What is the pathogenesis of the disease

The pathogenesis is not precisely known. It is speculated that a small trauma, that often goes unnoticed because of the sensory loss, can initiate the process of joint and bone destruction. The inability to perceive pain, due to loss of sensation, allows the continued utilization of the foot, resulting in deterioration of the damage. Simultaneously, increased perfusion in the affected region (most likely and intraosseously) is observed, through an abnormal - due to the neuropathy of the peripheral sympathetic nervous system - opening of arteriovenous anastomoses, that results in increased absorption of bone. The body tries to restore the damage, but this is done without organization, due to the continuous pressure-loading of the foot. The final result can be big deformities of the foot (Figures 17.9 and 17.10), especially when the offence concerns the middle and the rear department of the foot as well as the ankle joint.

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