Unyawo lwesifo sikashukela: izimpawu, ukwelashwa, ukunakekelwa kwezinyawo

Kungani unyawo sikashukela lukhula?

Ukuthuthukiswa konyawo lwesifo sikashukela kwandulelwa yisifo esigcina isikhathi eside sikashukela seminyaka engu-15 ukuya kwe-20 kanye nokuba khona kwezinye izingqinamba ezivela ngenxa yesinxephezelo esibi sohlobo 2 noma uhlobo 1 sikashukela.

Izizathu ezinkulu ezibangela ukuvela kwalezi zindlela zokugula yilezi:

• Ukwehlulwa kwemithambo yegazi yemikhawulo engezansi - i-hyperglycemia yesikhathi eside iholela ekuguqukeni kwesakhiwo ezindongeni zemithambo yegazi yeziphathimandla ezahlukahlukene.
• Isifo sikashukela i-Angiopathy ne-Neuropathy - ushintsho emikhunjini luholela ekunciphiseni kokuqina kwawo, ubunikazi bawo, kanye nokuqina futhi kukhuphuke ukuvela kwegazi. Njengomphumela we-vascular pathology, kukhona ukwehla, bese kulahleka ngokuphelele kokuzwela kokuphela kwezinzwa. Lezi zinqubo zibangela ukwehla kokuhamba okuhlanganayo, okuholela kumthwalo ongalungile onyaweni. Ngokuzayo, ukuguqulwa kwayo nokukhula kwesifo sikashukela sikashukela noma unyawo lukaCharcot kwenzeka.
• Ukutheleleka ngegciwane - ngokumelene nesizinda sezinguquko ze-neurotrophic kwezicubu ezithambile, ngokuhlanganiswa nokungatheleleki kokunciphisa umzimba, noma ikuphi ukulimala kwesikhumba kuholela enqubweni yokulimala okunzima ukuyelapha futhi ayiphili isikhathi eside. Imvamisa amanxeba atheleleka nge-staphylococcus noma ukutheleleka kwe-anaerobic, okuholela ekusakazekeni kwenqubo kanye nasekwakheni i-necrosis. Kulokhu, kunengozi ye-abscess, i-phlegmon noma i-gangrene.

Izipikili ze-Ingrown, ummbila, imifantu ezithendeni noma izilonda zokukhunta zamapuleti ezipikili nazo zingadala ukuthuthukiswa konyawo lwesifo sikashukela.

Izimpawu nezimpawu zokuqala

Ukubonakala kwanoma yiluphi ushintsho esikhunjeni sezinyawo noma amapuleti ezipikili, kanye nokwehla kokuzwela, kuwuphawu olungathandeki maqondana nokuthuthuka kwezinkinga zesifo sikashukela.

Izimpawu zokuqala zokuthuthukisa unyawo lwesifo sikashukela:

• ukwehla noma ukungabikho kwazo zonke izinhlobo zokuzwela (ukuthambekela, izinhlungu, izinga lokushisa);
• ukungahambi kahle ezicathulweni ezijwayelekile nezikade zikhululekile;
• ukwakheka kwamabele nezimbila;
• ukubonakala kwepikili elingaphakathi;
• mnyama mnyama ipuleti lezipikili;
• ukuvuvukala kanye nokuvela kwezinyawo ngaphandle kwesizathu esibonakalayo;
• isikhumba esomile, sihambisana nokuxhuma;
• imizwa engathandeki emilenzeni ngesimo sokuxhuga, ukuzindla, imizwa "yokwehla kolaka."

Isici esibonakalayo sokubonakaliswa kliniki yonyawo lwesifo sikashukela ukuba khona kwama-callus angapholi, imifantu yesikhumba noma izilonda emaphethelweni aphansi. Uma ukutheleleka kwenzeka, inqubo ihlanganiswa nokukhipha i-purulent, ehambisana nephunga elingathandeki.

Ubuhlungu besikhathi somlenze emlenzeni, obukhuliswa umthwalo, buqamamana nokushintshana, kube yisithiyo sokunyakaza okusebenzayo. Ukwephulwa kokugeleza kwegazi onyaweni kuvusa ukuvuvukala komlenze, ngenxa yalokho isikhumba somlenze sithola ukugcwala okuluhlaza kanye nokukhanya okuthile. Ukuqina, ukudinwa emilenzeni kuqina.

Ezimweni ezingavamile, ngokuphathwa ngokungafanele noma okunganele, inqubo ingahle ibe yinkimbinkimbi ngokuthuthukiswa konyawo lukaCharcot, lapho kunokubhujiswa okuqhubekayo kwamalunga amancane onyawo ne-ankle okuhlanganisiwe. Le nqubo ye-pathological ayitheleleki futhi inohlangothi olulodwa.

