Gangrene is the most serious symptomatic feature or cardinal
sign of arterial insufficiency, after intermittent claudication
and rest pain. Gangrene is necrosis or death of tissue, and
commonly affects the extremities of the hands and feet (Hoffman
When presented with gangrene, the clinician must determine the
cause of the pathology, so as to address it and prevent further
damage. Whilst ischaemia may be evaluated as being the cause, it
should be determined whether it was from atherosclerosis,
myocardial infarct, valvular heart disease or emboli. Also
ascertain if they are a smoker, have diabetes mellitus, and
history of vascular problems. Treating gangrene is beyond the
scope of a podiatrist, so if gangrene is found, refer to a
The podiatrist may see gangrene as dry or moist (Hoffman 1992).
Dry gangrene is most commonly due to ischaemia and is often a
secondary complication of type 2 diabetes mellitus. It presents
as cold, dry, shriveled and blackened tissue, often running deep
into the fascia, but first appearing on the distal apices.
Wet or moist gangrene is the more serious condition, as it
usually indicates a bacterial infection that may quickly spread
and be fatal. Most commonly caused by an acute occlusion, such
as tourniquet, restrictive bandage or trauma. It present like
dry gangrene, but is softer to touch with an offensive odour,
and the foot may be swollen, red and warm (Lorimer et al, 1997,
As mentioned previously, presence of gangrene must be taken
seriously and appropriate referrals made immediately.
More horrifying Pictures on Gangrene
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