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Location of ulcerations in diabetic patients may be explained by blood flow

April 9, 2003 (San Diego, CA) -- Sixty percent of hospital admissions of patients with diabetes are caused by complications of foot ulcers. More than 70 percent of these admissions require surgical intervention with 40 percent resulting in amputations. Of those with below knee amputations, 40 percent will require an amputation on the contralateral limb within three years.

It is estimated that at least half of the amputations are preventable through improved foot care programs. Unfortunately, significant portions of patients continue to develop plantar (sole of the foot) ulcers even with prescriptive footwear compliance. Consequently, efforts to understand the skin vasculature response to plantar pressures may provide insight into re-ulceration issues, since cutaneous perfusion is suspected to be influenced by arterial circulation but and the mechanical effects of repetitive pressure.

Background

Type II diabetes is related to poor glycemic control and if uncontrolled, leads to microvascular and neuropathic complications that can result in foot ulceration and amputation. Paramount to diabetes control is glycemic control due to the strong relationship between hyperglycemia, microvascular complications and neuropathic symptoms. Much work is being done to evaluate treatments for improved glycemic control. Research is ongoing, but the strong causal relationship between poor glycemic control, poor microcirculation and peripheral neuropathy continues to cause insensate feet, poor skin circulation, high plantar pressures, ulceration, and eventually amputation.

Fifty percent of diabetic patients have some degree of peripheral sensory neuropathy, with nerve damage increasing in incidence with the duration of disease. The most common type of peripheral neuropathy affecting diabetic patients is symmetric polyneuropathy involving distal sensory and motor fibers. This causes sensory loss and motor abnormalities in the distal parts o
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Contact: Donna Krupa
djkrupa1@aol.com
703-967-2751
American Physiological Society
9-Apr-2003


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