Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Blood flow in the foot, polyneuropathy and foot ulceration in diabetes mellitus

  • 167 Accesses

  • 37 Citations

Summary

Comparable groups of diabetic patients asymptomatic of neuropathy (Group A), with chronic painful polyneuropathy (Group B) and painless polyneuropathy causing recurrent foot ulceration (Group C) were studied for differences in pedal blood flow, peripheral somatic and autonomic neuropathy and vascular calcification. Blood flow abnormalities detected by doppler waveform analysis, and consistent with reduced peripheral vascular resistance, were found in all three diabetic patient groups. The abnormalities were of similar severity in Group A and B but generally more marked in Group C. Tests of peripheral somatic nerve function became progressively more abnormal from Group A to Group C. Autonomic neuropathy was equally severe in Groups B and C, although mild abnormalities were recorded in diabetic patients asymptomatic of neuropathy. A similar pattern was seen for vascular calcification in the tarsal and metatarsal arteries: marked in both neuropathic groups (B and C) but mild in Group A. It was concluded that abnormal blood flow consistent with reduced peripheral vascular resistance is very common in the feet of diabetic patients whether or not they are symptomatic of neuropathy, and is most severe in those with chronic painless polyneuropathy and recurrent foot ulceration. No clear relationship was found between autonomic nerve dysfunction and the degree of abnormality of blood flow.

References

  1. 1.

    Christensen NJ (1969) Spontaneous variations in resting blood flow, post-ischaemic peak flow and vibratory perception in diabetes. Diabetologia 5: 171–178

  2. 2.

    Partsch H (1978) Neuropathien vom ulzero-mutilierenden Typ, Klinik, Klassifikation, Durchblutungsmessungen. Z Gefäßkr [Suppl 6]: 1–48

  3. 3.

    Scarpello JHB, Martin TRP, Ward JD (1980) Ultrasound measurements of pulse-wave velocity in the peripheral arteries of diabetic subjects. Clin Sci 58: 53–57

  4. 4.

    Edmonds ME, Nicholaides K, Watkins PJ (1986) Autonomic neuropathy and diabetic neuropathic foot ulceration. Diabetic Med 3: 56–59

  5. 5.

    Boulton AJM, Scarpello JHB, Ward JD (1982) Venous oxygenation in the diabetic neuropathy foot: evidence of ateriovenous shunting. Diabetologia 22: 6–8

  6. 6.

    Rayman G, Hassan A, Tooke JE (1986) Blood flow in the skin of the foot related to posture in diabetes mellitus. Br Med J 292: 87–90

  7. 7.

    Ward JD (1982) The diabetic leg. Diabetologia 2: 141–147

  8. 8.

    Edmonds ME, Wilton GN, Roberts VC, Watkins PJ (1983) Blood flow in the neuropathic limb of the diabetic. In: Taylor DEM, Stevens AL (eds) Blood flow: theory and practice. Academic, London, pp 157–171

  9. 9.

    Archer AG, Roberts VC, Watkins PJ (1984) Blood flow patterns in painful diabetic neuropathy. Diabetologia 27: 563–567

  10. 10.

    Watkins PJ, Edmonds ME (1983) Sympathetic nerve failure in diabetes. Diabetologia 25: 73–77

  11. 11.

    Gosling RG, Dunbar G, King DH, Newman DL, Side CD, Woodcock JP, Fitzgerald DE, Keates JS, Macmillan D (1971) The quantitative analysis of peripheral arterial disease by a noninvasive quantitative doppler waveform analysis. Br J Surg 68: 789–792

  12. 12.

    Skidnore R, Woodcock JP, Wells PNT, Bird D, Baird RN (1980) Physiological interpretation of doppler-shift waveforms — III. Clinical Results. Ultrasound Med Biol 6: 227–231

  13. 13.

    Skidmore R, Woodcock JP (1980) Physiological interpretation of doppler-shift waveforms — I. Theoretical considerations. Ultrasound Med Biol 6: 7–10

  14. 14.