Ukuhlukaniswa kwesifo sikashukela

Ngokuya ngokwanda kwezimpawu ezithile zomtholampilo, amafomu alandelayo ahlukaniswa ngezigaba zonyawo lwesifo sikashukela:

• Ifomu le-Ischemic (kuze kufike ku-10% wamacala) - isibonakaliso esivelele ukwephulwa kokuhamba kwegazi onyaweni ngenxa yomonakalo emithanjeni yegazi yezinsimbi ezikhululekile. Emtholampilo walesi sifo, kuboniswa izimpawu zokuqubuka kwezinyawo okuqhubekayo, izinhlungu emilenzeni, ukukhumuzelana ngezikhathi ezithile, ukukhathala okusheshayo kwemilenze, ukudilika kwesikhumba. Kukhona buthaka noma ukungabikhona kwesiphuzo onyaweni, kanye nokuqina okungapheli kanye nomuzwa wokubanda. Ukuzwela kuyagcinwa.
• Ifomu le-Neuropathic (kuze kufinyelele ku-75% wamacala) - ukulimala kwezinzwa okuphathelene ne-peripheral predominates in the form of dryness and peeling kwesikhumba sezinyawo, ukuncipha kokuzwa, ukwehla okuqinile kokujuluka, ukuthuthukiswa kwezinyawo ezibucayi kanye nokushintshwa kwezinyawo. Isici esibonakalayo salolu hlobo lwalesi sifo ukubakhona kwesikhafu nokuqhekeka okujulile onyaweni, ukubonakala kwesilonda kuso noma ezikhaleni phakathi kweminwe. Isikhumba sifudumele, i-pulsation emithanjeni yethambo igcinwa. Ukuchazwa konyawo, okuhambisana nokuqina kwemisipha, kuyaphawulwa.
• Ifomu elihlanganisiwe le-neuroischemic (kuze kufike ku-30% wamacala) - izimpawu zomonakalo emaphethelweni wezinzwa nenethiwekhi yemithambo yonyawo. Leli fomu linesici esiyingozi - ukungabikho kobuhlungu, okuwumphumela wokwelashwa sekwedlule kweziguli kudokotela. Ukuba khona kwesilonda esikhulu nokuthuthukiswa kwezinqubo ezingenakuphikiswa ezicutshini kwenza ukwelashwa okulondoloziwe kwe-pathology kungasebenzi.

I-Wagner F. W Diabetesic Class Classization:

• isiteji zero - ukubonakaliswa kwangaphandle kwalesi sifo kuqapheleka ngesimo se-pallor yesikhumba sezinyawo, kuhambisana nokukhonkotha, ukuba khona kwama-corns kanye ne-deformation yonyawo;
• Isigaba 1 - ukubukeka kwenqubo ephezulu kakhulu yolcerative ngaphakathi kwesikhumba;
• Isigaba 2 - ukuthuthukiswa kwezilonda ezijulile ngaphandle kokulimala kwezicubu zamathambo;
• Isigaba 3 - ukuqhubeka kwenqubo yesilonda ngaphakathi nokubandakanyeka kwamathambo;
• Isigaba 4 - ukuthuthuka kwenqubo yobugebengu bemvelo elinganiselwe;
• Isigaba 5 - ukuthuthukiswa kwenqubo ebanzi yezigebengu.

Ukuxilonga

Ukuxilongwa kokuqala konyawo lwesifo sikashukela kusungulwa ngenkathi kuhlolwa isiguli inhloso, lapho isimo nobungako besonda buqunywa. Ukucacisa lokhu kutholwa, kuhlolwe indawo yokuhlolwa kwelebhu, kanye nokubonisana kochwepheshe, kubandakanya:

• Ukuhlaziywa komtholampilo kwegazi nomchamo;
• ushukela wegazi kanye ne-glycosylated hemoglobin;
• chemistry kwegazi lipids, cholesterol, triglycerides;
• inoculation ye-bacterial yokuqukethwe kwezilonda ezihlukanisiwe ukunquma i-pathogen nokuzwela kwama-antibiotics;
• i-radiography yonyawo ngamaphrojekthi ama-2;
• i-dopplerography ye-ultrasound yemithambo yemilenze ephansi;
• ukubonisana nodokotela oyi-neurologist, i-endocrinologist, i-orthopedist, udokotela ohlinza ngemithambo, udokotela ohlinzayo jikelele.

