The diagnosis of an autonomic dysfunction of the lower limb as a major aspect of the neurological investigation and risk assessment of a diabetic foot syndrome
Forst, T.; Pfützner, A.
MMW Fortschritte der Medizin 146(3-4): 35-38
2004
ISSN/ISBN: 1438-3276 PMID: 15035446 Document Number: 574917
Sensomotoric diabetic polyneuropathy is often associated with damage to autonomic nerve fibers. In the case of the lower extremity, this manifests in the form of a sudomotoric and/or vasomotoric disorder. This in turn is believed to be closely related to the development of neurotrophic ulcerations of the foot. The sudomotoric disorder leads to anhidrosis of the skin of the foot, leading to the formation of rhagades and fissures. Neurovascular problems with disordering of microvascular perfusion and trophic disturbances then become risk factors for foot ulcers, in particular when skin traumata occur in addition. Various methods for identifying an autonomic function disturbance in the lower limb are based either on the measurement of sweat secretion or on the investigation of peripheral microvascular function. A purposeful assessment of risk and prevention of neurotrophic damage in the lower limb is possible only on the basis of a rigorous differential diagnostic work-up of the diabetic polyneuropathy.