The concept of microcirculation being implicated in the pathogenesis of diabetic foot disease is being challenged by evidence that fails to confirm it. However, there is evidence of structural changes with capillary and in the basement membrane that do not permit the concept to be denied either. The lack of evidence should not be a reason to argue against surgery in the diabetic foot.
Flynn MD
, Tooke JE.Aetiology of diabetic foot ulceration: a role for microcirculation?Diabet Med1992;9: 320-329.
2.
Krishnan TM
, Rayman G.Microcirculation and diabetic foot. In: Boulton AJM, Cavanagh PR, Rayman G, editors. The foot in diabetes. Chichester, UK: Wiley; 2006. p. 41-50.
3.
Goldenberg S
, Alex M, Joshi RA, Blumenthal HT.Non atheromatous peripheral vascular disease of the lower extremity in diabetes mellitus. Diabetes1959;8: 261-273.
4.
Logerfo FW
, Coffman JD.Vascular and microvascular disease of the foot in diabetes; implications for foot care. N Engl J Med1984; 311: 1615-1619.
5.
Parving HH
, Viberti GC, Keen H, Christiansen JS, Lassen NA.Hemodynamic factors in the genesis of diabetic microangiopathy. Metabolism1983;32: 943-949.
6.
Dinh T
, Veves A.Microcirculation of the diabetic foot. Curr Pharm Des2005;11: 2301-2309.
7.
Watkins PJ
, Edmonds ME.Diabetic autonomic failure. In: Mathias CJ, Bannister R, editors. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. 4th ed.Oxford (UK): Oxford University Press; 1999. p. 378-386.
8.
Archer AG
, Roberts VC, Watkins PJ.Blood flow patterns in painful diabetic neuropathy. Diabetologia1984;27: 563-567.
9.
Jörneskog G
, Brismar K, Fagrell B.Skin capillary circulation is severely impaired in toes of patients with IDDM with and without late diabetic complications. Diabetologia1995;38: 474-480.
10.
Jörneskog G
, Fagrell B.Discrepancy in skin capillary circulation between fingers and toes in patients with type 1 diabetes. Int J Microcirc Clin Exp1996;16: 313-319.
11.
Jörneskog G
, Brismar K, Fagrell B.Pronounced skin capillary ischemia in the feet of diabetic patients with bad metabolic control. Diabetologia1998;41: 410-415.
12.
Flynn MD
, Edmonds ME, Tooke JE, Watkins PJ.Direct measurement of capillary blood flow in the diabetic neuropathic foot. Diabetologia1988;31: 652-666.
13.
Fagrell B
, Jorneskog G, Intaglietta M.Disturbed microvascular reactivity and shunting—a major cause for diabetic complications. Vasc Med1999;4: 125-127.
14.
Netten PM
, Wollersheim H, Thien T, Lutterman JA.Skin micro-circulation of the foot in diabetic neuropathy. Clin Sci1996;91: 559-565.
15.
Sandemann DD
, Shore AC, Tooke JE.Relation of skin capillary pressure in patients with insulin dependent diabetes mellitus to complications and metabolic control. N Engl J Med1992;327: 760-764.
16.
Rayman G
, Malik RA, Sharma AK, Day JL.Microvascular response to tissue injury and capillary ultrastructure in the foot skin type 1 diabetic patients. Clin Sci1995;89: 467-474.
17.
Jaap AJ
, Tooke JE.Is microvascular disease important in the diabetic foot? In: Boulton JM, Connor H, Cavanagh PR, editors. The foot in diabetes. Chichester (UK): Wiley; 1994. p. 49-56.
18.
Sandeman DD
, Pym CA, Green EM, Seamark C, Shore AC, Tooke JE.Microvascular vasodilatation in feet of newly diagnosed non-insulin dependent diabetic patients. BMJ1991;302: 1122-1123.
19.
Railton R
, Newman P, Hislop J, Harrower AD.Reduced transcutaneous oxygen tension and impaired vascular response in type 1 (insulin dependent) diabetes. Diabetologia1983;25: 340-342.
20.
