Narrowing and occlusion of the large arteries in the legs lead to impaired blood circulation. The feet and toes are no longer adequately supplied with oxygen. This condition is referred to as peripheral arterial disease (PAD).
Circulatory disorders are the primary cause of diabetic foot syndrome in approximately 20% of affected individuals. In about 40% of cases, both circulatory disorders and nerve damage are present, while in the remaining 40%, nerve damage is the main cause of diabetic foot complications. It is often difficult to determine the exact extent to which peripheral arterial disease contributes to the development of foot ulcers. However, it is clear that it significantly impairs the healing process and increases susceptibility to infection. Most diabetic ulcers associated with vascular disease occur in areas of the foot farthest from the heart, such as the toes.
Circulatory disorders occur about five times more frequently in people with diabetes. To diagnose them, the examiner first palpates the foot pulses. However, even if foot pulses are detectable, significant circulatory disorders may still be present. Therefore, if in doubt, further diagnostic methods such as Doppler ultrasound, color Doppler, and other imaging techniques (X-ray, MRI) are used.
If circulatory disorders occur alongside diabetes-related nerve damage, the prognosis regarding possible amputation is significantly worse. In Germany, approximately 25,000 amputations are performed annually on patients with diabetes. Half of these patients must expect that within the next four years, the other leg may also require amputation. Dialysis patients have a particularly high risk of amputation: about 30% of dialysis-dependent patients with diabetes face the risk of an acute diabetic foot syndrome and the resulting risk of amputation.
Diabetes-related wounds recur in up to 70% of cases within five years after healing. However, this outcome can be significantly improved through professionally qualified preventive and therapeutic treatment in a specialized wound clinic. Scientific studies have shown that such clinics help to significantly reduce the number of recurrent wounds, hospital admissions, and especially amputations.
Medications that promote blood circulation unfortunately do not achieve the desired effect in most cases. Measures to widen the blood vessels have proven more effective. In these procedures, catheters—very fine wires—are carefully inserted through the skin into the artery and advanced to the site of narrowing. At the tip of the catheter is an expandable balloon, which is used to widen the constricted area and thereby improve blood flow.
Surgical procedures can be similarly successful, with the advantage that improved blood circulation often lasts longer after surgery. Therefore, it is important to consider not only which procedure is possible, but also which intervention is necessary.
In some cases, a temporary improvement in blood flow lasting a few months may be sufficient to allow a wound to heal. However, in critical situations where amputation of the foot or leg is imminent, surgical intervention is often required. In a wound care center, all established methods for improving circulation are made available promptly according to the patient’s needs.