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Waibel FWA, Böni T. Nonoperative Treatment of Charcot Neuro-osteoarthropathy. Foot Ankle Clin 2022; 27:595-616. [PMID: 36096554 DOI: 10.1016/j.fcl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Conservative treatment of Charcot neuro-osteoarthropathy (CN) aims to retain a stable, plantigrade, and ulcer-free foot, or to prevent progression of an already existing deformity. CN is treated with offloading in a total contact cast as long as CN activity is present. Transition to inactive CN is monitored by the resolution of clinical activity signs and by resolution of bony edema in MRI. Fitting of orthopedic depth insoles, orthopedic shoes, or ankle-foot orthosis should follow immediately after offloading has ended to prevent CN reactivation or ulcer development.
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Affiliation(s)
- Felix W A Waibel
- Division of Technical and Neuroorthopaedics, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland.
| | - Thomas Böni
- Division of Technical and Neuroorthopaedics, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland
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Petrova NL, Donaldson NK, Bates M, Tang W, Jemmott T, Morris V, Dew T, Meacock L, Elias DA, Moniz CF, Edmonds ME. Effect of Recombinant Human Parathyroid Hormone (1-84) on Resolution of Active Charcot Neuro-osteoarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study. Diabetes Care 2021; 44:1613-1621. [PMID: 34088701 PMCID: PMC8323189 DOI: 10.2337/dc21-0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Fractures in Charcot neuro-osteoarthropathy (CN) often fail to heal despite prolonged immobilization with below-knee casting. The aim of the study was to assess the efficacy of recombinant human parathyroid hormone (PTH) in reducing time to resolution of CN and healing of fractures. RESEARCH DESIGN AND METHODS People with diabetes and acute (active) Charcot foot were randomized (double-blind) to either full-length PTH (1-84) or placebo therapy, both in addition to below-knee casting and calcium and vitamin D3 supplementation. The primary outcome was resolution of CN, defined as a skin foot temperature difference >2°C at two consecutive monthly visits. RESULTS Median time to resolution was 5 months (95% CI 4, 12) in intervention and 6 months (95% CI 2, 9) in control. On univariate mixed Cox and logistic regression, there was no significant difference in time to resolution between the groups (P = 0.64) or in the likelihood of resolution (P = 0.66). The hazard ratio of resolution was 0.84 (95% CI 0.41, 1.74; P = 0.64), and the odds ratio of resolution by 12 months was 0.80 (95% CI 0.3, 2.13; P = 0.66) (intervention vs. control). On linear regression analysis, there were no significant differences in the effect of treatment on fracture scores quantitated on MRI scans (coefficient 0.13 [95% CI -0.62, 0.88]; P = 0.73) and on foot and ankle X-rays (coefficient 0.30 [95% CI -0.03, 0.63]; P = 0.07). CONCLUSIONS This double-blind placebo-controlled trial did not reduce time to resolution or enhance fracture healing of CN. There was no added benefit of daily intervention with PTH (1-84) to below-knee casting in achieving earlier resolution of CN.
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Affiliation(s)
- Nina L Petrova
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, U.K .,Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | | | - Maureen Bates
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, U.K
| | - Wegin Tang
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, U.K
| | - Timothy Jemmott
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, U.K
| | - Victoria Morris
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, U.K
| | - Tracy Dew
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, U.K
| | - Lisa Meacock
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, U.K
| | - David A Elias
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, U.K
| | - Cajetan F Moniz
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, U.K
| | - Michael E Edmonds
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, U.K.,Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, U.K
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Bandeira MA, Dos Santos ALG, Woo K, Gamba MA, de Gouveia Santos VLC. Incidence and Predictive Factors for Amputations Derived From Charcot's Neuroarthropathy in Persons With Diabetes. INT J LOW EXTR WOUND 2021:15347346211025893. [PMID: 34142879 DOI: 10.1177/15347346211025893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Charcot's neuroarthropathy (CN) is the progressive destruction of the bones and joints of the feet, as a consequence of severe peripheral neuropathy, which predisposes patients to amputations. The purpose of this study was to measure the cumulative incidence of amputations resulting from CN and risk factors among amputated people with diabetes mellitus (DM). This was an epidemiological, observational, and retrospective study of 114 patients with DM who had an amputation involving the lower limbs. Data were collected from 2 specialized outpatient clinics between 2015 and 2019, including socio-demographic and clinical variables (cause of amputation: CN, peripheral arterial disease [PAD], infected ulcers, fracture, osteomyelitis, and others; body mass index [BMI]; 1 or 2 DM, time since DM diagnosis, insulin treatment, glycated hemoglobin; creatinine; smoking and drinking; systemic arterial hypertension, diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, acute myocardial infarction, PAD, and stroke; characteristics of amputation [level and laterality], in addition to the specific variables related to CN [time of amputation in relation to the diagnosis of CN, diagnosis of CN in the acute phase, and treatment implemented in the acute phase]). We compared socio-demographic and clinical characteristics, including types of amputation, between patients with and without CN. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the possible association of predictive factors for a CN amputation was carried out through logistic regression. The amputation caused by CN was present in 27 patients with a cumulative incidence of 23.7% in 5 years. There was a statistically significant association between BMI and the occurrence of CN (odds ratio: 1.083; 95% confidence interval: 1.001-1.173; P = .048); higher values of BMI were associated with a higher occurrence of amputations secondary from CN.
