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Fernando ME, Woelfel SL, Perry D, Najafi B, Khan T, DuBourdieu C, Shin L, Armstrong DG. Dosing Activity and Return to Preulcer Function in Diabetes-Related Foot Ulcer Remission. J Am Podiatr Med Assoc 2021; 111. [PMID: 33783527 DOI: 10.7547/20-166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetes-related foot ulcers are a leading cause of global morbidity, mortality, and health-care costs. People with a history of foot ulcers have a diminished quality of life attributed to limited walking and mobility. One of the largest concerns is ulceration recurrence. Approximately 40% of patients with ulcerations will have a recurrent ulcer in the year after healing, and most occur in the first 3 months after wound healing. Hence, this period after ulceration is called "remission" due to this risk of reulceration. Promoting and fostering mobility is an integral part of everyday life and is important for maintaining good physical health and health-related quality of life for all people living with diabetes. In this short perspective, we provide recommendations on how to safely increase walking activity and facilitate appropriate off-loading and monitoring in people with a recently healed foot ulcer, foot reconstruction, or partial foot amputation. Interventions include monitored activity training, dosed out in steadily increasing increments and coupled with daily skin temperature monitoring, which can identify dangerous "hotspots" prone to recurrence. By understanding areas at risk, patients are empowered to maximize ulcer-free days and to enable an improved quality of life. This perspective outlines a unified strategy to treat patients in the remission period after ulceration and aims to provide clinicians with appropriate patient recommendations based on best available evidence and expert opinion to educate their patients to ensure a safe transition to footwear and return to activity.
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Chaudhary N, Huda F, Roshan R, Basu S, Rajput D, Singh SK. Lower Limb Amputation Rates in Patients With Diabetes and an Infected Foot Ulcer: A Prospective Observational Study. Wound Manag Prev 2021; 67:22-30. [PMID: 34264200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Lower extremity amputation is a serious complication of diabetes mellitus and occurs most commonly in persons who have a foot ulcer. PURPOSE To examine variables that affect the rate of lower extremity amputation in patients with diabetes and infected foot ulcers. METHODS A prospective observational study was performed including all consecutive patients who were 18 to 65 years, had a diagnosis of diabetes, and a foot ulcer showing clinical signs of infection. Patients were followed for 6 months or until ulcer healing, minor, or major amputation. A total of 81 persons were enrolled. Demographic variables were obtained, and clinical assessments, blood tests, and radiological investigations were performed. Ulcers were categorized using the Perfusion, Extent, Depth, Infection and Sensation classification system. Differences between variables and outcomes were assessed using the Wilcoxon test, Fisher's exact test, Chi-square test, and t-test. RESULTS Mean patient age was 54.58 ± 9.04 years, and the majority (61, 75%) were male. After 6 months, 33 (41%) were healed, 2 patients died, and 17 (21%) underwent major and 24 (30%) minor amputations. Major amputation rates were significantly higher in patients with a high Perfusion, Extent, Depth, Infection and Sensation score (6.92 ± 1.36; P = .005), elevated HbA1c (%) (9.43 ± 2.19; P = .049), presence of growth on wound culture (41 [64.1%]; P = .016), culture sensitivity to beta lactam (20 [31.2%]; P = .012), and presence of peripheral arterial disease seen on arterial Doppler ultrasound (P < .001). Minor amputation rates were higher in men (P = .02) and in the presence of peripheral arterial disease (P = .01). CONCLUSION The presence of the above factors in persons with diabetes and foot ulcer with clinical signs of infection should alert the clinician to the need for focused and individualized treatment to attempt to prevent amputation.
