Recognizing diabetic peripheral vasculopathy

  Diabetic peripheral angiopathy (PAD) is an independent risk factor for the development of diabetic foot and amputation. Initial clinical screening methods for PAD include palpation of the dorsalis pedis artery and measurement of the ankle-brachial index (ABI).  Studies have shown that diminished arterial pulsation in the foot and decreased ABI values are independent risk factors for foot ulcers and amputations. Compared with non-diabetic patients, diabetic patients have early onset, diffuse lesions, rapid progression and high incidence of vascular lesions.  PAD mainly involves lower limb arteries, especially the N artery below the knee, posterior tibial artery, peroneal artery, etc. These atherosclerotic plaques and thrombosis cause luminal narrowing and occlusion, resulting in distal limb ischemia, so that the tissue cannot get enough oxygen and nutrients, and cannot discharge metabolic waste in time, i.e., the therapeutic drugs cannot reach the lesion effectively.  In addition, the formation of blood vessels in the diabetic foot ulcer wound is also reduced, which is another form of ischemia in the lesioned tissue and increases the risk of amputation. Abnormal biomechanical changes in the foot are associated with the development of foot ulcers and amputations, including increased plantar pressure, abnormal bone changes, and limited joint motion.  In addition, bunion, hindfoot pronation, claw toe, and anterior displacement of the plantar fat pad of the flexor tendon can also cause an increase in pressure at a point in the foot, which can lead to ulcer formation. Restricted joint movement can lead to increased pressure on the plantar metatarsal muscles, which can predispose to foot ulcers.  The treatment of diabetic foot is mainly based on blood glucose control, pharmacological intervention, arterial bypass, stem cell transplantation and other clinical treatment methods.