Ischemic foot: definition, etiology and angiosome concept

Ischemic foot is a condition of decreased arterial perfusion. It has several etiologies, atherosclerotic peripheral arterial disease, including that secondary to diabetes mellitus, being the most common. Other potential causes of ischemic foot are acute embolism from cardiac, arterial or paradoxical sources, and thrombosis secondary to arterial blood clots due to procoagulative states (e.g. vasculitis and hematologic disorders), arterial spasms or injury resulting from drug use or from external or iatrogenic trauma. Prompt diagnosis and revascularization of the affected limb play a crucial role in the treatment of ischemic foot. The angiosome principle, defined by Ian Taylor's landmark anatomic study in 1987, divides the body into three-dimensional anatomic units of tissue fed by a source artery (the angiosome). Detailed knowledge of the vascular anatomy of the leg, and in particular of angiosomes in the foot, helps the clinician make better decisions when dealing with ischemic foot. The physician can better estimate the possibility of wound healing, and decide which type of revascularization has the most chance of success, given the existing blood supply. If surgical or endovascular revascularization is successful, the foot should no longer appear ischemic and painful, and the wounds should granulate. Newly granulating wounds should be carefully protected, and meticulous daily local wound care should be performed to promote healing and prevent infection. The quality of subsequent wound care is also a critical component in promoting healing and avoiding further tissue loss.