Fig. 3. The vasodilatory response to the iontophoresis of acetylcholine (hatched bars) and sodium nitroprusside (black bars) at the foot level. The response to acetylcholine (endothelium dependent vasodilation) was equally reduced in the diabetic neuropathic patients with a history of foot ulceration (DN group), the patients with both neuropathy and peripheral vascular disease (DI), and the patients with Charcot neuroarthropathy (DA) when compared with nonneuropathic diabetic patients (D) and healthy controls (C), p < 0.0001. The response to sodium nitroprusside (endothelium independent vasodilation) was more pronounced in the DI group and also, reduced in the DN and DA groups compared with D and C groups, p < 0.0001. These results indicate that both the endothelial cell and vascular smooth muscle cell of the skin microcirculation are impaired in the neuropathic diabetic foot (from ref. 50).

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