%0 Journal Article
%T The Diabetic Foot Syndrome An Ignored and Potential Problem in Medical Practice SciDoc Publishers | Open Access | Science Journals | Media Partners
%A Kamran M.A. Aziz
%J Diabetology & Vascular Disease Research (IJDVR)
%D 2018
%R http://dx.doi.org/10.19070/2328-353X-130003e
%X Pathogenesis of Diabetic Foot Ulcers Apart from the patients' ignorance, poor footwear and poor hygienic conditions, diabetic neuropathy is the most common cause of foot ulcerations; neuropathy itself is most common form of the long-term complications of diabetes. Most common amongst the neuropathies which cause foot ulcers are chronic sensorimotor distal symmetrical polyneuropathy [20]. This type of neuropathy commonly results in a sensory loss of stocking distribution confirmed on examination by a deficit in the all sensory modalities. Patients may also give history of neuropathic symptoms such as burning/ pricking or stabbing pain, and paresthesia especially at night. Hence neuropathy appears to be one of the most important risk factor and pathology for the development of diabetic foot ulceration. Others risk factors include cigarette smoking, dyslipidemia, and peripheral vascular disease (PVD). These all facts can be collected as a model for development of foot ulcers or Rothman model for causation. Both Pecoraro et al. [21] and later Reiber et al. [22] have taken the Rothman model as an explanation for the development of foot ulcers. According to this model, a component cause (e.g., neuropathy) is not sufficient in itself to lead to foot ulceration, but instead when component causes act together, they result in ulceration. Under this model, weight bearing areas (in the presence of dry skin due to neuropathy) are susceptible for callus (hypertrophic hard skin) formation due to repeated friction and trauma. This callus then acts as foreign body with central hemorrhage or necrosis. Plantar callus is the first trigger for the ulcer formation [23]. Similarly, abnormal plantar pressures play also an important role in the pathogenesis of foot ulcers [24]. Thus a combination of sensory and motor neuropathy with altered gait patterns result in the foot deformity or ¡° high risk ¡± neuropathic foot with clawing of the toes, prominent metatarsal heads, Hallux valgus, high arch and small muscle wasting. Advanced stages of neuropathy may lead to Charcot deformity. In contrast to the neuropathic ulcers (which are usually painless), vascular ulcers are painful, and as a result of peripheral vascular disease (PVD). PVD is a major contributory factor in the pathogenesis of foot ulceration and subsequent major amputations [25]. Common unique symptoms of vascular involvement of lower limbs include claudication (pain in leg/calf by walking and relieved by rest) and rest pain. Patient also may present clinically with non-healing ulcers [26,27]
%K n/a
%U https://scidoc.org/IJDVR-2328-353X-01-003e.php