Microvascular Changes in the Diabetic Foot

The microcirculation—arterioles, venules, and capillaries—is critical for gas exchange, delivery of nutrients, and removal of waste products at the tissue level. Perfusion of the microcirculation is tightly controlled and highly regulated. Diabetes has a profound effect on the entire cardiovascular system and the microcirculation is particularly impacted. Diabetes induces basement membrane thickening impairing diffusion. Capillary perfusion is ultimately reduced producing local tissue ischemia despite normal pedal pulses. Diabetes disrupts the nerve–axon reflex, increases oxidative stress, and results in endothelial dysfunction. These effects of diabetes on the microcirculation have important clinical significance for practitioners caring for patients with diabetes. Understanding the effects of diabetes on the microcirculation impacts preventative care, diagnosis of the complications of diabetes, managing wounds, and ultimately has implications for the surgical treatment of complications of diabetes.