Ngemuva kokuhlolwa okugcwele, kutholwa ukuxilongwa kokugcina bese kunikezwa inkambo yokwelashwa kucatshangelwa izici zomzimba ngamunye.

Ukwelashwa kwezifo

Izindlela zokwelapha zihloselwe ukumisa ukuqhubeka kwenqubo ye-pathological. Ngokuya esigabeni sesifo kanye nokubonakaliswa komtholampilo, ukwelashwa kungenziwa ngezindlela ezahlukahlukene, kufaka phakathi ukwelashwa okulondolozayo nokuhlinzwa.

Okulondolozayo

Ukwelashwa okulondoloziwe konyawo lwesifo sikashukela kuqala ngokulungiswa okuphoqelekile kwe-carbohydrate metabolism, okuhloswe ngayo ukugcina ushukela wegazi ojwayelekile. Ngokwezinkomba zesifo sikashukela sohlobo 1, kuyenziwa ukulungiswa komthamo we-insulin. Ngohlobo 2 sikashukela, ukukhuphuka komthamo wezidakamizwa ezonciphisa ushukela + ukunikezwa kokulashwa kwe-insulin.

Izinkomba zokucindezela kwegazi nazo zingaphansi kokulungiswa, ngenxa yokujwayelekile okusetshenziswa amaqembu alandelayo wezidakamizwa:

• ama-beta-blockers - Nevibolol, Carvedilol;
• Ama-inhibitors e-ACE - Berlipril, Captopril;
• abamelene ne-calcium - uCorffar, uNicardipine;
• ama-diuretics - I-Hypothiazide, i-Indapamide.

Ngokuya esigabeni sesifo, irejimeni yokwelashwa yesifo sikashukela sikashukela iyohluka. Ezigabeni zokuqala zonyawo lwesifo sikashukela, izindlela zokwelapha zenzelwe ukumisa i-pain syndrome, ukunciphisa i-spasm, kanye nokwenza ngcono umsoco wezicubu. Ngale njongo, izidakamizwa ezilandelayo zinqunyelwe:

• ama-antispasmodics nokuvuselela izicubu kwemisipha okunciphisa izinhlungu - uPapaverine, uDrotaverin;
• ama-vascular agents noma ama-angioprotectors athuthukisa i-microcirculation kanye ne-metabolism kwezicubu - I-Pentoxifylline, iVenoruton;
• ama-antioxidants athuthukisa i-carbohydrate metabolism futhi enze izinqubo zokwenza i-oxidative zingasebenzi - i-Lipoic acid, iTocopherol;
• izidakamizwa ezibuyisela udonga lwe-vascular - Troxerutin, Detralex;
• imishanguzo ebanzi ebanzi - iCephalosporins, Macrolides;
• Ukwelashwa kwe-detoxification - ukuphathwa kwamakhambi kwezixazululo ezahlukahlukene;
• izidakamizwa eziqinisa;
• ukwelashwa ngamavithamini.

Okubaluleke kakhulu ngezilonda ze-purulent-necrotic zonyawo kungukuthulula kwayo kuhlanganiswe nokwelashwa kwasendaweni. Ngale njongo, izicathulo ezikhethekile zamathambo noma ama-insoles, imishini, isihlalo sabakhubazekile sisetshenziselwa ukudambisa ingcindezi ethweni elithintekile.

Ukwelashwa kwendawo yezinkinga zokulimala kufaka phakathi ukusetshenziswa kwama-antibacterial ahlukahlukene, ama-antiseptic agents kanye nokugqoka okukhethekile kwe-hydrogel esilondeni. Kuyadingeka nokususa ummbila kanye nezimbila ezizungeze isilonda, okunciphisa umthwalo onyaweni obuhlungu.

Ukuhlinzwa

Ukwelashwa okuhlinzwa konyawo lwesifo sikashukela kuyasetshenziswa uma kungabikho mphumela ovela ekwelashweni okulondoloziwe, kanye nezimpawu ezibalulekile ekwakhiweni kwe-gangore yonyawo nenqubo isatshalaliswa emlenzeni ophansi.

