The Foot in Diabetes

*The Eye and Foot in Diabetes*

10.4103/2008-322X.180697

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**49**

**Chapter 4**

Foot

**1. Introduction**

**2. Etiopathogenesis**

**2.1 Neuropathy in diabetic foot**

tribute to diabetic neuropathy [5].

and the polyol pathway [7].

Introductory Chapter: Diabetic

Diabetic foot disease is an important problem confronting the diabetologist, internists, and surgeons as it reduces patient's quality of life and affects social participation. It is including several chronic complications as infection, foot ulceration and even tissue destruction of the foot. These complications are considered as a significant cause of morbidity and mortality among diabetic patients. Consequently, chronic complications or diabetic foot disease are a growing concern worldwide and

Diabetic Foot Ulcer (DFU) is one of the most distressing complications and it is

The main etiological factors for DFU are peripheral nerves damage and peripheral vascular disease. Series of mechanisms are documented such as decreased peripheral

Furthermore, biomechanical abnormalities and increased susceptibility for

The etipathogenesis of diabetic foot disease is multifactorial with major factors. Neuropathy, microvascular disease and infection are mainly included. These factors

About 50% of patients with diabetes mellitus develop symptomatic peripheral neuropathy within 25 years of disease onset. Distal polyneuropathy is commonly encountered. Whereas combined neuropathies with motor and autonomic fibers involvement can occur. Age, disease duration and poor glyceamic control quality over several years are strong predictors, leading to diabetic neuropathy [4].

Hyperglycemia, dyslipidemia, insulin resistance and oxidative stress can con-

According to Rochester Study [6], the severity of the neuropathy is related to the duration of hyperglycemia exposure. Other factors are studied in current researchs focusing on oxidative stress, advanced glycation-end products, protein kinase C

*Meriem Braiki, Mohamed Ali Khalifa, Bilel Faidi,* 

represent a major global medical, social, and economic problem.

blood flow and decreased local angiogenesis.

infection are associated factors exposing to DFU [1, 2].

are leading to foot tissue necrosis and ulcer occurrence [2, 3].

defined as the commonest major end-point of diabetic foot disease.

*Mosaab Ghannouchi and Fethi Derbel*

## **Chapter 4**