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Kress S, Anderten H, Borck A, Freckmann G, Heinemann L, Holzmüller U, Kulzer B, Portele A, Schnell O, Varlemann H, Zemmrich C, Lobmann R. Preulcerous Risk Situation in Diabetic Foot Syndrome: Proposal for a Simple Ulcer Prevention Score. J Diabetes Sci Technol 2021; 15:816-826. [PMID: 32522035 PMCID: PMC8258539 DOI: 10.1177/1932296820922592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preulcerous risk situations in patients with diabetes are often undiagnosed and care administered too late. Even with regular medical check-ups and status documentation, foot examinations have not been given enough attention. Diagnosing an individual patients' risk of developing diabetic foot ulcers may increase vigilance for diabetic foot syndrome (DFS), and the appropriate prevention measures matching the risk involved may prevent the emergence of diabetic ulcers. The classical DFS risk factors are well established and have been extensively covered in the literature; however, there is a lack of efficient screening tools that could be used for a rapid assessment of diabetic foot ulcer risk. METHODS A methodical literature search was conducted to assess relevant publications for the preparation of a simple risk score for amputation related to diabetic foot ulcer. We then analyzed the risk factors for predictive value as odds ratios in foot ulcers and/or amputation. We used the available data to deduce a mean value to reflect the authors' consensus. RESULTS In view of the current literature on the matter, we have developed a semi-quantitative scoring system using just a few items to allow rapid and visual risk assessment for diabetic foot ulcers alongside recommendations for prevention and a sensible follow-up strategy to match the risk. CONCLUSION This relatively simple score enables rapid risk classification for patients that can ease the way for both physicians and patients in gaining an insight into individual risk situations. The score provides more effective preventative measures for high-risk patients against future complications.
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Lee EJ, Jeong IS, Woo SH, Jung HJ, Han EJ, Kang CW, Hyun S. [Development of a Diabetic Foot Ulceration Prediction Model and Nomogram]. J Korean Acad Nurs 2021; 51:280-293. [PMID: 34215707 DOI: 10.4040/jkan.20257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/13/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). METHODS This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients' electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow-Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. RESULTS The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. CONCLUSION The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.
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Christensen D, Coviello J, Munn S, Petersen B, Whitaker E. A Novel Method to Offload Neuropathic Ulcers of the Distal Phalanges in the Presence of First Ray Metatarsal Hypermobility: 3 Case Reports. J Wound Ostomy Continence Nurs 2021; 48:253-255. [PMID: 33951714 DOI: 10.1097/won.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The standard practice to heal neuropathic ulcers on the toes is to offload the affected areas with special types of therapeutic footwear including shoes and boots to reduce the amount of pressure on the wound. Once healed, the individual wears custom insoles to prevent the development of new wounds. In our practice, we found that some newly healed wounds will reulcerate despite wearing therapeutic footwear. We devised a method to prevent and offload neuropathic foot ulcers on the distal phalanges in the presence of first ray metatarsal hypermobility, a common problem associated with the development of wounds. CASES Three individuals with first ray metatarsal hypermobility and recurrent neuropathic ulcers demonstrated healing using a buttress constructed from a tampon placed under the plantar surface of the proximal interphalangeal joint. The buttress was successful in supporting the first ray metatarsal to keep it in proper alignment. CONCLUSION We found using a buttress was an effective nonsurgical intervention for these 3 individuals with first ray metatarsal hypermobility to prevent and offload neuropathic hallux ulcers.
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Tironi FDC, Machado GU, Arruda SM, Machado PRL. Plantar ulcer as an atypical manifestation of cutaneous leishmaniasis. An Bras Dermatol 2021; 96:352-354. [PMID: 33775479 PMCID: PMC8178547 DOI: 10.1016/j.abd.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.
