Perspective Chapter: Diabetic Foot Pathophysiology and Prevention of Amputation through Behavioral Modification

Abstract

Diabetic foot complications are the result of a complex interplay involving various physiological factors, including macrovascular and microvascular alterations, neuropathy, inflammation, immune responses, hyperglycemia, oxidative stress, and susceptibility to infection. Macrovascular elements, such as atherosclerosis, give rise to tissue ischemia, while microvascular dysfunction exacerbates impairments in perfusion. Neuropathy plays a pivotal role in the development of these complications, manifesting as sensory loss, motor impairments, and autonomic dysfunction. These neurological deficits lead to the occurrence of unnoticed injuries, muscle atrophy, deformities, and dry skin, thereby increasing the vulnerability to nonhealing wounds and infections. Inflammation and immune responses intricately augment tissue damage while concurrently impeding the healing process. The persistent elevation of blood glucose levels in diabetes leads to the formation of advanced glycation end products, which contribute to tissue stiffening. Additionally, oxidative stress exacerbates the extent of damage. Mitochondrial dysfunction further exacerbates these challenges by compromising cellular energy production, thereby exacerbating the difficulties in tissue repair. These multifaceted factors collectively form a significant contributory framework for the onset and progression of diabetic foot complications. Moreover, with regard to modifiable factors, an examination of the influence of behaviors such as smoking, excessive alcohol consumption, and physical activity on the likelihood of lower extremity amputation (LEA) among individuals with diabetes becomes evident. Comprehensive data analysis discerns an elevated risk of LEA associated with smoking and heavy alcohol consumption, while regular exercise is associated with a decreased risk. The cumulative effect of these behaviors underscores the paramount importance of behavior modification in the prevention of LEA and the enhancement of the overall well-being of diabetic patients. Profound comprehension of these mechanisms is imperative for the formulation of efficacious preventive measures, diagnostic protocols, and therapeutic interventions, thereby addressing the considerable impact of diabetic foot complications on both individuals and healthcare systems.