Ukuhlinzwa emikhunjini kukuvumela ukuthi uyeke ukuqhubeka kwesifo futhi ubuyisele nokudla okujwayelekile kwezicubu, okuholela ekuphulukisweni okusheshayo kokulimala kwesikhumba. Izindlela ezisetshenziswa kakhulu zokuhlinzwa zokwelapha isifo sikashukela sonyawo yile:

• Ukuhlinzwa kweBypass - Ukwakha i-workaround eyengeziwe yokugeleza kwegazi usebenzisa ukufakelwa.
• I-Balloon angioplasty - Ukwethulwa kwebhaluni elikhethekile esikebheni salo esinciphile, okunomthelela ekwenzeni kwalo ekukhupheni nasekuvuseleleni ukugeleza kwegazi. Ngemuva kwalokho, kufakwa izitena emkhunjini obuyiselwe, okungukuthi, ifreyimu yensimbi evimba ukuthi umkhumbi unganciphisi.
• Sympathectomy - Ukususwa kwezinzwa ezithile emgogodleni we-lumbar, obhekene ne-vasasm spasm. Le ndlela inzima ekusebenzeni kobuchwepheshe kudokotela ohlinzayo futhi akuvamile ukuthi isetshenziselwe izinkomba ezithile kuphela.

Ngaphezu kokungenelela kokuhlinzwa okunjalo kwe-volumetric, ekwelapheni amanxeba onyaweni, kusetshenziswa ukuhlinzwa "okuncane", okungukuthi, ukususwa kwezicubu ze-necrotic, ummbila, ummbila onomqubuko. Ukusebenza okunjalo kuyadingeka ukuhlanza inxeba nokuvikela ukusakazeka kokutheleleka kwenxeba.

Ngemuva kokungenelela okunjalo, ukuphuma kwegazi kuyalungiswa kusetshenziswa ukuhlinzwa kwemithambo. Kepha uma inqubo yokusabalalisa i-gangrene ingamiswa, khona-ke lonke unyawo luyanqunyelwa.

Izindlela zokwelapha ezintsha

Ngaphezu kwezindlela zendabuko zokwelapha ushukela onesifo sikashukela, odokotela baqala ukusebenzisa izindlela zokwelapha zakamuva, ezibandakanya:

• ukwelashwa kwe-wave wave - ukwelashwa kwenxeba kwenziwa kusetshenziswa iziphambeko zesisu;
• kusetshenziswa amaseli we-stem;
• indlela ye-plasma jet - isilonda siphathwa ngensimbi equkethe iplasma ionized;
• ukwelashwa okwenziwe ngamanxeba.

Ukukhetha okuzokwelashwa ngonyawo lwesifo sikashukela kuyohlale kunqunywa uchwepheshe, kucatshangelwa idatha yenhloso, isigaba sokuthuthuka kwenqubo ye-pathological kanye nezimpawu zomzimba ngamunye.

Ukuvimbela

Zonke iziguli ezinesifo sikashukela kufanele zilandele imithetho ethile ukuvimba ukuthuthukiswa kwale nkinga yesifo sikashukela. Ukugcinwa okuhleliwe kwezinyathelo ezithile zokuvimbela ukukhula konyawo lwesifo sikashukela kuzogwema le nkinga ngisho nasenkingeni yesifo sikashukela esibi. Lokhu kufaka phakathi:

1. Ukuhlolwa kwezinyawo okuphelele kwezinsuku zonke, kufaka phakathi izikhala ezihlangene.
2. Ukususwa ngesikhathi kwamabele omile namabele, kusetshenziswa okhilimu abakhethekile kanye namafutha okugcoba.
3. Ukuqapha okuhleliwe kwamazinga kashukela egazini.
4. Ukudla njalo izidakamizwa ezinciphisa ushukela wegazi.
5. Ukuhambisana nokudla okuhlose ukwehlisa umthamo we-carbohydrate.
6. Ukuyeka ukubhema notshwala.
7. Bheka izinyathelo zokuvikela ukuvimbela ukulimala kwezinyawo.
8. Ukulonda impilo esebenzayo.

Ukulandela lezi zinyathelo ezilula zokuvimbela kuzovimba ukuvela kwenkinga enkulu njengonyawo lwesifo sikashukela.

Ukunakekelwa kwezinyawo

Iziguli ezinesifo sikashukela i-mellitus akufanele ziqaphele kuphela izinga likashukela egazini, kodwa futhi zinakekele imilenze yazo, ngoba isifo sikashukela sinikeza ubunzima obukhulu obungaholela ekukhubazekeni. Isidingo sokuvimbela ukunakekelwa kwezinyawo, okubandakanya lezi zinyathelo ezilandelayo:

