O’Brien KE, Chandramohan V, Nelson DA et al. (2003) Effect ofa physician-directed educational campaign on performanceof proper diabetic foot exams in an outpatientsetting. J Gen Intern Med 18: 258–265
Papanas N, Ziegler D (2011) New diagnostic tests for diabeticdistal symmetric polyneuropathy. J Diabetes Complications25:44–51
Pinzur MS, Shields N, Trepman E, Dawson P, Evans A (2000) Current practice patterns in the treatment of Charcotfoot. Foot Ankle Int 21: 916–920
Rumenapf G, Dittler S, Morbach S, Amendt K, Radu A: (2008) The vascular surgeon's role in interdisciplinary treatmentof diabetic foot syndro]. Chirurg 79:535–545
Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, Mills JL, Reekers J, Shearman CP, Zierler RE, Hinchliffe RJ (2012) Diagnosis and treatment of peripheralarterial disease in diabetic patients with a foot ulcer. A progress report of the International WorkingGroup on the Diabetic Foot. Diabetes Metab Res Rev 28Suppl 1:218–224
Schultz GS, Sibbald RG, Falanga V et al. (2003) Wound bedpreparation: a systematic approach to wound management. Wound Repair Regen 11 (Suppl 1): S1–S28
Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D (2003) Preparing the wound bed 2003: focus on infection andinflammation. Ostomy Wound Manage 49: 23–51
Spruce MC, Potter J, Coppini DV (2003) The pathogenesis andmanagement of painful diabetic neuropathy: a review. Diabet Med 20: 88–98
Sumpio BE, Lee T, Blume PA (2003) Vascular evaluation andarterial reconstruction of the diabetic foot. ClinPodiatrMed Surg 20: 689–708
Vinik AI (2003) Management of neuropathy and footproblems in diabetic patients. Clin Cornerstone5: 38–55
Zangaro GA, Hull MM (1999) Diabetic neuropathy: pathophysiologyand prevention of foot ulcers. Clin Nurse Spec13: 57–65
Zimny S, Schatz H, Pfohl M (2002) Determinants and estimationof healing times in diabetic foot ulcers. J DiabetesComplications 16: 327–332
Zimny S, Voigt A, Schatz H, Pfohl M (2003) Prediction ofwound radius reductions and healing times in neuropathicdiabetic foot ulcers. Diabetes Care 26: 959–960
Literatur zu Kap. 3.2
Ford ES, Gilles WH, Dietz WH (2002) Prevalence of the metabolicsyndrome among US Adults: findings from the thirdNational Health and Nutrition Examination study. JAMA287: 356–359
Gordon T, Kannel WB (1972) Predisposition to atherosclerosisin the head, heart and legs: the framingham study.J Am Med Assoc 221: 661–666
Grundy SM, Howard B, Smith S et al. (2002) Prevention ConferenceVI: Diabetes and cardiovascular disease: Executivesummary: conference proceeding for healthcareprofessionals from a special writing group of the AmericanHeart Association. Circulation 105: 2231–2239
Kannel WB (1994) Risk factors for atherosclerotic cardiovascularoutcomes in different arterial territories. J CardiovascRisk 1: 333–339
Kannel WB, Hjortland M, Castelli WP (1974) Role of diabetesin congestive heart failure: the Framingham Study.Am J Cardiol 34: 29–34
Kannel WB, Wolf PA, Garrison RJ (1988) The FraminghamStudy: An epidemiological Investigation of cardiovasculardisease. Survival following initial cardiovascularevents: 30-year follow-up. NIH Publication No. 88–2909. Washington: US Public Health Service; Secion 35
Khaw KT, Wareham N, Luben R et al. (2001) Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohortof European prospective investigation of cancer and nutrition (EPIC-Norfolk). BMJ 322: 15–18
Lawall H, Diehm C, Pittrow P (2009) Deutsche Gesellschaftfur Angiologie, Gesellschaft fur Gefasmedizin. LeitlinienzurDiagnostik und Therapie der peripherenarte riellenVerschlusskrankheit (PAVK). VASA 38 [suppl75]:1–72
Scheffler A, Driessen G, Rieger H (1999) TranskutaneMessungdes O2-Partialdruckes. In: Rieger H, Schoop W (Hrsg.)KlinischeAngiologie; Springer Heidelberg Berlin NewYork
Scheffler A, Rieger H (1992) A comparative analysis of transcutaneousoxymetry during oxygen inhalation and legdependency in severe peripheral arterial occlusivedisease. J VascSurg 16: 218–224
