Foot, claudication

Claudication and nonhealing foot ulcers are common in type 2 DM. Smoking cessation, correction of dyslipidemia, and antiplatelet therapy are important treatment strategies. 

Intermittent claudication has also been reported to be worsened by beta-adrenoceptor antagonists, but has been difficult to document because of the difficulty of study design in patients with advanced atherosclerosis. As early as 1975 it was reported from one small placebo-controlled study that propranolol did not exacerbate symptoms in patients with intermittent claudication (70). This has subsequently been supported by the results of several large placebo-controlled trials of beta-blockers in mild hypertension and reports of trials of the secondary prevention of myocardial infarction, in which intermittent claudication was not mentioned as an adverse effect, even though it was not a specific contraindication to inclusion (71). In addition, a comprehensive study of the effects of beta-adrenoceptor antagonists in patients with intermittent claudication did not show beta-blockade to be an independent risk factor for the disease (72). In men with chronic stable intermittent claudication, atenolol (50 mg bd) had no effect on walking distance or foot temperature (73). These findings have been confirmed in a recent meta-analysis of 11 randomized, controlled trials to determine whether beta-blockers exacerbate intermittent claudication (SEDA-17, 234). 

Claudication and nonhealing foot ulcers are common in type 2 DM patients. Smoking cessation, correction of lipid abnormalities, and antiplatelet therapy are important strategies in treating claudicants. Pentoxifylline or cilostazol may he useful in selected patients. Revascularization is successful in selected patients. Local debridement and appropriate footwear and foot care are vitally important in the early treatment of foot lesions. In more advanced lesions, topical treatments may be of benefit. Diabetic foot care is an excellent example of the adage, an ounce of prevention is worth a pound of cure. ... 

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