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Microvascular Changes in the Diabetic Foot

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The Diabetic Foot

Part of the book series: Contemporary Diabetes ((CDI))

Abstract

Diabetes affects the microcirculation through many different pathological mechanisms, including endothelial dysfunction and abnormal neurovascular control. These functional changes in microvascular function have a compounding relationship with structural changes in the cutaneous microcirculation of the diabetic foot. Ultimately, such adverse adaptations in function and structure contribute to the formation of diabetic foot complications such as ulceration, and in more severe circumstances to amputation. Indeed, diabetes and its associated complications place an enormous economic burden on public health systems, globally, highlighting the need for early intervention and prevention. In recent decades, several noninvasive imaging techniques and tests of microvascular reactivity have evolved that may have the potential to allow clinicians to more accurately predict the risk of foot ulceration in those with diabetes, as well as provide the ability to monitor wound healing rates and determine the success of therapeutic interventions. This chapter will summarize these methods used to assess the cutaneous microcirculation while also describing the respective roles of hyperglycemia, insulin resistance, and inflammation in endothelial dysfunction and its complex relationship with neurovascular function.

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Authors and Affiliations

  1. Microcirculatory Lab, Rongxiang Xu, MD, Center for Regenerative Therapeutics, Joslin-Beth Israel Deaconess Foot Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Matthieu Roustit PharmD, PhD, Jordan Loader, Dimitrios Baltzis MD, PhD & Wanni Zhao MD, PhD

  2. The Rongxiang Xu, MD, Center for Regenerative Therapeutics Research Director, Joslin-Beth Israel Deaconess Foot Center, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Aristidis Veves MD, DSc

Authors
  1. Matthieu Roustit PharmD, PhD
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  2. Jordan Loader
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  3. Dimitrios Baltzis MD, PhD
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  4. Wanni Zhao MD, PhD
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  5. Aristidis Veves MD, DSc
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Corresponding author

Correspondence to Matthieu Roustit PharmD, PhD .

Editor information

Editors and Affiliations

  1. Rongxiang Xu, MD, Professor of Surgery, Harvard Medical School Director, The Rongxiang Xu, MD, Center for Regenerative Therapeutics Research Director, Joslin-Beth Israel Deaconess Foot Center Beth Israel Deaconess Medical Center, Boston, MA, USA

    Aristidis Veves

  2. Chief, Division of Podiatry, Beth Israel Deaconess Medical Center, Associate Professor of Surgery, Harvard Medical School, Co-director, Joslin-Bl Deaconess Diabetic Foot Center Consultant, Joslin Diabetes Center, Boston, MA, USA

    John M. Giurini

  3. Associate Professor of Surgery, Harvard Medical School, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Joslin Diabetes Center, Boston, MA, USA

    Raul J. Guzman

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Roustit, M., Loader, J., Baltzis, D., Zhao, W., Veves, A. (2018). Microvascular Changes in the Diabetic Foot. In: Veves, A., Giurini, J., Guzman, R. (eds) The Diabetic Foot. Contemporary Diabetes. Humana, Cham. https://doi.org/10.1007/978-3-319-89869-8_10

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  • DOI: https://doi.org/10.1007/978-3-319-89869-8_10

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