Hopp til innhold
NHI.no
Annonse

Den nevropatiske fot

En nevropatisk fot er typisk varm, tørr, nummen, følelsesløs og/eller smertefull og med områder med fortykket hud. Svekket muskulatur i foten kan gi nedpresset fothvelving og stressår. Nedsatt følesans øker risikoen for sår på grunn av nedsatt smerte- og temperaturfølsomhet. Skade på blodårene kan gi oksygenmangel i vevet og hevelse i foten. Det kan oppstå brudd i fotens småbein (Charcot-artropati). Nedsatt evne til å svette på føttene kan føre til tørr hud med sprekkdannelser. Dersom sår oppstår, vil nevropatiske fotsår uten sirkulasjonssvikt tilheles i 90 prosent av tilfellene med trykkavlasting og fjerning av infeksjon.

Annonse

Dette dokumentet er basert på det profesjonelle dokumentet Diabetisk nevropati . Referanselisten for dette dokumentet vises nedenfor

  1. Helsedirektoratet. Nasjonale faglig retningslinje for diabetes. Sist faglig oppdatert: 16. mars 2021. helsedirektoratet.no
  2. Malik RA, Alam U, Azmi S. Diabetic neuropathy. BMJ Best Practice, last updated June 2019.
  3. Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136-54. PubMed
  4. Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol 2012; 11: 521-34. PubMed
  5. Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(1):42. Published 2019 Jun 13. PMID: 31197183 PubMed
  6. Mizrak HI, Hansen TW, Rossing P, et al. Declining Incidence Rates of Distal Symmetric Polyneuropathy in People With Type 1 and Type 2 Diabetes in Denmark, With Indications of Distinct Patterns in Type 1 Diabetes. Diabetes Care 2023; 46: 1997-2003. pmid:37647323 PubMed
  7. Snyder MJ, Gibbs LM. Treating painful diabetic peripheral neuropathy: an update. Am Fam Physician 2016; 94: 227-34. American Family Physician
  8. Garces-Sanchez M, Laughlin RS, Dyck PJ, et al. Painless diabetic motor neuropathy: A variant of diabetic lumbosacral radiculoplexus neuropathy?. Ann Neurol 2011; 69: 1043-54. PubMed
  9. Agashe S, Petak S. Cardiac Autonomic Neuropathy in Diabetes Mellitus. Methodist Debakey Cardiovasc J. 2018;14(4):251-256. PubMed
  10. Fan J, Peng T, Hui J, et al. Erectile Dysfunction in Type-2 Diabetes Mellitus Patients: Predictors of Early Detection and Treatment. Urol Int. 2021;105(11-12):986-992. PMID: 33951654 PubMed
  11. American Diabetes Association. Standards of medical care in diabetes - 2014. Diabetes Care. 2014;37:S14-S80.
  12. Callaghan BC, Little AA, Feldman EL, Hughes RA. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev 2012; :CD007543. Cochrane (DOI)
  13. Selvarajah D, Kar D, Khunti K, et al. Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. Lancet Diabetes Endocrinol. 2019;7(12):938-948. PubMed
  14. Griebeler ML, Morey-Vargas OL, Brito JP, et al. Pharmacologic interventions for painful diabetic neuropathy: An umbrella systematic review and comparative effectiveness network meta-analysis. Ann Intern Med 2014; 161: 639-49. doi:10.7326/M14-0511 DOI
  15. Tesfaye S, Sloan G, Petrie J, et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet 2022. pmid:36007534 PubMed
  16. Price R, Smith D, Franklin G, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. 2022;98(1):31-43. PubMed
  17. Ziegler D, Fonseca V. From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy. J Diabetes Complications. 2015;29(1):146–156.
  18. Griebeler ML, Morey-Vargas OL, Brito JP, et al. Pharmacologic interventions for painful diabetic neuropathy: an umbrella systematic review and comparative effectiveness network meta-analysis published corrections appear in Ann Intern Med. 2015;162(8):600, and Ann Intern Med. 2015;162(10)739. Ann Intern Med. 2014;161(9):639–649.
  19. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;1:CD007115. PMID: 24385423 PubMed
  20. Kaur H, Hota D, Bhansali H, et al. A comparative evaluation of amitriptyline and duloxetine in painful diabetic neuropathy: A randomized, double-blind, cross-over clinical trial. Diabetes Care 2011; 34: 818-22. PubMed
  21. Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. Neurology 2017. doi:10.1212/WNL.0000000000003882 DOI
  22. Jingxuan L, Litian M, Jianfang F. Different Drugs for the Treatment of Painful Diabetic Peripheral Neuropathy: A Meta-Analysis. Front Neurol. 2021;12:682244. Published 2021 Oct 29. PMID: 34777192 PubMed
  23. Ko SH, Kwon HS, Yu JM, et al. Comparison of the efficacy and safety of tramadol/acetaminophen combination therapy and gabapentin in the treatment of painful diabetic neuropathy. Diabet Med 2010; 27: 1033-40. PubMed
  24. Tesfaye S, Wilhelm S, Lledo A, et al. Duloxetine and pregabalin: High-dose monotherapy or their combination? The ``COMBO-DN study`` - a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain 2013. doi:10.1016/j.pain.2013.05.043 DOI
  25. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006146. DOI: 10.1002/14651858.CD006146.pub2. DOI
  26. Vinik AI, Shapiro DY, Rauschkolb C, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy. Diabetes Care. 2014;37(8):2302–2309.
  27. Simpson DM, Robinson-Papp J, Van J, et al. Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Study. J Pain. 2017; 18: 42-53. PMID: 27746370 PubMed
  28. Nøkleby K, Julsrud Berg T. Diabetisk nevropati - en klinisk oversikt. Tidsskr Nor Lægeforen 2005; 125: 1646-9. PubMed
  29. Feldman EL. Management of diabetic neuropathy. UpToDate, last updated Aug 30, 2022. UpToDate
  30. Thour A, Marwaha R. Amitriptyline. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 15, 2022. PMID: 30725910 PubMed
Annonse
Annonse