reported as vascular complications of diabetes mellitus
associated with a high degree of morbidity and
mortality. Diabetic foot syndrome (DFS), as defined
by the World Health Organization, is an “ulceration
of the foot (distally from the ankle and including
the ankle) associated with neuropathy and different
grades of ischemia and infection”. Pathogenic events
able to cause diabetic foot ulcers are multifactorial.
Among the commonest causes of this pathogenic
pathway it’s possible to consider peripheral neuropathy,
foot deformity, abnormal foot pressures, abnormal joint
mobility, trauma, peripheral artery disease. Several studies
reported how diabetic patients show a higher mortality
rate compared to patients without diabetes and in
particular these studies under filled how cardiovascular
mortality and morbidity is 2-4 times higher among
patients affected by type 2 diabetes mellitus. This
higher degree of cardiovascular morbidity has been
explained as due to the observed higher prevalence
of major cardiovascular risk factor, of asymptomatic
findings of cardiovascular diseases, and of prevalence and
incidence of cardiovascular and cerebrovascular events
in diabetic patients with foot complications. In diabetes
a fundamental pathogenic pathway of most of vascular
complications has been reported as linked to a complex
interplay of inflammatory, metabolic and procoagulant
variables. These pathogenetic aspects have a direct
interplay with an insulin resistance, subsequent obesity,
diabetes, hypertension, prothrombotic state and blood
lipid disorder. Involvement of inflammatory markers such
as IL-6 plasma levels and resistin in diabetic subjects
as reported by Tuttolomondo et al confirmed the
pathogenetic issue of the a “adipo-vascular” axis that
may contribute to cardiovascular risk in patients with
type 2 diabetes. This “adipo-vascular axis” in patients
with type 2 diabetes has been reported as characterized
by lower plasma levels of adiponectin and higher
plasma levels of interleukin-6 thus linking foot ulcers
pathogenesis to microvascular and inflammatory events.
The purpose of this review is to highlight the immune
inflammatory features of DFS and its possible role as a
marker of cardiovascular risk in diabetes patients and to
focus the management of major complications related to
diabetes such as infections and peripheral arteriopathy
