Summary
Many clinical problems arise as a result of tissue pathology in the diabetic leg. Neuropathic or vascular ischaemic syndromes are readily identified but on occasions differentiation of the two may be difficult. This survey reviews the aetiological background of neuropathy and ischaemia, examines the relationship of physiological blood flow abnormalities to both areas and comments on management of the clinical states encountered, including the common problem of the ulcerated diabetic foot.
Article PDF
Similar content being viewed by others
References
Thomas PK, Ward JD (1975) Diabetic neuropathy. In: Keen H, Jarratt J (eds) Complications of diabetes. Edward Arnold, London, pp 151–177
Brown MJ, Martin JR, Asbury AK (1976) Painful diabetic neuropathy: A morphanetic study. Arch Neurol 33:164–171
Greenbaum D (1964) Observations on the homogeneous nature and pathogenesis of diabetic neuropathy. Brain 87:215–232
Garland H (1955) Diabetic amyotrophy. Br Med J 2:1287–1290
Pirart J (1978) Diabetes mellitus and its degenerative complications: A prospective study of 4400 patients observed between 1947 and 1978. Diabetes Care 1: 168–188, 252–263
Thomas PK, Lascelles RG (1966) The pathology of diabetic neuropathy. Q J Med 35:489–509
Behse JH, Buchthal F, Carlsen F (1977) Nerve biopsy and conduction studies in diabetic neuropathy. J Neurol Neurosurg Psychiatr 40: 1072–1082
Greenbaum D, Richardson PC, Salmon MV, Urich H (1964) Pathological observations on six cases of diabetic neuropathy. Brain 87:215–232
Jakobsen J (1976) Axonal dwindling in early experimental diabetes. Diabetologia 12: 539–553
Thomas PK, Lascelles, RG (1965) Schwann-cell abnormalities in diabetic neuropathy. Lancet 1:1355–1357
Bischoff A (1973) Ultrastructural pathology of the peripheral nervous system in early diabetes. In: Camerine-Davlos RA, Cole HS (eds) Advances in metabolic disorders. Suppl 2, Academic Press, New York Amsterdam, pp 441–449
Eliasson SG (1966) Lipid synthesis in peripheral nerve from alloxan diabetic rats. Lipids 1:237–241
Sherman WR, Stewart MA (1966) Identification of sorbitol in mammalian nerve. Biochem Biophys Res Commun 22: 492–495
Clements RS Jr (1979) Dietary myo-inositol and diabetic neuropathy. Adv Exp Med Biol 119:287–294
Sidenius P, Jakobsen J (1980) Impaired retrograde axonal transport from a nerve crush in streptozotocin diabetic rats. Diabetologia 19:222–228
Fagerberg SE (1959) Diabetic neuropathy; a clinical and histological study on the significance of vascular affections. Acta Med Scand 164 (Suppl): 1–97
O'Malley BC, Ward JD, Timperley WR (1975) Platelet abnormalities in diabetic peripheral neuropathy. Lancet 2: 1274–1276
Timperley WR, Preston FE, Ward JD (1974) Cerebral intravascular coagulation in diabetic keto-acidosis. Lancet 1: 952–956
Timperley WR, Preston FE, Duckworth T, O'Malley BC (1976) Clinical and histological studies in diabetic neuropathy: A reassessment of vascular factors in relation to intravascular coagulation. Diabetologia 12:237–243
Williams E, Timperley WR, Ward JD, Duckworth T (1980) Electron microscopical studies of vessels in diabetic peripheral neuropathy. J Clin Pathol 33:462–470
Boulton AJM, Drury J, Ward JD (1981) Treatment of painful and ulcerative diabetic neuropathy by continuous subcutaneous insulin infusion. Diabetologia 21:253 (Abstract)
Garcia M, McNamara P, Gordon T, Kannel WB (1973) Cardiovascular complications in diabetes. Adv Metab Disord 2 (Suppl): 493–499
Yao ST (1970) Haemodynamic studies in peripheral vascular disease. Br J Surg 57:761–766
Faris I (1975) Small and large vessel disease in the development of foot lesions in diabetics. Diabetologia 11:249–253
Strandness DE Jr, Priest RE, Gibbons GE (1964) Combined clinical and pathological study of diabetic and non-diabetic peripheral arterial disease. Diabetes 13:366–372
Marinelli MR, Beach KW, Glass MJ, Primozich JF, Strandness DE (1979) Non-invasive testing against clinical evaluation of arterial disease. J Am Med Assoc 241:2031–2034
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
