Foot alterations in the hemodialyzed patient.

On the basis of their experience, the authors refer to complications observable at the foot level in chronic uremic patients in long-term hemodialytic treatment. These complications, termed renal osteodystrophy, are attributed to alterations in the phosphocalcium metabolism and to hyperparathyroidism. From an anatomopathologic viewpoint, they are characterized by alteration in bone tissue (osteomalacia and/or fibrous osteitis) and by soft tissue alterations. Alterations in the foot are the same as those observed in other osteoarticular regions. They consist of bone subperiosteal reabsorption of the phalanges, vascular calcifications, articular and para-articular calcifications, spontaneous disinsertion of the Achilles tendon and peripheral canalicular neuropathies specifically represented by the tarsal tunnel syndrome. Another complication of this pathology is represented by "Calciphylaxis," characterized by calcifications of the middle tunica of arteries and small arteries, by ulcerations and tissue necrosis at the foot level.