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Affiliation(s)
| | | | - Kevin Woo
- 4257Queen's University, Kingston, Ontario, Canada
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Diacogiorgis D, Perrin BM, Kingsley MIC. Factors impacting the evidence-based assessment, diagnosis and management of Acute Charcot Neuroarthropathy: a systematic review. J Foot Ankle Res 2021; 14:26. [PMID: 33827640 PMCID: PMC8025319 DOI: 10.1186/s13047-021-00469-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute Charcot Neuroarthropathy (CN) is a destructive condition that is characterised by acute fractures, dislocations and joint destruction in the weight-bearing foot. The acute phase is often misdiagnosed and can rapidly lead to devastating health outcomes. Early diagnosis and management of CN is imperative to attenuate progression of this condition. Consequently, timely evidence-based assessment, diagnosis and management of acute CN is imperative. OBJECTIVE To identify the factors that impact the delivery of evidence-based care in assessment, diagnosis and management of people with acute CN. METHOD Systematic searches were conducted in four databases to identify studies in English that included factors that impact the delivery of evidence-based care in the assessment, diagnosis and management of people with acute CN. Articles and consensus/guideline documents were assessed for inclusion by the researchers and disagreements were resolved through consensus. Additionally backward citation searching was used to source other potentially relevant documents. Information relevant to the research question was extracted and thematic analyses were performed using qualitative synthesis. RESULTS Thirty-two articles and four additional consensus/guideline documents were included for data extraction and analyses. Information related to the research question was of expert opinion using the National Health and Medical Research Council (NHMRC) Levels of Evidence guidelines. Themes explaining practices that deviated from evidence-based care in assessment, diagnosis and management of acute CN centred around patient, health professional and health organisation/environmental. Delay to diagnosis is particularly influenced by the patient's knowledge of when to seek help, practitioner knowledge in knowing how to recognise and refer for appropriate immediate care, confusion in imaging and offloading and geographical and local health service resources to appropriately manage the condition. CONCLUSION Individual and health professional awareness and geographical barriers are key challenges to the effective delivery of evidence-based assessment, diagnosis and management of people with acute CN. Acute CN represents a medical emergency warranting the need for expedited assessment, diagnosis and management by appropriately trained health professionals in the appropriate.
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Affiliation(s)
- D Diacogiorgis
- Department of Podiatry and Allied Health Assistants, Ballarat Health Services, Ballarat, Australia
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia
| | - B M Perrin
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia.
- Holsworth Research Initiative, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia.
| | - M I C Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
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Keukenkamp R, Busch‐Westbroek TE, Barn R, Woodburn J, Bus SA. Foot ulcer recurrence, plantar pressure and footwear adherence in people with diabetes and Charcot midfoot deformity: A cohort analysis. Diabet Med 2021; 38:e14438. [PMID: 33084095 PMCID: PMC8048542 DOI: 10.1111/dme.14438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/30/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022]
Abstract
AIMS To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. METHODS Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom-made footwear were assessed with regard to barefoot and in-shoe plantar pressures during walking, footwear adherence (% of daily steps over 7-day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non-Charcot foot group) with custom-made footwear and similar ulcer risk factors. RESULTS Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non-Charcot foot group [756 (260-1267) vs 146 (100-208) kPa; P<0.001]. In-shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104-201) vs 119 (94-160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non-Charcot foot group [median (interquartile range) 94.4 (85.4-95.0)% vs. 64.3 (25.4-85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non-Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non-Charcot foot group (1/55; P=0.001). CONCLUSIONS Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom-made footwear design may be required to improve clinical outcome.
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Affiliation(s)
- R. Keukenkamp
- Amsterdam UMCUniversity of Amsterdam, Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - T. E. Busch‐Westbroek
- Amsterdam UMCUniversity of Amsterdam, Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - R. Barn
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - J. Woodburn
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - S. A. Bus
- Amsterdam UMCUniversity of Amsterdam, Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
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Kloska A, Korzon-Burakowska A, Malinowska M, Bruhn-Olszewska B, Gabig-Cimińska M, Jakóbkiewicz-Banecka J. The role of genetic factors and monocyte-to-osteoclast differentiation in the pathogenesis of Charcot neuroarthropathy. Diabetes Res Clin Pract 2020; 166:108337. [PMID: 32707214 DOI: 10.1016/j.diabres.2020.108337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/07/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022]
Abstract
Charcot neuroarthropathy is a chronic, progressive condition of the skeletal system that affects some patients with diabetic neuropathy. It results in progressive destruction of bones of the foot and disorganisation of pedal joints and ligaments. Effective prevention and treatment for Charcot neuroarthropathy remain a challenge. Currently, there are no reliable repeatable markers to identify patients with diabetes who are at higher risk of developing Charcot neuroarthropathy. The pathogenesis underlying the development of Charcot neuroarthropathy also remains unclear. In this review, we provide an overview of the history, prevalence, symptoms, risk factors, diagnostics and treatment of Charcot neuroarthropathy. We also discuss the potential for OPG and RANKL gene variants to act as predictive markers for the development of Charcot neuroarthropathy. Finally, we summarise the latest research on the role of monocyte-to-osteoclast differentiation in the development of acute Charcot neuroarthropathy.
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Affiliation(s)
- Anna Kloska
- University of Gdańsk, Faculty of Biology, Department of Medical Biology and Genetics, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Anna Korzon-Burakowska
- Medical University of Gdańsk, Faculty of Medicine, Department of Hypertension and Diabetology, Dębinki 7, 80-211 Gdańsk, Poland
| | - Marcelina Malinowska
- University of Gdańsk, Faculty of Biology, Department of Medical Biology and Genetics, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Bożena Bruhn-Olszewska
- University of Gdańsk, Faculty of Biology, Department of Bacterial Molecular Genetics, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Magdalena Gabig-Cimińska
- University of Gdańsk, Faculty of Biology, Department of Medical Biology and Genetics, Wita Stwosza 59, 80-308 Gdańsk, Poland; Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Laboratory of Molecular Biology, