Diabetic foot pathophysiology

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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, ischemia and trauma. [1]

Neuropathy

Ischemia

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

Trauma

Defective hypoxic response

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. McMillan DE (1985). "Blood flow and the localization of atherosclerotic plaques". Stroke. 16 (4): 582–7. doi:10.1161/01.str.16.4.582. PMID 2411027.
  10. 10.0 10.1 10.2 Alexiadou K, Doupis J (2012). "Management of diabetic foot ulcers". Diabetes Ther. 3 (1): 4. doi:10.1007/s13300-012-0004-9. PMID 22529027.
  11. 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.
  12. Semenza GL (2012). "Hypoxia-inducible factors in physiology and medicine". Cell. 148 (3): 399–408. doi:10.1016/j.cell.2012.01.021. PMC 3437543. PMID 22304911.
  13. Semenza GL (2014). "Oxygen sensing, hypoxia-inducible factors, and disease pathophysiology". Annu Rev Pathol. 9: 47–71. doi:10.1146/annurev-pathol-012513-104720. PMID 23937437.
  14. Catrina SB, Zheng X (2016). "Disturbed hypoxic responses as a pathogenic mechanism of diabetic foot ulcers". Diabetes Metab Res Rev. 32 Suppl 1: 179–85. doi:10.1002/dmrr.2742. PMID 26453314.
  15. Botusan IR, Sunkari VG, Savu O, Catrina AI, Grünler J, Lindberg S; et al. (2008). "Stabilization of HIF-1alpha is critical to improve wound healing in diabetic mice". Proc Natl Acad Sci U S A. 105 (49): 19426–31. doi:10.1073/pnas.0805230105. PMC 2614777. PMID 19057015.
  16. Mace KA, Yu DH, Paydar KZ, Boudreau N, Young DM (2007). "Sustained expression of Hif-1alpha in the diabetic environment promotes angiogenesis and cutaneous wound repair". Wound Repair Regen. 15 (5): 636–45. doi:10.1111/j.1524-475X.2007.00278.x. PMID 17971009.
  17. Catrina SB, Okamoto K, Pereira T, Brismar K, Poellinger L (2004). "Hyperglycemia regulates hypoxia-inducible factor-1alpha protein stability and function". Diabetes. 53 (12): 3226–32. doi:10.2337/diabetes.53.12.3226. PMID 15561954.
  18. Bento CF, Fernandes R, Ramalho J, Marques C, Shang F, Taylor A; et al. (2010). "The chaperone-dependent ubiquitin ligase CHIP targets HIF-1α for degradation in the presence of methylglyoxal". PLoS One. 5 (11): e15062. doi:10.1371/journal.pone.0015062. PMC 2993942. PMID 21124777.
  19. Jhamb S, Vangaveti VN, Malabu UH (2016). "Genetic and molecular basis of diabetic foot ulcers: Clinical review". J Tissue Viability. 25 (4): 229–236. doi:10.1016/j.jtv.2016.06.005. PMID 27372176.
  20. Rafehi H, El-Osta A, Karagiannis TC (2011). "Genetic and epigenetic events in diabetic wound healing". Int Wound J. 8 (1): 12–21. doi:10.1111/j.1742-481X.2010.00745.x. PMID 21159125.
  21. Laato M, Kähäri VM, Niinikoski J, Vuorio E (1987). "Epidermal growth factor increases collagen production in granulation tissue by stimulation of fibroblast proliferation and not by activation of procollagen genes". Biochem J. 247 (2): 385–8. doi:10.1042/bj2470385. PMC 1148420. PMID 3501286.
  22. Singh K, Singh VK, Agrawal NK, Gupta SK, Singh K (2013). "Association of Toll-like receptor 4 polymorphisms with diabetic foot ulcers and application of artificial neural network in DFU risk assessment in type 2 diabetes patients". Biomed Res Int. 2013: 318686. doi:10.1155/2013/318686. PMC 3725976. PMID 23936790.


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