• Kubekwe eceleni ngokuqinile ukuhamba ngezinyawo noma kuphi, ngaphandle kwezimo zasekhaya. Lokhu kuzogwema ukulimala okuhlukahlukene, ngoba ngisho ne-paresis encane noma injekishini emlenzeni ingaphenduka inkinga enkulu.
• Uma izinyawo zihlala zibanda, kubalulekile ukusebenzisa amasokisi woboya. Ngasikhathi sinye, i-elastic akufanele iqinise umlenze ophansi ukuze ingaphazamisi ukuhamba kwegazi ngokukhululekile. Ukusetshenziswa kwesifudumeza sonyawo akufakiwe ngaphandle, ngoba ngokuzwa okuncishisiwe ukushiswa kwesikhumba sezinyawo kungenzeka.
• Qiniseka ukuthi ugeza izinyawo nsuku zonke ngamanzi okushisa egumbi, ulandelwa ukusula okuphelele, ikakhulukazi ezindaweni ezihlukanisayo.
• Ukugcotshwa nsuku zonke kwezinyawo ngamakhilimu akhethekile aqukethe urea, ngaphandle kokucutshungulwa phakathi kweminwe.
• Ngokujuluka ngokweqile kwemilenze ngemuva kwezinqubo zamanzi, kunconywa ukusetshenziswa kwe-talcum powder noma i-baby powder.
• Ukusikwa kwezipikili ngesikere noma nge-forceps akufakiwe eceleni ukuvikela ukulimala esikhunjeni. Kulokhu, ifayela lezipikili zengilazi lisetshenziselwa ukucubungula izipikili, ngokubhekisisa ikakhulukazi emakhoneni epuleti lezipikili.
• Ukwelashwa kwezithende, ummbila owomile noma ummbila kufanele wenziwe kuphela ngosizo lwama-pumice noma amafayela wezimonyo. Ukubamba kwemilenze okokuqala, ukusetshenziswa kwezixazululo ezikhethekile kanye nama-plasters ukususa amabele akuhlanganisiwe.

Izindlela zokuzivocavoca zokwelapha

Ukuzivocavoca umzimba okwenzelwe iziguli ezinesifo sikashukela kuyadingeka, ngoba akuneli nje ukufaka isandla ekwehliseni i-glucose egazini, kodwa futhi kwandisa nokuvikelwa komzimba. Okokuqala, kukhishwa ukuhamba. Ngaphezu kwalokho, imidlalo elandelayo inika umphumela omuhle:

• ukushushuluza;
• ukubhukuda;
• umdlalo we-badminton;
• umdlalo we-tennis yetafula.

Izindlela zokwelapha ezivivinya umzimba okhethekile kumele zikhethwe kuphela ngudokotela wokwelapha ngokomzimba, kucatshangelwa isimo esivamile sesiguli kanye nesigaba sokuthuthuka kwezinkinga zesifo sikashukela. Ukuqaliswa kwekhambi lokuzivocavoca lokwenziwa kwenziwa ngokuhamba kancane, kancane kancane kukhulisa umthwalo nesikhathi samakilasi.

Ukungezwa okuhle kwinkimbinkimbi yezindlela zokuzivocavoca zokwelapha izinqubo zesikhashana, ezibuye zichazwe uchwepheshe. Le ndlela yokwelashwa kwesifo sikashukela inika umphumela omuhle ngokwemigomo yokuthuthukisa impilo yesiguli.

Izicucu zamathambo

Izicucu zeziguli ezinesifo sikashukela kufanele zihlangabezane nezidingo ezikhethekile, ngoba ikakhulukazi zivimbela ukwehla kwempilo, okuyindlela yokuvimbela ukuthuthukiswa kwezinkinga zesifo sikashukela. Izicucu zamathambo zinezimpawu zazo, ezikhonjiswa ngale ndlela elandelayo:

• ukuntuleka kwengxenye enzima endaweni yezinzwane;
• okuqinile (okuqinile kuphela);
• ukuntuleka komthungo ngaphakathi kwesihlangu;
• ivolumu eyengeziwe yezicucu ngaphakathi kwezicubu ze-orthopedic insoles, ezikhethwe uchwepheshe onaka uhlobo lwenqubo ye-pathological;
• izinto ezisetshenziswayo ezisezingeni eliphakeme zokukhiqiza izicathulo, kufaka phakathi ukuqeda ingaphakathi elingaphezulu ngezinto zalo zokungenisa ukuze uvimbele ukuqunjelwa okungaphakathi.

Isimo sezulu

Ukwelashwa okufike ngesikhathi kwaqala, ukwenziwa okuqinile kwazo zonke izincomo zikadokotela ngokuboniswa kokuqala kwesifo sikashukela sikashukela, kunikeza ukubekezela okuhle mayelana nekhwalithi yempilo nekhono lesiguli ukusebenza. Kepha uma inqubo ingena enkambweni enzima ngokwenziwa kwezilonda ezijulile, ukuvuvukala kuzoba kungathandeki, ngoba ezimweni eziningi ukwephulwa okunjalo kuholela ekukhubazekeni kwesiguli.