Diabetic Foot

A diabetic foot ulcer is a break in the skin of the foot that develops when three problems converge. Neuropathy removes the warning signal of pain, deformity or limited joint mobility concentrates pressure, and peripheral arterial disease limits the tissue's ability to repair itself. A pebble in a shoe, a cracked heel or a blister can therefore become an ulcer without the person noticing it. The three mechanisms usually coexist, which is why one finding rarely tells the whole story. Each pathway has its own chain of events: - Neuropathy. Chronic metabolic injury damages sensory nerves, so protective sensation falls, repetitive trauma goes unrecognized, and the skin breaks down. - Peripheral artery disease. Atherosclerotic narrowing reduces perfusion, oxygen and nutrient delivery fall, healing is delayed, and the risk of tissue loss rises. - Repetitive pressure. Foot deformity or abnormal loading concentrates plantar pressure, callus forms and damages the tissue beneath it, and an ulcer follows. Loss of protective sensation is not simply numbness. It means the patient may continue walking on tissue that is being injured with every step. Repetitive...