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***Conversely, [[diabetes|diabetic]] [[patients]] with [[sensory system|Sensory]] [[neuropathy]] are more prone to [[ulcer]] formation and related [[Complication (medicine)|complications]], since they don't feel [[pain]] with ever-deepening [[ulcers]].
***Conversely, [[diabetes|diabetic]] [[patients]] with [[sensory system|Sensory]] [[neuropathy]] are more prone to [[ulcer]] formation and related [[Complication (medicine)|complications]], since they don't feel [[pain]] with ever-deepening [[ulcers]].


===Angiopathy===
===Ischemia===  
[[Microvascular disease|Micro]] and [[Macrovascular disease|macrovascular]] [[Complication (medicine)|complications]] are the leading cause of [[diabetes|diabetic]] [[Complication (medicine)|complications]]. [[Atherosclerosis]] occurs due to [[inflammation]] and leads to the accumulation of [[foam cells]]. The vascular changes which are responsible for [[foot]] problems include stiff [[artery|arteries]] due to [[calcification]] of the [[Smooth muscle|smooth muscle cells]] in the [[artery|arterial wall]] (mediasclerosis). It is usually discovered by an impaired [[ABI|ankle brachial index]] ([[ABI]]). The resting [[ABI]] is the ratio of the [[blood pressure]] in the lower legs to the blood pressure in the arms. The ABI is calculated by dividing the [[systolic blood pressure]] at the ankle by the systolic blood pressures in the arm. It is a non-invasive method to assess the lower extremity arterial system and to detect the presence of arterial occlusion disease.  In severe cases, it leads to ischemic foot problems, which the only treatment is [[vascular surgery]]. Even in neuropathic foot ulcers, the non healing wounds are the result of impaired blood supply to the tissue. Decreasing the central blood pressure by antihypertensive drugs may be deleterious for these patients<ref name="pmid22529027">{{cite journal| author=Alexiadou K, Doupis J| title=Management of diabetic foot ulcers. | journal=Diabetes Ther | year= 2012 | volume= 3 | issue= 1 | pages= 4 | pmid=22529027 | doi=10.1007/s13300-012-0004-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22529027  }} </ref>. Microvascular complications cause skin damage, [[infection]] and impaired wound healing. Once a foot ulcer develops, peripheral vascular disease is the most important factor which may contribute to adverse outcomes. Vascular complications are like a positive feedback which worsen the skin and nerve damage in [[diabetes]] <ref name="pmid22623440">{{cite journal| author=Venermo M, Vikatmaa P, Terasaki H, Sugano N| title=Vascular laboratory for critical limb ischaemia. | journal=Scand J Surg | year= 2012 | volume= 101 | issue= 2 | pages= 86-93 | pmid=22623440 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22623440  }} </ref>
*[[Atherosclerosis]]:<ref name="pmid9839111">{{cite journal| author=Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM| title=Preventive foot care in people with diabetes. | journal=Diabetes Care | year= 1998 | volume= 21 | issue= 12 | pages= 2161-77 | pmid=9839111 | doi=10.2337/diacare.21.12.2161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9839111  }} </ref><ref name="pmid6390204">{{cite journal| author=LoGerfo FW, Coffman JD| title=Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care. | journal=N Engl J Med | year= 1984 | volume= 311 | issue= 25 | pages= 1615-9 | pmid=6390204 | doi=10.1056/NEJM198412203112506 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6390204  }} </ref>
**[[Atherosclerosis]] of the [[Limb (anatomy)|lower limb]] is 2 to 3 times more common in [[diabetes|diabetic]] [[patients]], compared to the normal population.
**Investigations reported that [[atherosclerosis]] in [[diabetes|diabetic]] [[patients]] is more prominent in [[Anterior tibial artery|tibial]] and [[fibular arteries]] of the calf and [[artery|arteries]] of the [[foot]] are usually spared.
**It usually occurs due to [[inflammation]] and consequently leads to accumulation of the [[foam cells]].
*[[Microvascular disease|Micro]] and [[Macrovascular disease|macrovascular]] [[Complication (medicine)|complications]] are one of the leading causes of [[diabetes|diabetic]] [[Complication (medicine)|complications]].<ref name="pmid22623440">{{cite journal| author=Venermo M, Vikatmaa P, Terasaki H, Sugano N| title=Vascular laboratory for critical limb ischaemia. | journal=Scand J Surg | year= 2012 | volume= 101 | issue= 2 | pages= 86-93 | pmid=22623440 | doi=10.1177/145749691210100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22623440  }} </ref>
**[[[[Microvascular disease|Microvascular]] [[Complication (medicine)|complications]] cause [[skin]] damage, infection and impaired wound healing. Once a foot ulcer develops, peripheral vascular disease is the most important factor which may contribute to adverse outcomes. Vascular complications are like a positive feedback which worsen the skin and nerve damage in diabetes.
*The vascular changes which are responsible for [[foot]] problems include stiff [[artery|arteries]] due to [[calcification]] of the [[Smooth muscle|smooth muscle cells]] in the [[artery|arterial wall]] (mediasclerosis).  
*Most of these changes are discovered by an impaired [[ABI|ankle brachial index]] ([[ABI]]).  
**The resting [[ABI]] is the ratio of the [[blood pressure]] in the [[Limb (anatomy)|lower limb]] to the [[blood pressure]] of the [[arms]]. It is calculated by dividing the [[systolic blood pressure]] of the [[ankle]] by the [[systolic blood pressure]] of the [[arm]].  
**It is a non-invasive method to assess the [[Limb (anatomy)|lower extremty]] [[artery|arterial system]] and to detect the presence of [[artery|arterial]] occlusion [[disease]].   
*Even in the presence of [[neuropathy|neuropathic]] [[diabetic foot|foot ulcers]], the reason of non healing [[wounds]] could be due to impaired [[blood]] supply to the [[Tissue (biology)|tissue]], which could be further augmented by [[antihypertensive]] [[medications]].<ref name="pmid22529027">{{cite journal| author=Alexiadou K, Doupis J| title=Management of diabetic foot ulcers. | journal=Diabetes Ther | year= 2012 | volume= 3 | issue= 1 | pages= 4 | pmid=22529027 | doi=10.1007/s13300-012-0004-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22529027  }} </ref>.  


