Distal polyneuropathy
Distal polyneuropathy is one of the types of polyneuropathy. This is a disease characterized by the process of death of nerve fibers, which, in turn, entails the loss of any sensitivity and further development of foot ulcers. This disease is the most common complication that develops in diabetes mellitus, which significantly reduces the patient's performance and, in general, threatens his life and health.
The main type of damage to nerve fibers in patients with diabetes mellitus is the so-called distal polyneuropathy. With this type of polyneuropathy, in most cases, the lower and occasionally upper limbs are affected.
The most common symptom in distal polyneuropathy is pain. Usually these are pulling and dull pains. Sometimes the pain reaches such a level that it does not allow sleep at night. The pain syndrome becomes worse when the patient is at rest, but can also be observed with prolonged walking. Quite often, paresthesias make themselves felt, which are manifested in the form of numbness, a feeling of "creeping creeps", tingling, chilliness or, conversely, burning. Feeling heaviness and even weakness in the legs.
Shoulders, forearms and upper legs - thighs can also hurt. The pain can be felt when palpating the upper part of the lower leg - this is one of the main symptoms in the diagnosis of dangerous distal polyneuropathy. In the absence of appropriate treatment, the pathology becomes more and more serious.
The initial signs of diabetic distal neuropathy manifest themselves in the fingers of the lower extremities, with the development of the process, similar symptoms of deterioration in sensitivity make themselves felt in the fingers of the upper extremities. The disease rarely begins in the distal arms.
Distal polyneuropathy usually affects thin, sometimes thick nerve fibers. If thin fibers are more affected, the disease is characterized by a significant decrease in temperature and pain sensitivity. In the case of damage to thick fibers, tactile sensitivity is partially lost or even completely lost. Signs of diabetic distal neuropathy are observed in about 40% of people with diabetes mellitus, about half of these people complain of pain.
Further development of distal polyneuropathy can lead to serious disorders of the locomotor system - weakness in the lower extremities and muscle atrophy. The patient's sweating process deteriorates markedly, while the skin becomes drier. Typical bone deformities are acquired.
The skin color also changes slightly, acquiring a bright pink, even reddish hue, symmetrical areas of pigmentation appear on the lower leg and the back of the foot. Nails can atrophy or, conversely, can undergo deformation.
n
As a result, osteoarthropathy develops, which is characterized by flat feet, both transverse and longitudinal, increased deformity of the ankle, as well as an increase in the size of the foot in the transverse dimension. Such changes observed in the foot can be either one- or two-sided.
Long-term pressure in the area of bone deformities, ultimately, inevitably leads to the occurrence of neuropathic ulcers, usually on the outside of the foot and between the toes. Such ulcers for a certain period of time do not cause pain due to partially lost sensitivity, and only the development of the inflammatory process draws attention to this defect.
In this regard, early diagnosis of distal polyneuropathy is especially important - this reduces the risk of tongue formation and even possible amputation of the lower limb. Unfortunately, no standard has yet been established for determining neuropathic abnormalities in a patient with diabetes mellitus.
To make a diagnosis of distal polyneuropathy, it is sufficient to identify the following criteria, according to the scale of symptoms and signs. These include mild signs with no symptoms or presence and minor signs with mild symptoms.
For a more accurate determination of the severity of clinical manifestations, an additional neurological examination for the presence of sensorimotor disorders is necessary. This examination includes a detailed study of absolutely all types of sensitivity and the definition of reflexes.
The main reason for the progressive development of distal neuropathy, first of all, is the presence of large amounts of glucose. In this regard, the most effective method of treating the disease, which allows you to reverse the process in the opposite direction, is constant monitoring of the level of glycemia in the blood. In addition, it is necessary to carry out symptomatic treatment, which is important when relieving pain.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
