Zusammenfassung
Das diabetische Fußsyndrom ist weltweit eine der bedeutendsten Komplikationen des Diabetes mellitus. Zudem ist es der häufigste Grund für eine Krankenhausbehandlung. Die Ätiologie des diabetischen Fußsyndroms ist multifaktoriell und komplex. Pathophysiologisch steht die Polyneuropathie im Vordergrund. Durch geeignete Behandlungsstrategien sowie interdisziplinäre und sektorenübergreifende Strukturen ist es möglich, die Amputationsraten zu senken.
Abstract
Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. Polyneuropathy plays an important role in the pathophysiology of diabetic foot ulceration. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the high rates of major amputations.
Literatur
Andersen H (2012) Motor dysfunction in diabetes. Diabetes Metab Res Rev 28(Suppl 1):89–92
Barker AR, Rosson GD, Dellon AL (2006) Wound healing in denervated tissue. Ann Plast Surg 57:339–342
Bentley J, Foster A (2007) Multidisciplinary management of the diabetic foot ulcer. Br J Community Nurs 12:S6, S8, S10 passim
Boulton AJ (2008) The diabetic foot: grand overview, epidemiology and pathogenesis. Diabetes Metab Res Rev 24(Suppl 1):S3–S6
Boulton AJ (2014) Diabetic neuropathy and foot complications. Handb Clin Neurol 126:97–107
Boulton AJ (2013) The pathway to foot ulceration in diabetes. Med Clin North Am 97:775–790
Boulton AJ (2010) What you can’t feel can hurt you. J Vasc Surg 52:28S–30S
Boulton AJ, Kirsner RS, Vileikyte L (2004) Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med 351:48–55
Brandner JM, Zacheja S, Houdek P et al (2008) Expression of matrix metalloproteinases, cytokines, and connexins in diabetic and nondiabetic human keratinocytes before and after transplantation into an ex vivo wound-healing model. Diabetes Care 31:114–120
Broussard KC, Powers JG (2013) Wound dressings: selecting the most appropriate type. Am J Clin Dermatol 14:449–459
Bruhn-Olszewska B, Korzon-Burakowska A, Gabig-Ciminska M et al (2012) Molecular factors involved in the development of diabetic foot syndrome. Acta Biochim Pol 59:507–513
Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Neuropathie bei Diabetes im Erwachsenenalter – Langfassung. Version 1.2, 2011. http://www.diabetes.versorgungsleitlinien.de; http://www.versorgungsleitlinien.de; http://www.awmf-leitlinien.de. Zugegriffen: 2. Februar 2015
Cavanagh PR, Bus SA (2011) Off-loading the diabetic foot for ulcer prevention and healing. Plast Reconstr Surg 127(Suppl 1):248S–256S
Cavanagh PR, Bus SA (2010) Off-loading the diabetic foot for ulcer prevention and healing. J Am Podiatr Med Assoc 100:360–368
Da Silva L, Carvalho E, Cruz MT (2010) Role of neuropeptides in skin inflammation and its involvement in diabetic wound healing. Expert Opin Biol Ther 10:1427–1439
Generini S, Tuveri MA, Matucci Cerinic M et al (2004) Topical application of nerve growth factor in human diabetic foot ulcers. A study of three cases. Exp Clin Endocrinol Diabetes 112:542–544
Gilbey SG (2004) Neuropathy and foot problems in diabetes. Clin Med 4:318–323
Graiani G, Emanueli C, Desortes E et al (2004) Nerve growth factor promotes reparative angiogenesis and inhibits endothelial apoptosis in cutaneous wounds of type 1 diabetic mice. Diabetologia 47:1047–1054
Hochlenert D, Engels G (2007) Integrated management in patients with diabetic foot syndrome. MMW Fortschr Med 149:41–43
Jeffcoate WJ (2012) Wound healing – a practical algorithm. Diabetes Metab Res Rev 28(Suppl 1):85–88
Kamenov ZA, Traykov LD (2012) Diabetic autonomic neuropathy. Adv Exp Med Biol 771:176–193
Kamenov ZA, Traykov LD (2012) Diabetic somatic neuropathy. Adv Exp Med Biol 771:155–175
Krishnan ST, Quattrini C, Jeziorska M et al (2007) Neurovascular factors in wound healing in the foot skin of type 2 diabetic subjects. Diabetes Care 30:3058–3062
Lobmann R (2011) Diabetic foot syndrome. Internist 52:539–548
Lobmann R (2013) Diabetic foot: how to avoid therapeutic mistakes. MMW Fortschr Med 155:63–66
Lobmann R, Achwerdov O, Brunk-Loch S et al (2014) The diabetic foot in Germany 2005–2012: Analysis of quality in specialized diabetic foot care centers. Wound Med 4:27–29