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Rojubally S, Simoneau A, Monlun M, Foussard N, Blanco L, Domenge F, Mohammedi K, Ducasse E, Caradu C, Rigalleau V. For diabetic type 1 patients, the skin autofluorescence predicts ulcers and amputations. J Diabetes Complications 2021; 35:107808. [PMID: 33386214 DOI: 10.1016/j.jdiacomp.2020.107808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022]
Abstract
We searched whether the accumulation of Advanced Glycation End-products (AGEs), reflected by the skin autofluorescence (SAF), could predict diabetic foot ulcers (DFUs) during the long-term follow-up of people with type 1 diabetes. During year 2009, we measured the SAF with an AGE-Reader in 206 subjects with type 1 diabetes. DFU and amputations were registered during the 10 following years. The relation between the SAF and later DFU was analyzed by Cox model regression, adjusted for vascular risk factors. The 206 participants were mainly men (55.8%), 51 ± 15 years old, with a 22 ± 13 years diabetes duration. Twelve subjects presented a DFU. Their SAF were higher: 2.61 ± 0.89 AU vs 2.11 ± 0.53 for the others (p = 0.003), related to the risk of DFU (OR:3.69; 95% CI: 1.06-12.79) after adjustment for age, gender, diabetes duration, initial HbA1c, arterial hypertension, history of smoking, blood lipids and use of a statin. Five subjects were amputated, also related to the initial SAF: OR: 11.28 (95% CI: 1.76-79.97) after adjustment for age, gender, duration of diabetes, and HbA1c. The SAF has already been related to diabetic neuropathy and peripheral arterial disease. It predicts DFU in type 1 diabetes, which suggests that AGEs play a role in this highly specific and feared complication.
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Khan MJ, Stoupine A, Farha K, Kim JH, Klinoubol P. The Custom Total Contact Cast to Offload Foot Ulcers in the Presence of Biomechanical Deformities: A Case Report. Wound Manag Prev 2021; 67:12-20. [PMID: 33788771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although offloading foot ulcers with a total contact cast (TCC) remains the cornerstone of managing these wounds, the TCC is underutilized. Patient intolerance and potential iatrogenic complications due to TCCs' general lack of customizability and the inability to address flexible biomechanical deformities that are not in the sagittal plane may be one of the reasons patients with foot ulcers do not receive this crucial component of care. PURPOSE To describe the use of a novel approach to the standard TCC technique that uses strategic padding to potentially increase patient compliance and comfort while decreasing the likelihood of iatrogenic ulceration, as well as to correct flexible frontal plane biomechanical deformities with casting tape that is pulled medial to lateral, or lateral to medial, to bring the plantar surface of the foot to neutral position. METHODS The custom total contact cast (C-TCC) was used in a 54-year-old woman who had diabetes, obesity, and a flexible cavovarus foot type with a recurring plantar fifth metatarsal base wound. Weekly debridement followed by silver dressings and C-TCC application were performed. The latter included strategic padding, 2 forms of plaster of paris with contouring, fiberglass, and medial-to-lateral positioning of the foot during application. RESULTS This case study describes two (2) treatment episodes, with a focus on the second episode. At initial presentation, the ulcer took 5 weeks to heal. During the second treatment, a 48.7% reduction in wound volume was noted after 1 week. By the fourth week of treatment, a 98.7% wound volume reduction was achieved. By the ninth week, the ulcer epithelialized completely. At 1-month and 12-month follow-ups, the site remained fully epithelialized. No iatrogenic ulcerations, cast discomfort, or ambulatory dysfunction were reported by the patient. CONCLUSION In this case, the C-TCC helped address flexible frontal plane deformities and facilitated healing. Randomized, controlled clinical studies to evaluate the safety and effectiveness of different TCC methods are needed to guide care and improve the utilization of optimal offloading methods for the management of plantar foot ulcers.
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Shabhay A, Horumpende P, Shabhay Z, Mganga A, Van Baal J, Msuya D, Chilonga K, Chugulu S. Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania. BMC Surg 2021; 21:34. [PMID: 33435942 PMCID: PMC7802243 DOI: 10.1186/s12893-021-01051-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. METHODS A cross-sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients' files. RESULTS A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30-87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. CONCLUSION In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.
