the diabetic foot by gregory p. guyton, and charles l. saltzman j bone joint surg am volume...
TRANSCRIPT
The Diabetic Foot
by Gregory P. Guyton, and Charles L. Saltzman
J Bone Joint Surg AmVolume 83(7):1083-1096
July 1, 2001
©2001 by The Journal of Bone and Joint Surgery, Inc.
Diabetic neuropathy can present in a wide variety of patterns.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
The results of the Diabetes Control and Complications Trial (DCCT) indicated that the percentage of patients in whom abnormalities developed was significantly lower in association with
intensive glucose control, according to the findings of both neurologic ...
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
Photograph of the foot of a patient with neuropathic claw toes, showing ulcerations over the prominent dorsal aspects of the proximal interphalangeal joints where the toes rubbed against
the shoe.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
Figs. 4-A and 4-B A radiograph and clinical photograph of the foot of a patient with a midfoot ulceration from Charcot arthropathy with subsequent collapse.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
Figs. 4-A and 4-B A radiograph and clinical photograph of the foot of a patient with a midfoot ulceration from Charcot arthropathy with subsequent collapse.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
A patient with diabetic cheiropathy (limited joint mobility) exhibits the “prayer sign.” Subtle contractures at the interphalangeal and metacarpophalangeal joints prevent the fingers from
fully opposing each other.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
The hallux of a patient with severe autonomic neuropathy.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
A diagram representing a partial explanation of the pathogenesis of microangiopathy.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
Diabetic patients with autonomic dysfunction often have engorged vasculature when the foot is dependent (left).
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.
Mönckeberg sclerosis (medial arterial calcification) is readily apparent on radiographs and is strongly associated with autonomic failure and Charcot arthropathy, as it was in this patient.
Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096
©2001 by The Journal of Bone and Joint Surgery, Inc.