Causes of diabetic foot lesions

• Published in: The Lancet (British edition) Vol. 366; no. 9498; pp. 1675 - 1676
• Main Author: Urbancic-Rovan, Vilma
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 12.11.2005; Elsevier Limited
• Subjects: Aging; Biomechanical Phenomena; Biomechanics; Diabetes; Diabetic Foot - etiology; Diabetic Foot - physiopathology; Feet; Foot Injuries - complications; Humans; Medical treatment; Podiatry; Preventive medicine; Risk Factors; Shoes - adverse effects; Smoking - adverse effects; Socioeconomics
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(05)67673-8

The causal pathways to diabetic foot disease and amputation have been studied extensively. Many patients and health-care workers believe that diabetic foot problems are caused solely by impaired blood supply,1 whereas neuropathy, trauma, and infection are, if anything, of even greater importance.2 Other risk factors include previous foot ulcer, improper footwear, unobtainable or low-quality chiropody service, poor metabolic control, psychological factors, tobacco smoking, old age, and low socioeconomic status. Foot complications usually develop from an interplay of several causes, of which neuropathy may be the most important. Diabetic neuropathy can involve sensory, motor, or autonomic nerves, and is usually insidious in onset and therefore unnoticed. It renders the feet deaf and blind to stimuli that normally arouse a feeling of pain or discomfort. Motor neuropathy leads to muscle atrophy, foot deformity (figure), altered biomechanics of walking, and redistribution of foot pressures during standing and walking. Abundant callus formation on pressure points, together with thinning of the sub-metatarsal head fat-pads, additionally increases the force of plantar pressure and ultimately results in foot ulceration.3 Autonomic neuropathy results in loss of sweating, which leaves the skin dry and vulnerable to cracks and fissures, and altered neurogenic regulation of cutaneous blood flow. The acute Charcot's foot is a rare but severe limb-threatening complication of neuropathy, in which complex causes lead to gross disorganisation of the bones of the foot.4