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Diabetic Foot and Ankle: Vascular Pathology

- 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.

Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care.