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Marco M, Valentina I, Daniele M, Valerio DR, Andrea P, Roberto G, Laura G, Luigi U. Peripheral Arterial Disease in Persons with Diabetic Foot Ulceration: a Current Comprehensive Overview. Curr Diabetes Rev 2021; 17:474-485. [PMID: 33023453 DOI: 10.2174/1573399816999201001203111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
In developed countries, the prevalence of persons with diabetes and peripheral arterial disease (PAD) is approximately 50%. The presence of PAD is associated with non-healing ulcers, major amputation, cardiovascular morbidity, and mortality. It is estimated that persons with diabetes, foot ulceration and PAD have 50% of 5-years mortality rate. Therefore, subjects with ischemic diabetic foot ulcers (DFUs) should be considered a special group of patients with specific clinical characteristics, general health status and prognosis. In persons with ischemic DFUs, an early diagnosis and treatment are mandatory to reduce the risk of worse outcomes such as major amputation. Revascularization of occluded lower extremity arteries is the main treatment to restore blood flow in the foot and promote wound healing. Nonetheless, there are several unmet needs in the management of diabetic subjects with PAD and foot ulceration as medical therapy, diagnostic criteria and indications for revascularization, revascularization strategy and technical approach as well as the management of no-option critical limb ischemia patients. It is a common opinion that there is an evolution of PAD features in diabetic persons, which seems to present a more aggressive pattern. This may be related to the frequent presence of concomitant comorbidities such as renal failure which could influence the characteristics of atherosclerotic plaques and their distribution. The aim of this review is to commence a complete overview and state of the art in the treatment of patients with diabetes, PAD, and foot ulceration and to describe the current challenges and future perspectives.
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de Figueiredo CS, Dos Reis LC. Stem Cell Therapies for the Treatment of Diabetic Neuropathies: Future Perspectives. Curr Diabetes Rev 2021; 17:2-10. [PMID: 32303173 DOI: 10.2174/1573399816666200417121915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic neuropathies (DN) are the most common complications in diabetic patients, affecting about 70% of them. Patients with DN may lose sensation in certain areas of the body, facilitating the onset of foot ulcers, as well as chronic pain. This is due to the progressive degeneration of nerve fibers, demyelination, and axonopathy. Recent studies about stem cell therapies for the treatment of DN show promising potential for tissue regeneration. Results with mesenchymal stem cells derived from various organs/tissues demonstrate great therapeutic potential considering their easy obtainment, as well as their immunomodulatory and pro-regenerative effects. However, problems such as cell transplant rejection, tumor formation, transplantation safety, and effectiveness still need to be solved. Developmental biology lacks detailed insights into some aspects of cell mechanisms, like the genetic components of cell growth or differentiation. These gaps can limit a rapid advance in stem cell therapy research and put it in the future a little bit farther from the expectations that have emerged in recent media. CONCLUSION In the present review, we attempt to discuss the potential of most studied types of stem cells, their application for the treatment of experimental diabetic neuropathies and associated clinical manifestations including future perspectives around these themes.
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Aan de Stegge WB, Abu-Hanna A, Bus SA. Development of a multivariable prediction model for plantar foot ulcer recurrence in high-risk people with diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001207. [PMID: 32193202 PMCID: PMC7103819 DOI: 10.1136/bmjdrc-2020-001207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Forty per cent of people with diabetes who heal from a foot ulcer recur within 1 year. The aim was to develop a prediction model for plantar foot ulcer recurrence and to validate its predictive performance. RESEARCH DESIGN AND METHODS Data were retrieved from a prospective analysis of 171 high-risk patients with 18 months follow-up. Demographic, disease-related, biomechanical and behavioral factors were included as potential predictors. Two logistic regression models were created. Model 1 for all recurrent plantar foot ulcers (71 cases) and model 2 for those ulcers indicated to be the result of unrecognized repetitive stress (41 cases). Ten-fold cross-validation, each including five multiple imputation sets, was used to internally validate the prediction strategy; model performance was assessed in terms of discrimination and calibration. RESULTS The presence of a minor lesion, living alone, increased barefoot peak plantar pressure, longer duration of having a previous foot ulcer and less variation in daily stride count were predictors of the first model. The area under the receiver operating curve was 0.68 (IQR 0.61-0.80) and the Brier score was 0.24 (IQR 0.20-0.28). The predictors of the second model were presence of a minor lesion, longer duration of having a previous foot ulcer and location of the previous foot ulcer. The area under the receiver operating curve was 0.76 (IQR 0.66-0.87) and the Brier score was 0.17 (IQR 0.15-0.18). CONCLUSIONS These validated prediction models help identify those patients that are at increased risk of plantar foot ulcer recurrence and for that reason should be monitored more carefully and treated more intensively.
