Vascular Evaluation of Diabetic Patients Presenting with Radiographic Calcified Vessels of the Foot and Ankle

CATEGORY: Diabetes INTRODUCTION/PURPOSE: Calcification of the vessels is a common finding in patients with peripheral arterial disease (PAD) and can indicate a compromised extremity. The incidence of PAD disease has been reported in approximately 29% of diabetics and calcification may also indicate a foot or ankle at risk. The purpose of this study was to evaluate toe pressures (TP) in patients who presented with radiographic calcification of vessels in the foot and ankle and determine if adequate flow existed despite the calcification. METHODS: Using a Diabetic Registry from January, 2011 through February, 2021, a retrospective review was used to identify patients who presented with x-ray calcifications of the foot and ankle and was compared to patients who had undergone TP. For the purpose of this study, the findings of Vitti et al., who demonstrated that no surgical failures occurred in patients with TP >68 mm Hg, were used to stratify patients as having adequate (68 mm Hg) or a compromised (<68 mm Hg) blood flow to the foot. The patients' age, body mass index (BMI), hemoglobin A1C, smoking history, use of insulin, whether they could adequately detect a 5.07 monofilament and whether they had adequate TP were all recorded. RESULTS: A total of 43 patients were identified with radiographic calcification of the foot and ankle. Within this population the average age was 68.1 years (45-89), the average BMI was 30. 8 (18.4-51.1), with an average A1C of 7.7 (5.5-14.2). Three patients (7%) were smokers. Eighteen patients (42%) could adequately detect a 5.07 monofilament and only 20 patients (47%) were on insulin. A TP evaluation was performed on a total of 53 patients. A total of 13 patients who had calcification of the vessels and who had TP evaluations were identified. Within this group, 11 patients demonstrated TP values > 68 mm Hg with only 2 patients demonstrating compromised TP. CONCLUSION: Calcification of vessels in the foot and ankle has been stated to suggest vascular compromise and indicate a foot and ankle at risk. These patients are obese, older individuals with poor glycemic control who, for the most part, are neuropathic. However, in this small study group, patients who had calcification of their vessels and had TP, demonstrated that despite the calcifications, adequate blood flow was achieved into the foot. This may indicate that combined with improved glycemic control, patients can undergo elective or semi-elective surgical procedures with adequate healing rates expected.