Lobmann R, Ambrosch A, Schultz G et al (2002) Expression of matrix-metalloproteinases and their inhibitors in the wounds of diabetic and non-diabetic patients. Diabetologia 45:1011–1016
Lobmann R, Schultz G, Lehnert H (2005) Proteases and the diabetic foot syndrome: mechanisms and therapeutic implications. Diabetes Care 28:461–471
Molines L, Darmon P, Raccah D (2010) Charcot’s foot: newest findings on its pathophysiology, diagnosis and treatment. Diabetes Metab 36:251–255
Monteiro-Soares M, Boyko EJ, Ribeiro J et al (2011) Risk stratification systems for diabetic foot ulcers: a systematic review. Diabetologia 54:1190–1199
Morbach S, Muller E, Reike H et al (2014) Diabetic foot syndrome. Exp Clin Endocrinol Diabetes 122:416–424
Motzkau M, Tautenhahn J, Lehnert H et al (2011) Expression of matrix-metalloproteases in the fluid of chronic diabetic foot wounds treated with a protease absorbent dressing. Exp Clin Endocrinol Diabetes 119:286–290
Mulder G, Tenenhaus M, D’Souza GF (2014) Reduction of diabetic foot ulcer healing times through use of advanced treatment modalities. Int J Low Extrem Wounds 13:335–346
Peltier A, Goutman SA, Callaghan BC (2014) Painful diabetic neuropathy. BMJ 348:g1799
Pereira Da Silva L, Miguel Neves B, Moura L et al (2014) Neurotensin decreases the proinflammatory status of human skin fibroblasts and increases epidermal growth factor expression. Int J Inflam 2014:248240
Rhim B, Harkless L (2012) Prevention: can we stop problems before they arise? Semin Vasc Surg 25:122–128
Risse A (2007) The diabetic foot syndrome – an interdisciplinary challenge. Hamostaseologie 27:117–122
Robinson C, Major MJ, Kuffel C et al (2015) Orthotic management of the neuropathic foot: an interdisciplinary care perspective. Prosthet Orthot Int 39:73–81
Rumenapf G, Dittler S, Morbach S et al (2008) The vascular surgeon’s role in interdisciplinary treatment of diabetic foot syndrome. Chirurg 79:535–545
Russell JW, Zilliox LA (2014) Diabetic neuropathies. Continuum 20:1226–1240
Said G (2013) Diabetic neuropathy. Handb Clin Neurol 115:579–589
Sandireddy R, Yerra VG, Areti A et al (2014) Neuroinflammation and oxidative stress in diabetic neuropathy: futuristic strategies based on these targets. Int J Endocrinol 2014:674987
Shalaby SY, Blume P, Sumpio BE (2014) New modalities in the chronic ischemic diabetic foot management. Clin Podiatr Med Surg 31:27–42
Singh VP, Bali A, Singh N et al (2014) Advanced glycation end products and diabetic complications. Korean J Physiol Pharmacol 18:1–14
Soliman M, Rajbhandari SM (2013) Assessing outcome of diabetic foot ulcers and multidisciplinary foot clinic. Curr Diabetes Rev 9:397–401
Tavee J, Zhou L (2009) Small fiber neuropathy: a burning problem. Cleve Clin J Med 76:297–305
Tiaka EK, Papanas N, Manolakis AC et al (2011) The role of nerve growth factor in the prophylaxis and treatment of diabetic foot ulcers. Int J Burns Trauma 1:68–76
Van Battum P, Schaper N, Prompers L et al (2011) Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabet Med 28:199–205
Vinik AI, Maser RE, Mitchell BD et al (2003) Diabetic autonomic neuropathy. Diabetes Care 26:1553–1579
Wukich DK, Armstrong DG, Attinger CE et al (2013) Inpatient management of diabetic foot disorders: a clinical guide. Diabetes Care 36:2862–2871
Zenker J, Ziegler D, Chrast R (2013) Novel pathogenic pathways in diabetic neuropathy. Trends Neurosci 36:439–449
Ziegler D, Keller J, Maier C et al (2014) Diabetic neuropathy. Exp Clin Endocrinol Diabetes 122:406–415
Zimmermann A, Reeps C, Hartl F et al (2009) The diabetic foot. Chirurg 80:430–436
Boucek P (2006) Advanced diabetic neuropathy: a point of no return? Rev Diabet Stud 3:143–150
Einhaltung ethischer Richtlinien
Interessenkonflikt. R. Lobmann: Vortragstätigkeit für Lilly, Novo Nordisk, Novartis, MSD, Boehringer Ingelheim, AstraZeneca, Sanofi Aventis, URGO, Pfizer und Wörwag; Beratertätigkeit für Lilly, URGO und Wörwag.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lobmann, R. Neuropathie und diabetisches Fußsyndrom. Internist 56, 503–512 (2015). https://doi.org/10.1007/s00108-014-3630-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-014-3630-7