Uccioli L
, Monticone G, Russo F, Mormile F, Durola L, Mennuni G, et al.Autonomic neuropathy and transcutaneous oxymetry in diabetic lower extremities. Diabetologia1994;37: 1051-1055.
21.
Casselli A
, Rich J, Hanane T, Uccioli L, Veves A.Role of c-nociceptive fibers in the nerve axon reflex-related vasodilatation in diabetes. Neurology2003;60: 297-300.
22.
Parkhouse N
, Le Quesne PM.Impaired neurogenic vascular response in patients with diabetes and neuropathic foot lesions. N Engl J Med1988;318: 1306-1309.
23.
Walmsley D
, Wiles PG.Early loss of neurogenic inflammation in the human diabetic foot. Clin Sci1991;80: 605-610.
24.
Calver A
, Collier J, Vallance P.Inhibition and stimulation of nitric oxide synthesis in the human forearm arterial bed of patients with insulin dependent diabetes. J Clin Invest1992;90: 2548-2554.
25.
McVeigh GE
, Brennan GM, Johnston GD, McDermott BJ, McGrath LT, Henry WR, et al.Impaired endothelium dependent and independent vasodilation in patients with type 2 (non insulin dependent) diabetes mellitus. Diabetologia1992;35: 771-776.
26.
Krishnan ST
, Rayman G.The LDI flare: a novel test of C-fiber function demonstrates early neuropathy in type 2 diabetes. Diabetes Care2004;27: 2930-2935.
27.
Greenman RL
, Panasyuk S, Wang X, Lyons TE, Dinh T, Longoria L, et al.Early changes in the skin microcirculation and muscle metabolism of the diabetic foot. Lancet2005;336: 1711-1717.
28.
McMillan DE
, Utterback NG, Stocki J.Low shear rate blood viscosity in diabetes. Biorheology1980;17: 355-362.
29.
Ernst E
, Matrai A.Altered red and white blood cell rheology in type 2 diabetes. Diabetes1986;35;1412-1415.
30.
MacRury SM
, Lowe GD.Blood rheology in diabetes mellitus. Diabet Med1990;7: 285-291.
Pitei DL
, Watkins PJ, Edmonds ME.NO-dependent smooth muscle vasodilatation is reduced in the NIDDM patients with peripheral sensory neuropathy. Diabet Med1997;14: 284-290.
33.
Krishnan ST
, Baker NR, Carrington AL, Rayman G.Comparative roles of microvascular and nerve function in foot ulceration in type 2 diabetes. Diabetes Care2004;27: 1343-1348.
34.
Arora S
, Smakowski P, Frykberg RG, Simeone LR, Freeman R, LoGerfo FW, et al.Differences in foot and forearm skin microcirculation in diabetic patients with and without neuropathy. Diabetes Care1998;21: 1339-1344.
35.
Caballero AE
, Arora S, Saouaf R, Lim SC, Smakowski P, Park JY, et al.Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 diabetes. Diabetes1999;48: 1856-1862.
36.
Rayman G
, Baker NR, Krishnan STM.Wound healing and microvascular responses in the foot skin of type 2 diabetic subjects with neuropathy [abstract]. Diabetic Foot Study Group, 5th Meeting, 2005, Greece.
37.
Edmonds ME
, Archer AG, Watkins PJ.Ephedrine: a new treatment for diabetic neuropathic oedema. Lancet1983;1: 548-551.
38.
Edmonds M
, Foster AVM, Sanders LJ.A practical manual of diabetic foot care. Oxford (UK): Blackwell Science; 2004.
39.
Quigley FG
, Faris IB, Duncan HJ.A comparison of Doppler ankle pressures and skin perfusion pressure in subjects with and without diabetes. Clin Physiol1991;11: 21-25.
40.
Arora S
, Pomposelli F, Lo Gerfo FW, Veves A.Cutaneous microcirculation in the neuropathic diabetic foot improves significantly but not completely after successful lower extremity revascularization. J Vasc Surg2002;35: 501-505.
41.
Zimmermann J
, Schramm L, Wanner C, Mulzer E, Henrich HA, Langer R, et al.Hemorheology, plasma protein composition and von Willebrand factor in type I diabetic nephropathy. Clin Nephrol1996;46: 230-236.