[[Image:Microcirculation image.png|500px|Neuropathy and angiopathy in the foot have a positive feedback on each other]]
[[Image:Microcirculation image.png|500px|Neuropathy and angiopathy in the foot have a positive feedback on each other]]

Revision as of 07:33, 10 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]Vishnu Vardhan Serla M.B.B.S. [3]

Overview

Pathophysiology

Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. There are numerous responsible pathogenesis, such as arterial abnormalities, diabetic neuropathy, delayed wound healing and being more vulnerable to infection or gangrene of the foot. The key components of diabetic foot are neuropathy, angiopathy and trauma. [1]

Neuropathy

Ischemia

Neuropathy and angiopathy in the foot have a positive feedback on each other

Trauma

Genetics

Associated Conditions

Conditions associated with [disease name] include:

  • [Condition 1]
  • [Condition 2]
  • [Condition 3]

Gross Pathology

On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Microscopic Pathology

On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

References

  1. Assal JP, Mehnert H, Tritschler HJ, Sidorenko A, Keen H, Hellmut Mehnert Award Workshop Participants (2002). "On your feet! Workshop on the diabetic foot". J Diabetes Complications. 16 (2): 183–94. PMID 12039404.
  2. Grunfeld C (1992). "Diabetic foot ulcers: etiology, treatment, and prevention". Adv Intern Med. 37: 103–32. PMID 1557993.
  3. Younger DS, Rosoklija G, Hays AP (1998). "Diabetic peripheral neuropathy". Semin Neurol. 18 (1): 95–104. doi:10.1055/s-2008-1040865. PMID 9562671.
  4. Borssén B, Bergenheim T, Lithner F (1990). "The epidemiology of foot lesions in diabetic patients aged 15-50 years". Diabet Med. 7 (5): 438–44. doi:10.1111/j.1464-5491.1990.tb01420.x. PMID 2142042.
  5. Ebenezer GJ, O'Donnell R, Hauer P, Cimino NP, McArthur JC, Polydefkis M (2011). "Impaired neurovascular repair in subjects with diabetes following experimental intracutaneous axotomy". Brain. 134 (Pt 6): 1853–63. doi:10.1093/brain/awr086. PMC 3140859. PMID 21616974.
  6. Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM (1998). "Preventive foot care in people with diabetes". Diabetes Care. 21 (12): 2161–77. doi:10.2337/diacare.21.12.2161. PMID 9839111.
  7. LoGerfo FW, Coffman JD (1984). "Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care". N Engl J Med. 311 (25): 1615–9. doi:10.1056/NEJM198412203112506. PMID 6390204.
  8. Venermo M, Vikatmaa P, Terasaki H, Sugano N (2012). "Vascular laboratory for critical limb ischaemia". Scand J Surg. 101 (2): 86–93. doi:10.1177/145749691210100203. PMID 22623440.
  9. 9.0 9.1 9.2 Alexiadou K, Doupis J (2012). "Management of diabetic foot ulcers". Diabetes Ther. 3 (1): 4. doi:10.1007/s13300-012-0004-9. PMID 22529027.
  10. Noor S, Zubair M, Ahmad J (2015). "Diabetic foot ulcer--A review on pathophysiology, classification and microbial etiology". Diabetes Metab Syndr. 9 (3): 192–9. doi:10.1016/j.dsx.2015.04.007. PMID 25982677.


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