VASCULAR ASSESSMENT IN THE NEUROPATHIC DIABETIC FOOT

Diabetic foot infections, a common source of morbidity and mortality, often have been related to vasculopathy and neuropathy in its etiopath ogenesis, especially in the elderly person with diabetes, However, blo od flow in the neuropathic diabetic foot has not been evaluated extens ively, and there is evidence of abnormal blood flow patterns in the ne uropathic diabetic foot unrelated to ischemia, The authors studied you ng persons with diabetes, with varying degrees of neuropathy, to asses s the extent of vasculopathy in their lower limbs, Twelve young person s with insulin-dependent (Type I) diabetes (mean age, 36.1 +/- 1.975 y ears) and peripheral neuropathy, all of whom had previous surgery for diabetic foot infections, were identified, Confirmatory evidence of ne uropathy was made using electromyographic studies and clinical tests t hat showed severe peripheral neuropathy, The results of vascular asses sment of both lower limbs did not reveal any change in the pulse wave velocities from the popliteal to the digital vessels of the big toe as compared with correspondingly matched controls. There also was no sig nificant stenosis in any of the vessels studied as far as the level of the dorsalis pedis and posterior tibial vessels, The normal triphasic pattern of arterial blood flow was lost, A monophasic pattern was pre sent in all patients with prolonged diastolic flow at the level of the dorsalis pedis and posterior tibial arteries and distally, The pulsat ility index was 3.14 +/- 0.81 as compared with 9.85 +/- 5.2. Mean toe pressures in the patient with diabetes was 64.17 +/- 20.87 mm Hg as co mpared with 98.23 +/- 10.12 mm Hg in controls, A linear correlation of decreasing toe pressures with increasing severity of neuropathy was s een (R = 0.7). The data suggest that changes exist in the blood flow p atterns in young patients with diabetes and neuropathy, even in the ab sence of lower limb ischemia.