Edmonds ME, Wilton GN, Roberts VC, Watkins PJ (1980) Blood flow in the diabetic neuropathic leg. Diabetologia 19: 272 (Abstract)
Gundersen HJG (1974) Peripheral blood flow and metabolic centre in juvenile diabetes. Diabetologia 10:225–231
Yao ST, Hobbs JT, Irvine WT (1969) Ankle systolic measurements in arterial disease affecting the lower extremities. Br J Surg 56:676–679
Scarpello JHB, Martin TRP, Ward JD (1978) Blood velocity studies in diabetic subjects with neuropathic ulcers. Clin Sci 55: 3P (Abstract)
Edmonds ME, Nicolaides K, Watkins PJ (1981) The importance of autonomic neuropathy in the aetiology of diabetic neuropathic foot ulceration. Diabetologia 21: 506 (Abstract)
Boulton AJM, Scarpello JHB, Ward JD (1981) Venous oxygenation in the diabetic neuropathic foot: evidence of arteriovenous shunting. Diabetologia 22:6–8
Raines JK, Darling RC, Buth J, Brewster DC, Augsten WG (1976) Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities. Surgery 79: 21–29
Brown RS, Hollier LH, Batson RC (1980) Non-invasive evaluation of the diabetic extremity. Am Surg 46:481–484
Lazarus HM, Albo D Jr, Welling D, Hutto W (1978) Doppler ankle pressure and stiff arteries. In: Diethrich EB (ed) Non-invasive cardiovascular diagnosis: current concepts. University Park Press, Baltimore, pp 127–135
Emanuele MA, Buchanan BJ, Abraira C (1981) Elevated leg systolic pressure and arterial calcification in diabetic occlusive vascular disease. Diabetes Care 4:289–292
Partsch H (1977) Neuropathien vom ulzero-mutilierenden Typ. Vasa 2 (Suppl): 1–48
Sherman JL (1963) Normal arteriovenous anastomoses. Medicine (Baltimore) 42:247–267
Richards RL (1970) The normal peripheral circulation. In: Richards RL (ed) Peripheral arterial disease. Livingstone, Edinburgh London, pp 6–25
Odel HM, Roth GM, Keating FR (1955) Autonomic neuropathy simulating the effects of sympathectomy as a complication of diabetes mellitus. Diabetes 4:92–98
Deanfield JE, Daggett PR, Harrison NJG (1980) The role of autonomic neuropathy in diabetic foot ulceration. J Neurol Sci 47:203–210
Ronenwett JL, Lindenaur SM (1977) Direct measurement of arteriovenous anastomotic blood flow after lumbar sympathectomy. Surgery 82: 82–89
Friedman SA, Rakow RB (1971) Osseous lesions of the foot in diabetic neuropathy. Diabetes 20:302–307
Edmonds ME, Barrett JJ, Clarke M, Ruffels E, Lawe JW, Watkins PJ (1980) The bone scan: A new aid to the study and diagnosis of the Charcot joint in diabetics. Diabetologia 19: 559 (Abstract)
Greene DA, Brown MJ, Braunstein SN, Schwartz SS, Asbury AK, Winegrad AI (1981) Comparison of clinical course and sequential electrophysiological tests in diabetics with symptomatic polyneuropathy and its implications for clinical trials. Diabetes 30: 139–147
Ward JD, Armstrong WD, Preston FE, Best L, O'Malley BC, Scarpello JHB (1981) Pain in the diabetic leg: a trial of aspirin and dipyridamole in diabetic neuropathy. Pharmatherapeutica 2:642–647
Mayne N (1968) The short term prognosis in diabetic neuropathy. Diabetes 17:270–273
Boulton AJM, Scarpello JHB, Martin TRP, Pilling D, Ward JD (1981) Claudication in neuropathic diabetics with supra-normal pressure indices. Diabetologia 20: 666 (Abstract)
Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2: 175–184
Lovelace RE, Myers SJ, Zablow L (1973) Sensory conduction in peroneal and post tibial nerves using averaging techniques. J Neurol Neurosurg Psychiatry 36:942–950
Buchthal F, Rosenflack A, Behse F (1975) Sensory potentials of normal and diseased nerves. In: Dyck PJ, Thomas DK, Lambert EH (eds) Peripheral neuropathy, vol 1. Saunders, Philadelphia, pp 42–53
Steiness IB (1963) Diabetic neuropathy, vibration sense and abnormal tendon reflexes in diabetes. Acta Med Scand 173 (Suppl): 15–89
Seneviratne KN, Peiris OA (1968) The effect of ischaemia on the excitability of sensory nerves in diabetes mellitus. J Neurol Neurosurg Psychiatry 31:348–353
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ward, J.D. The diabetic leg. Diabetologia 22, 141–147 (1982). https://doi.org/10.1007/BF00283741
Issue Date:
DOI: https://doi.org/10.1007/BF00283741