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Mönckeberg's medial calcific sclerosis in diabetic and non-diabetic foot infections
Mehmet A Suludere1, Amanda L Killeen1, Peter A Crisologo1
1Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Abstract:
The aim of this study was to evaluate the prevalence and extent of lower extremity Mönckeberg's Medial Calcific Sclerosis (MMCS) in patients with and without diabetes in patients admitted to the hospital for foot infections. This study retrospectively reviewed 446 patients admitted to the hospital with a moderate or severe foot infection. We defined diabetes based on ADA criteria and reviewed electronic medical records for demographics, medical history and physical examination data. Anterior-posterior and lateral foot radiographs were examined to identify the presence and extent of vascular calcification. We categorised MMCS based on anatomical location: ankle joint to the navicular-cuneiform joint, Lis Franc joint to metatarsophalangeal joints and distal to the metatarsophalangeal joints. The prevalence of MMCS was 40.6%. The anatomic extent of MMCS was 19.3% in the toes, 34.3% in the metatarsals and 40.6% in the hindfoot/ankle. Calcification was not common solely in the dorsalis pedis artery (DP) (3.8%) or solely in the posterior tibial artery (PT) (7.0%). Usually, both DP and PT arteries were affected by MMCS (29.8%). The prevalence of MMCS was higher in people with diabetes (in hindfoot and ankle [50.1% vs. 9.9%, p ≤ 0.01]; metatarsals [42.6% vs. 5.9%, p ≤ 0.01]; and toes [23.8% vs. 4.0%, p ≤ 0.01]). People with diabetes were 8.9 (CI: 4.5-17.8) times more likely to have MMCS than those without diabetes. This is a group that often has poor perfusion and needs vascular assessment. The high prevalence of MMCS raises questions about the reliability of the conventional segmental arterial Doppler studies to diagnose PAD.
Insights
Mönckeberg's Medial Calcific Sclerosis (MMCS) affects 40.6% of patients with foot infections, with significantly higher prevalence in those with diabetes. This vascular condition may impact peripheral artery disease diagnosis in diabetic patients.
Area of Science:
- Vascular Medicine
- Radiology
- Diabetology
Background:
- Mönckeberg's Medial Calcific Sclerosis (MMCS) is a vascular condition characterized by calcification of the medial layer of arteries.
- Diabetic patients often present with complications related to vascular health, including peripheral artery disease (PAD).
- Assessing vascular calcification in the lower extremities is crucial for understanding disease progression and treatment efficacy.
Purpose of the Study:
- To determine the prevalence and anatomical distribution of lower extremity Mönckeberg's Medial Calcific Sclerosis (MMCS) in hospitalized patients with foot infections.
- To compare the prevalence of MMCS in diabetic versus non-diabetic patients.
- To evaluate the potential impact of MMCS on the reliability of standard vascular diagnostic methods in diabetic individuals.
Main Methods:
- Retrospective review of 446 patients hospitalized for moderate to severe foot infections.
- Classification of diabetes based on American Diabetes Association (ADA) criteria.
- Analysis of anterior-posterior and lateral foot radiographs to identify and categorize vascular calcification (MMCS) in different anatomical regions (toes, metatarsals, hindfoot/ankle).
Main Results:
- Overall prevalence of MMCS was 40.6%.
- MMCS was significantly more prevalent in patients with diabetes across all evaluated anatomical regions (hindfoot/ankle: 50.1% vs. 9.9%; metatarsals: 42.6% vs. 5.9%; toes: 23.8% vs. 4.0%).
- Diabetic patients were 8.9 times more likely to have MMCS than non-diabetic patients, with calcification often affecting both dorsalis pedis and posterior tibial arteries.
Conclusions:
- Mönckeberg's Medial Calcific Sclerosis (MMCS) is highly prevalent in patients with foot infections, particularly those with diabetes.
- The high prevalence of MMCS in diabetic patients with foot infections suggests a need for careful vascular assessment.
- The findings raise concerns about the accuracy of conventional segmental arterial Doppler studies for diagnosing PAD in this patient population.
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