Diabetic Foot Ulcers and the Link to Peripheral Artery Disease (PAD)
If you are a diabetic and have ever experienced the uncertainty of a slow-healing diabetic foot ulcer, you already know the importance of a multidisciplinary approach. Utilizing not only podiatry but vascular surgery is crucial to promoting the best medical outcomes and in trying to prevent amputations. There are 38.4 million diabetics in the United States, according to the CDC.
When you have Diabetes Type 1, your body is unable to produce insulin, whereas Diabetes Type 2 is when your body does not make enough insulin, which is known as insulin resistance. Insulin is vital in regulating our blood sugar levels. When our bodies lack the necessary insulin hormonal levels, it can lead to high blood sugar levels in our bloodstream, otherwise known as hyperglycemia. When hyperglycemia becomes a chronic condition, it can wreak havoc on your body—especially on your organs, nerves, and blood vessel systems.
Having diabetes puts you at risk for heart attacks, strokes, Peripheral Artery Disease (macrovascular), neuropathy (microvascular), and kidney and eye problems.
Peripheral Artery Disease (PAD) is a macrovascular problem that is associated with atherosclerosis. Atherosclerosis occurs when plaque buildup clogs arteries or restricts blood flow to the lower extremities by narrowing the arterial pathway. When your blood circulation is drastically impaired, it will inevitably lead to diabetic foot ulcers.
Per the NIH, “A study by Song et al. compiled 37 PAD-related parameters in China and showed that diabetes is the third leading cause of PAD after smoking and hypertension.” The Song study reiterates how PAD and diabetes are highly likely comorbidities and how imperative it is to screen those with diabetes for PAD due to the heightened risk of developing diabetic foot ulcers. Also from the NIH, “Diabetic Mellites patients have more than two-fold increased prevalence of PAD compared with the general population.”
There are 3 types of diabetic foot ulcers: “purely neuropathic (35%), purely ischemic (15%), and mixed neuroischemic (50%).”
Neuropathic ulcers are related to damage to the nerves. Ischemic ulcers are caused by poor circulation due to arterial damage. Neuroischemic ulcers are when patients have both nerve damage and poor blood flow issues. This type of ulcer is difficult to heal and, if not treated, will result in limb loss.
Here are the Six Stages of a Diabetic Foot, as described by the 7th Practical Diabetes International Foot Conference:
Stage 1 - Normal (not in jeopardy)
Stage 2 - High-risk for Ulcers
Stage 3 - Ulcers
Stage 4 - Cellulitis
Stage 5 - Necrosis
The National Institute of Health states that “[d]iabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus.”
Despite all the research that points to PAD and diabetes resulting in developing a diabetic foot ulcer, PAD “is grossly under diagnosed and hence undertreated, possibly because it is asymptomatic.”
In fact, neuropathy is most blamed for diabetic foot ulcers even though PAD bears an equal causation for its development. But since many symptoms of PAD are not noticeable in the preliminary stages, it can lead to diabetics not even realizing that they have PAD—and not knowing that you have PAD can have grave consequences.
If you have diabetes, it is crucial to get screened for PAD by a vascular surgeon and PAD specialist like Dr. David Nabi. PAD is a silent threat that can increase the risk of diabetic foot ulcers and limb loss. Diagnosing and treating vascular diseases is imperative to reduce catastrophic complication, so make an appointment today by calling 949-979-7106.