    Skidmore R, Woodcock JP (1980) Physiological interpretation of doppler-shift waveforms. — II. Validation of the Laplace transform method for characterisation of the common femoral blood velocity/time waveform. Ultrasound Med Biol 6: 219–225

  15. 15.

    Evans DH, Macpherson DS, Bentley S, Asher MJ, Bell PRF (1981) The effect of proximal stenosis on doppler waveforms; a comparison of three methods of waveform analysis in an animal model. Clin Phys Physiol Meas 2 (1): 17–25

  16. 16.

    Campbell WB, Cole SEA, Skidmore R, Baird RN (1984) The clinician and the vascular laboratory in diagnosis of aorto-iliac stenosis. Br J Surg 71: 302–306

  17. 17.

    Bird DR, Skidmore R, Woodcock JP (1980) The value of doppler transform function analysis in the diagnosis of aorto-iliac arterial occlusive disease. In: Baird RN, Woodcock JP (eds) Diagnosis and monitoring in arterial surgery. John Wright, Bristol, pp 121–126

  18. 18.

    Baker JD, Machleder HI, Skidmore R (1984) Analysis of femoral artery doppler signals by Laplace transform damping method. J Vasc Surg 1: 520–524

  19. 19.

    Law YF, Graham JC, Cotton LT, Roberts VC (1984) Validity of the transfer function model of the human arterial system of the lower limbs in man. Med Biol Eng Comput 22: 537–542

  20. 20.

    Macpherson DS, Evans DH, Bell PRF (1984) Common femoral artery doppler waveforms: a comparison of three methods of objective analysis with direct pressure measurements. Br J Surg 71: 46–49

  21. 21.

    Yao ST, Hobbs JT, Irvine WT (1969) Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg 56: 676–679

  22. 22.

    Yao ST (1970) Haemodynamic studies in peripheral arterial disease. Br J Surg 57: 761–766

  23. 23.

    Osmundson PJ, Chesebro JH, O'Fallon WM, Zimmerman BR, Kazmier FJ, Palumbo PJ (1981) A prospective study of peripheral occlusive arterial disease in diabetes. II. Vascular laboratory assessment. Mayo Clin Proc 56: 223–232

  24. 24.

    Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285: 916–918

  25. 25.

    Young RJ, Zhou YQ, Rodriguez E, Prescott RJ, Ewing DJ, Clarke BF (1986) Variable relationship between peripheral somatic and autonomic neuropathy in patients with different syndromes of diabetic polyneuropathy. Diabetes 35: 192–197

  26. 26.

    Deanfield JE, Daggett PR, Harrison MJG (1980) The role of autonomic neuropathy in diabetic foot ulceration. J Neurol Sci 47: 203–210

  27. 27.

    Ahmed ME, Delbridge L, Le Quesne LP (1986) The role of autonomic neuropathy in diabetic foot ulceration. J Neurol Neurosurg Psychiat 49: 1002–1006

  28. 28.

    Low PA, Zimmerman BR, Dyck PJ (1986) Comparison of distal sympathetic with vagal function in diabetic neuropathy. Muscle Nerve 9: 592–596

  29. 29.

    Fagius J (1982) Microneurographic findings in diabetic polyneuropathy with special reference to sympathetic nerve activity. Diabetologia 23: 415–420

  30. 30.

    Edmonds ME, Morrison N, Laws JW, Watkins PJ (1982) Medial arterial calcification in diabetes mellitus. Br Med J 284: 928–930

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Corbin, D.O.C., Young, R.J., Morrison, D.C. et al. Blood flow in the foot, polyneuropathy and foot ulceration in diabetes mellitus. Diabetologia 30, 468–473 (1987). https://doi.org/10.1007/BF00279614

Download citation

Key words

  • Blood flow
  • neuropathy
  • foot ulcers
  • diabetes mellitus