Strauss AL (1999) Konventionelle und farbcodierteDuplexsonographie.In: Rieger H, Schoop W (Hrsg.) KlinischeAngiologie. Springer Heidelberg Berlin New York
Sucker C, Lanzer P (2000) Arteriosklerose und Mediasklerose.EineGegenuberstellungzweierkalzifizierenderGefaserkrankungen.Med Klin 95: 207–210
TransAtlantic Inter-Society Consensus (TASC) Working group (2000) Management of peripheral arterial disease.J VascSurg 31: S1–S296
Windler E, Greten H (1999) Stoffwechselstorungen undGefaswand. In: Rieger H, Schoop W (Hrsg.) KlinischeAngiologie. Springer, Heidelberg Berlin New York
Literatur zu Kap. 3.3
Bakkers M, Merkies IS, et al. (2009) Intraepidermal nerve fiberd ensity and its application in sarcoidosis. Neurology73(14): 1142–1148
Devigili G, Tugnoli V, et al. (2008) The diagnostic criteria forsmall fibre n europathy: from symptoms to neuropathology. Brain 131(Pt 7): 1912–1925
Dyck PJ, Carter RE, et al. (2011) Modeling nerve conductioncriteria for diagnosis of diabetic polyneuropathy. MuscleNerve 44(3): 340–345
Dyck PJ, Davies JL, Litchy WJ, O’Brien PC (1997) Longitudinalassessment of diabetic polyneuropathy using a compositescore in the Rochester Diabetic Neuropathy Studycohort. Neurology 49: 229-23 9
Dyck PJ, Thomas PK (2005) Peripheral Neuropathy. Elsevier, Amsterdam
European Federation of Neurological Societies/PeripheralNerve Society (2010) Guideline on the use of skin biopsyin the diagnosis of small fiber neuropathy. Report of ajoint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. J PeripherNervSyst 15(2): 79–92
Herman WH, Pop-Busui R, et al. (2012) Use of the MichiganNeuropathy Screening Instrument as a measure of distalsymmetrical peripheral neuropathy in Type 1 diabetes:results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications.Diabet Med 29(7): 937–944
Idiculla J, Shirazi N, et al. (2004 ) Diabetic amyotrophy: a briefreview. Natl Med J India 17(4): 200–202
Kovac B, Marusic-Emedi S, et al. (2011) Clinical and electrophysiologicalsigns of diabetic polyneuropathy - effect ofglycemia and duration of diabetes mellitus. ActaClinCroat 50(2): 149–157
Kuehl M, Stevens MJ (2012) Cardiovascular autonomic neuropathies as complications of diabetes mellitus. Nat RevEndocrinol 8(7):405–1
Lauria G, Cornblath DR, et al. (2005) EFNS guidelines on theuse of skin biopsy in the diagnosis of peripheral neuropathy. Eur J Neurol 12(10): 747–758
Low PA, Caskey PE, Tuck RR, Fealey RD, Dyck PJ (1983) Quantitativesudomotor axon reflex test in normal and neuropathicsubjects. Ann Neurol 14: 573–580
O’Hare JA, Abuaisha F, Geoghegan M (1994) Prevalence andform s of neuropathic morbidity in 800 diabetics. Ir J MedSci 163: 132–135
Rolke R, Baron R, et al. (2006) Quantitative sensory testing inthe German Research Network on Neuropathic Pain(D FNS): standardized protocol and reference values. Pain123(3): 231–243
Simone DA, Nolano M, et al. (1998) Intradermal injection ofcapsaicin in humans produces degeneration and subsequentreinnervation of epidermal nerve fibers: correlation with sensory function. J Neurosci 18(21): 8947–8959
Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M (2003) The spectrum of neuropathy in diabetes andimpaired glucose tolerance. Neurology 60: 108–111
Suzuki C, Ozaki I, Tanosaki M et al. (2000) Peripheral andcentral conduction abnormalities in diabetes mellitus. Neurology 54: 1932–1937
Literatur zu Kap. 3.4
Eckardt A, Kraus O, Kustner E et al. (2003) Die interdisziplinareTherapie des diabetischenFussyndroms. Orthopade 32:190–198
ESuR Guidelines on Contrast Media European Society ofurogenital Radiology 8.1 aus 2014 http://www.esur.org/esur-guidelines/
Kreitner KF, Kalden P, Neufang A et al. (2000) Diabetes andperipheral arterial occlusive disease: Prospective comparisonof contrast-enhanced three-dimensional RAngiography with conventional digital subtractionangiography. AJR 174: 171–179
