Foot ulcerations are one of the most serious complications of diabetes, resulting in more than 80,000 lower-leg amputations each year in the U.S. alone.
A new study led by researchers at the Joslin-Beth Israel Deaconess Foot Center and Microcirculation Laboratory finds that early changes in the oxygenation of the skin could help foretell the development of ulcerations and enable doctors to treat patients at an earlier stage, before the onset of serious complications.
Reported in the Nov. 12 issue of the medical journal The Lancet, the study is part of a special issue devoted to diabetic foot disease.
"Nearly one in 40 diabetes patients will develop foot ulcers every year and more than 15 percent of these individuals will have to undergo amputation," explains Aristidis Veves, MD, DSc, research director of the Joslin-Beth Israel Deaconess Foot Center and Microcirculation Laboratory and associate professor of surgery at Harvard Medical School. "And, unfortunately, an amputation is often the beginning of a rapid downward cycle from which the patient never recovers."
The root of the problem is often a condition known as peripheral neuropathy, which develops when uncontrolled high blood sugar damages the nerves of the legs and feet, resulting in greatly decreased sensitivity.
"Peripheral neuropathy causes extreme numbness and a loss of protective sensation," explains Veves. "As a result, even a minor foot injury [such as a corn or callus, a splinter, or pressure from an improperly fitting shoe] can go undetected by the patient until it has escalated into a chronic wound that won't heal." Once an ulcer has become infected it can lead to the onset of gangrene, and in the most serious cases, to amputation of the limb.
Knowing that changes in large vessels and the microcirculation of the diabetic foot play a central role in the development of ulcers and their subsequent failure to heal, the authors set out to specifically identify what these changes are.