- See:
-
Diabetic Foot Menu:
-
Osteomyelitis in the Diabetic Patient:
-
Amputations in the Diabetic Patient:
- Discussion:
- several abnormalities of cutaneous circulatory anatomy & hemodynamics exist in pts with diabetes;
- increased incidence of atherosclerosis, calcification of tunica media, & thickening of
tunica media are among large vessel abnormalities;
- look for multisegmental involvement at the level of the popliteal trifurcation and below the trifurcation;
- microcircular changes include thickening of capillary basement membranes, arteriolar hyalinosis, & endothelial proliferation;
-
Mockerberg's sclerosis:
- most frequent form of vascular calcification in patients with diabetes and
renal failure
is localized to the medial layer of small and medium sized arteries;
- type of calcification is diffuse and continuous along vessel wall;
-
vascular exam
- check for pulses in the
dorsalis pedis,
posterior tibial artery, and and
popliteal artery;
- if popliteal artery pulses are present and pulses of the DP and PTA are absent, then it is likely
that diffuse distal vascular disease is present which is not amenable to vascular bypass;
- if there is absence of the politeal, DP, and posterior tibial artery pulses are absent, then it is possible
that a proximal vascular lesion is present, which may indicate that vascular reconstruction is possible;
-
diff dx: gout
The diabetic foot: evolving technologies.
Management of the diabetic foot.
Harrelson J: Orthop Clin North Am 1989;20:605.
Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care.
LoGerfo FW. Coffman JD. NEJM. 311(25):1615-9, 1984 Dec 20.
