Gangrene

The presence of atherosclerotic disease (disease in which arteries are stiff and hard, with fatty deposits blocking blood flow), is a major predisposing factor to gangrene, particularly of the toes, feet, and legs.

People with diabetes often have advanced, severe cases of atherosclerosis, as well as a condition called neuropathy. Neuropathy is a type of nerve disease which results in a significant decrease in sensation. Diabetics, then, may be unable to feel any pain from a relatively minor injury (for example, a developing blister) to their foot or leg. Because the diabetic patient does not feel the blister, due to neuropathy, and because the blood supply to the area is so severely compromised, a small initial area of damage can be extremely difficult to heal, and can rapidly spread. Furthermore, any small opening in the skin, such as a blister, can provide an entry point for bacteria (most commonly staphylococcal and/or streptococcal bacteria) The combination of tissue damage from a blister, along with lack of blood supply to the area to either help in healing the blister or in delivering immune cells to fight infection, can result in the ultimate development of gangrene from a seemingly insignificant injury. This can be severe enough to require amputation of part or all of the affected body part.

A close-up of gangrene in the toes of a diabetic patient. Science Photo Library, National Audubon Society Collection/Photo Researchers, Inc. Reproduced by permission.