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Bus SA. Preventing foot ulcers in diabetes using plantar pressure feedback. Lancet Digit Health 2019; 1:e250-e251. [PMID: 33323248 DOI: 10.1016/s2589-7500(19)30134-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 06/12/2023]
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Kotani S, Nishikage H. [Homecare Support for Patients with Foot Ulcers Rejecting Lower Limb Amputations: Effects of Visiting Nursing]. Gan To Kagaku Ryoho 2019; 46:151-153. [PMID: 31189843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The patient, a 60-year-old male with a combination of diabetes mellitus and hypertension, was hospitalized for peripheral arterial disease and recommended as a candidate for lower limb amputation after vascular IVR. The patient rejected this recommendation and left the hospital. The toes of both feet turned black and became mummified, which resulted in the patient being unable to walk at home and being prescribed narcotics for the pain. The patient requested home nursing where he was provided with lower limb wound care and rehabilitation to improve lower limb muscle strength together by visiting nurses and his wife. A daily regime was devised to prevent accompanying pain in the wounds, which improved gradually. The time spent together through repeated daily care helped build a relationship in which everyone involved was pleased with the improvements to the wounds. The necrotic site was auto-amputated and healed after 15 months. During this time, the feelings of the patient who did not want to amputate were considered and he was able to be cured without additional complications.
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Vos CG, de Vries JPPM. Improvement of the Quality of Evidence of Peripheral Artery Disease in Diabetic Foot Ulceration: Small Step for a Doctor, Giant Leap for Mankind? Eur J Vasc Endovasc Surg 2018; 56:409. [PMID: 29898825 DOI: 10.1016/j.ejvs.2018.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022]
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Agarwal A. Letter from Ganiyari. THE NATIONAL MEDICAL JOURNAL OF INDIA 2017; 30:294-295. [PMID: 29916437 DOI: 10.4103/0970-258x.234403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Tanudjaja T. Treat Foot Ulcers Conservatively. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:399. [PMID: 28655376 PMCID: PMC5504512 DOI: 10.3238/arztebl.2017.0399a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hunt DL. Diabetes: foot ulcers and amputations. BMJ CLINICAL EVIDENCE 2011; 2011:0602. [PMID: 21871137 PMCID: PMC3275104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades it from 1 to 5. The annual incidence of ulcers among people with diabetes is 2.5% to 10.7% in resource-rich countries, and the annual incidence of amputation for any reason is 0.25% to 1.8%. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent foot ulcers and amputations in people with diabetes? What are the effects of treatments in people with diabetes with foot ulceration? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 50 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review, we present information relating to the effectiveness and safety of the following interventions: debridement, human cultured dermis, human skin equivalent, patient education, pressure off-loading with felted foam or pressure-relief half-shoe, pressure off-loading with total-contact or non-removable casts, screening and referral to foot-care clinics, systemic hyperbaric oxygen for non-infected ulcers, systemic hyperbaric oxygen in infected ulcers, therapeutic footwear, topical growth factors, and wound dressings.