Ledermann HP, Morrison WB, Schweitzer ME, Raikin SM (2002) Tendon involvement in pedal infection: MR Analysis offrequency, distribution, and spread of infection. AJR 179:939–947
Marcus CD, Ladam-Marcus VJ, Leone J et al. (1996) MR Imagingof osteomyelitis and neuropathic osteoarthopathy inthe feet of diabetics. Radiographics 16: 1337–1348
Morrison WB, Ledermann HP (2002) Working-up of the diabeticfoot. RadiolClin N Am 40: 1171–1192
Tomas MB, Patel M, Marwin SE, Palestro CJ (2000) The diabeticfoot. Brit J Rad 73: 443–450
Schweitzer ME, Morrison WB (2004) MR Imaging of the diabetic foot. RadiolClin N Am 42: 61–71
Literatur zu Kap. 3.5
Alexander IJ (1991) Der Fus. Springer, Berlin Heidelberg NewYork
Armstrong DG, Stackpoole-Shea S, Nguyen H, Harkless L (1999) Lengthening of the achilles tendon in diabeticpatients who are at high risk for ulceration of the foot.J Bone Joint Surg Am 81: 535–538
Beckers D, Deckers J (1997) Ganganalyse und Gangschulung.Springer, Berlin Heidelberg New York
Brodsky JW, Rouse AM (1993) Exostectomy for symptomaticbony prominences in diabetic Charcot feet., ClinOrthop296: 21–26
Crisp AJ, Heathcote JG (1984) Connective tissue abnormalitiesin diabetes mellitus. J R CollPhys 18: 132–141
Fernando DJS, Masson EA, Veves A, Boulton AJM (1991) Relationshipof limited joint mobility to abnormal foot pressuresand diabetic foot ulceration. Diab Care 14: 8–11
Frykberg RG, Lavery LA, Pham H (1998) Role of neuropathyand high foot pressures in diabetic foot ulceration. DiabCare 21: 1714–1719
Hansen ST (2000) Functional reconstruction of the foot andankle, Lippincott Williams & Wilkins, Philadelphia, USA
Hicks JH (1955) The foot as a support. ActaAnatomie 25: 3–4
Holewski J et al. (1989) Prevalence of foot pathology andlower extremity complication in a diabetic outpatientclinic. J Rehabil 26: 35–44
Isman RE, Inman VT (1969) Anthropometric studies of thehuman foot and ankle. Bull Prosthet Res 10/11: 9–7
Kitaoka HB (2002) The foot and ankle. Lippincott Williams & Wilkins, Philadelphia, USA
Ledoux WR, Shofer JB, Smith DG et al. (2005): Relationshipbetween foot type, foot deformity, and ulcer occurrence inthe high-risk diabetic foot. J Rehabil Res Dev 42(5):665–72
Mann R, Coughlin M (1991) Lesser toe deformities. In: Jahss M(ed) Disorders of the foot and ankle. WB Saunders, Philadelphia
Marks RM, Long JT, Exten EL (2010) Gait abnormality followingamputation in diabetic patients. Foot Ankle Clin 15(3): 501–7
Megitt B (1976) Surgical management of the diabetic foot. Br J Hosp Med 16: 227–232
Muller MJ (1989) Insensitivity, limited joint mobility andplantar ulcers in patients with diabetes mellitus. PhysTher 69: 453–462
Pecoraro R, Reiber G, Burgess E (1990) Pathways to diabeticlimb amputations. Diab Care 13: 513–521
Pomeroy GC, Pike RH, Beals TC et al. (1999) Acquired flatfootin adults due to dysfunction of the posterior tibial tendon.J Bone Joint Surg Am 81: 1173–1182
Thomas N, Nissen KI, Helal B (1988) Disorders of the lesser raysIn: Helal B, Wilson D (eds) The foot. Churchill & Livingstone, Edinburgh
Wagner FW (1981) Thedysvascular foot: a system for diagnosisand treatment. Foot Ankle 2: 6–4
Waldecker U, Lehr HA (2009) Is there histomorphologicalevidence of plantar metatarsal fat pad atrophy in patientswith diabetes? Foot Ankle Surg 48 (6):648–52
Zimny S, Schatz H, Pfohl M (2004) The role of limited jointmobility in diabetic patients with an at risk foot. DiabetesCare 27 (4):942–6
Zwipp H, Oestern HJ, Dralle W (1982) ZurradiologischenDiagnostik der antero-lateralenRotationsinstabilitatimoberenSprunggelenk. Unfallheilkunde 85: 419–426
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Lobmann, R., Espinola-Klein, C., Krämer, H., Schadmand-Fischer, S., Waldecker, U., Eckardt, A. (2015). Diagnostik. In: Eckardt, A., Lobmann, R. (eds) Der diabetische Fuß. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38425-7_3
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