Title: The influence of diabetes and lower limb arterial disease on Cutaneous foot perfusion
Authors: Dean T. Williams, MD, Patricia Price, PhD, and Keith G. Harding, MD
Source: Journal of Vascular Surgery. October 2006. 44(4): 770-775
PODIATRIC RELEVANCE:
Diabetic patients are prone to non-healing foot wounds. Podiatrists’ efforts to optimize the wound environment will fail if the patient has impaired circulation limiting oxygen supply to the wound. The purpose of this study is to determine the effect of peripheral neuropathy and lower limb arterial disease on cutaneous foot perfusion.
METHODS:
In this article, a prospective clinical study was performed utilizing 130 limbs, none of which had any active foot disease, rest pain, or critical limb ischemia. There were two control groups, one with non-diabetics without peripheral vascular disease (PVD) and one with non-diabetics with PVD. The study groups consisted of two groups of diabetic subjects with and without peripheral neuropathy, both without PVD, and two groups of diabetic subjects with PVD, one neuropathic and one not. The following measurements were obtained: toe-brachial pressure indices (TBI), transcutaneous O2 tension (TcPO2), and color duplex imaging (CDI) of the lower extremity arteries.
RESULTS:
Severe calcification (involving greater than 50% of the arteries) was found more in the diabetic groups than the non-diabetic ones. All groups identified with arterial disease had lower toe pressures and TBI values than those without PVD (significant in the control vasculopath and the diabetes neuropathic vasculopath group (p<0.001). TcPO2 was decreased in all diabetic groups and significant in the diabetes neuropathic vasculopath group at 46.4 mmHg (p<0.001).
COMMENTS:
A wide range of TBI values was found in the patients without PVD, including extremely high values (>1.2) due to heavily calcified digital arteries. These values were associated with low TcPO2 values, indicating that severe digital calcification is associated with dysfunction of the cutaneous circulation. Many limbs with PVD had normal TcPO2 and TBI values (ex. the diabetes non-neuropathic vasculopath group) because there was no critical limb ischemia. The diabetes neuropathic vasculopath group had a mean TBI of 0.48 and a mean TcPO2 of 46.41. The control vasculopath group had TcPO2 values that were higher than those of diabetics without PVD, indicating that all individuals with diabetes have a greater decrease in perfusion. Among individuals with similar degrees of PVD, the diabetics may be more vulnerable to injury.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.