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Hunt D. Diabetes: foot ulcers and amputations. BMJ CLINICAL EVIDENCE 2009; 2009:0602. [PMID: 19445774 PMCID: PMC2907821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades it from 1 to 5. The annual incidence of ulcers among people with diabetes is 2.5-10.7% in resource-rich countries, and the annual incidence of amputation for any reason is 0.25-1.8%. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent foot ulcers and amputations in people with diabetes? What are the effects of treatments in people with diabetes with foot ulceration? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 41 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: debridement, human cultured dermis, human skin equivalent, patient education, pressure off-loading with felted foam or pressure-relief half-shoe, pressure off-loading with total-contact or non-removable casts, screening and referral to foot care clinics, systemic hyperbaric oxygen for non-infected ulcers, systemic hyperbaric oxygen in infected ulcers, therapeutic footwear, topical growth factors, and wound dressings.
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Frykberg RG, Williams DV. Negative-pressure wound therapy and diabetic foot amputations: a retrospective study of payer claims data. J Am Podiatr Med Assoc 2008; 97:351-9. [PMID: 17901338 DOI: 10.7547/0970351] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers. METHODS Administrative claims data for patients with diabetic foot ulcers from commercial payers (n=3,524) and Medicare (n=12,795) were retrospectively analyzed. Patients were divided into NPWT and control/traditional therapy groups on the basis of administrative codes. Risk-adjustment procedures were then performed to match patient risk categories (through total treatment costs) and wound severities (through debridement depth). RESULTS The incidence of amputations in the NPWT groups was lower than that in the control groups. For the cost-based risk-adjustment analysis, amputation incidences with NPWT versus traditional therapy were 35% lower in the Medicare sample (10.8% versus 16.6%; P=.0077) and 34% lower in the commercial payer sample (14.1% versus 21.4%; P=.0951). Whereas overall amputation rates increased progressively with increasing wound debridement depth in both control groups, the same increasing trend did not occur in the NPWT groups. CONCLUSIONS Patients with diabetic foot ulcers in the Medicare sample treated with NPWT had a lower incidence of amputations than those undergoing traditional wound therapy; this finding was evident in wounds of varying depth in both populations studied.
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Sogabe Y, Yasuda M, Yokoyama Y, Tamura A, Negishi I, Ohnishi K, Shinozaki T, Ishikawa O. Genetic analyses of two cases of Werner's syndrome. Eur J Dermatol 2004; 14:379-82. [PMID: 15564200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 05/01/2023]
Abstract
We report two cases of Werner's syndrome (WS). First, a 42-year-old Japanese man was referred on suspicion of systemic sclerosis (SSc) because of scleroderma-like skin atrophy and foot ulcers. Second, a 51-year-old woman with malignant fibrous histiocytoma was referred on suspicion of premature aging syndrome. Because both patients had many typical manifestations compatible with WS, we made a clinical diagnosis of WS. Genetic analyses revealed a homozygous mutation, an A deletion at nucleotide 3677 of WS gene (WRN) in the first case and a homozygous mutation, a G to C substitution at one base upstream of exon 26 of WRN in the second case. Both mutations were consistent with those previously reported in Japanese WS patients.
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Lechleitner M, Francesconi M, Abrahamian H. [The diabetic foot]. ACTA MEDICA AUSTRIACA 2004; 31:173-4. [PMID: 15747993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
These are the guidelines for preventive care, diagnosis and treatment of diabetic foot syndrome. Diabetic neuropathy, peripheral vascular disease, bone deformity and altered biomechanics are foot-related risk conditions. The position statement is focused on screening methods and recommendations for clinical care for diabetics, who currently have no foot ulcers. A decision pathway is offered with respect to diagnosis and management of diabetic patients at increased risk or who manifest injuries.
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Abstract
This report reflects the best data available at the time the report was prepared, but caution should be exercised in interpreting the data; the results of future studies may require alteration of the conclusions or recommendations set forth in this report.
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