Mönckeberg's medial calcific sclerosis in diabetic and non‐diabetic foot infections

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. Anteriorposterior 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.

Near‐infrared spectroscopy data for foot skin oxygen saturation in healthy subjects

“… 1 , 2 Mönckeberg's medial calcific sclerosis (MMCS) has been identified in 49.5%–59.4% of patients with diabetic foot wounds, and 34.3%–43.1% of these patients have non‐compressible arterial Doppler studies. 3 , 4 While arterial Doppler studies are commonly used, MMCS renders this approach unreliable for many high‐risk patients.…”

“…1,2 Mönckeberg's medial calcific sclerosis (MMCS) has been identified in 49.5%-59.4% of patients with diabetic foot wounds, and 34.3%-43.1% of these patients have non-compressible arterial Doppler studies. 3,4 While arterial Doppler studies are commonly used, MMCS renders this approach unreliable for many high-risk patients. Near-infrared spectroscopy (NIRS) is rapidly being adopted in the medical professions due to its potential for non-invasive diagnostic and therapeutic applications.…”

“…The most common assessments are arterial Doppler studies that evaluate systolic pressure, ankle brachial index (ABI) of the posterior tibial artery and dorsalis pedis artery, toe pressures, toe brachial indices and waveforms 1,2 . Mönckeberg's medial calcific sclerosis (MMCS) has been identified in 49.5%–59.4% of patients with diabetic foot wounds, and 34.3%–43.1% of these patients have non‐compressible arterial Doppler studies 3,4 . While arterial Doppler studies are commonly used, MMCS renders this approach unreliable for many high‐risk patients.…”