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Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Peripheral Artery Disease I: Introduction01:30

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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
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Functional Classification of Joints
The functional classification of joints is determined by the amount of mobility between the adjacent bones. Joints are functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, a freely moveable joint. Fibrous and cartilaginous joints can be functionally classified as either synarthroses  or amphiarthroses, whereas all synovial joints are classified as diarthroses.
Synarthrosis
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Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
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Atherosclerosis II: Clinical Manifestations and Diagnostic Tests01:27

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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
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Related Experiment Video

Updated: Apr 22, 2026

Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
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Charcot Neuro-Osteoarthropathy: A new Risk Class is Needed?

Andrea Mancini1, Secondina Viti1, Marco Perini1

  • 1Diabetes Unit and Diabetic Foot Unit, USL CENTRO TOSCANA, Pistoia, Italy.

The International Journal of Lower Extremity Wounds
|April 20, 2026
PubMed
Summary
This summary is machine-generated.

Chronic Charcot neuro-osteoarthropathy (CNO) indicates a high risk for recurrence, not fully captured by current diabetic foot ulcer risk systems. Intensified podiatry surveillance significantly reduced re-ulceration in CNO patients.

Keywords:
Charcot Neuro-Osteoarthropathyamputationsdiabetic foot recurrencediabetic foot ulcerperipheral vascular diseaserevascularization

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Area of Science:

  • Diabetology
  • Podiatry
  • Vascular Surgery

Background:

  • The International Working Group of Diabetic Foot (IWGDF) 2023 system lacks explicit risk stratification for Charcot neuro-osteoarthropathy (CNO).
  • Chronic CNO may represent a distinct high-risk phenotype for diabetic foot ulcer recurrence.

Purpose of the Study:

  • To determine if post-remission (chronic) CNO identifies a high-risk recurrence phenotype compared to IWGDF risk class 3.
  • To assess if intensified podiatry surveillance improves outcomes in chronic CNO patients.

Main Methods:

  • Prospective, single-centre observational study (2023-2024).
  • Comparison of IWGDF class 3 patients without CNO (n=184) versus chronic CNO patients (n=27), all ulcer-free at baseline.
  • Follow-up at 1-3 month intervals (Year 1) and intensified <=30-day intervals for CNO patients (Year 2).

Main Results:

  • Chronic CNO patients exhibited higher re-ulceration (70.4% vs 33.1%) and amputation (18.5% vs 7.6%) rates in Year 1 compared to IWGDF class 3.
  • Intensified surveillance in Year 2 markedly reduced re-ulceration in CNO patients (18.5% vs 70.4%).
  • Trends towards fewer amputations and revascularizations were observed with intensified surveillance.

Conclusions:

  • Chronic CNO represents a distinct high-risk recurrence phenotype not fully addressed by current IWGDF risk stratification.
  • Findings support evaluating CNO-specific surveillance strategies.
  • Consideration of CNO as a separate risk stratum within the IWGDF framework is warranted.