title: The influence of diabetes and lower limb arterial disease on cutaneous foot perfusion.
abstract: OBJECTIVE
  Peripheral arterial occlusive disease and peripheral neuropathy are major risk factors in diabetic foot disease. We evaluated the relative influences of noncritical lower limb arterial disease and peripheral neuropathy on cutaneous foot perfusion in diabetes.
  
  
  METHODS
  Toe-brachial pressure indices, transcutaneous oxygen, and carbon dioxide tensions at foot and chest sites were measured in individuals with diabetes, with or without detectable peripheral neuropathy and with or without significant arterial disease on color duplex imaging. Subjects without diabetes, with and without arterial disease, were used as controls.
  
  
  RESULTS
  A total of 130 limbs were studied during an 8-month period. Toe-brachial pressure indices reflected the presence of arterial disease in all groups. Foot transcutaneous oxygen values were reduced in diabetes and correlated with chest transcutaneous oxygen values. Low foot transcutaneous oxygen with elevated transcutaneous carbon dioxide values were only demonstrated in individuals with diabetes, arterial disease, and peripheral neuropathy. Toe-brachial pressure indices demonstrated a positive correlation with foot transcutaneous oxygen values, but values >1.2 demonstrated a negative correlation.
  
  
  CONCLUSIONS
  We demonstrated two influences on cutaneous foot perfusion in diabetes: (1) a global microcirculatory dysfunction, reflected in low chest and foot transcutaneous oxygen values, and (2) macrovascular disease as indicated by reduced toe-brachial pressure indices and foot transcutaneous oxygen values. Further, the results demonstrated that in diabetic individuals without critical limb ischemia, impaired foot perfusion secondary to arterial disease is amplified significantly by coexisting microcirculatory disease.
authors.affiliation: Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom. dwill1964@aol.com
authors.forename: Dean T
authors.initials: DT
authors.lastname: Williams
authors.forename: Patricia
authors.initials: P
authors.lastname: Price
authors.forename: Keith G
authors.initials: KG
authors.lastname: Harding
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology*; D001785:Blood Gas Monitoring, Transcutaneous; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply*; D018616:Ultrasonography, Doppler, Duplex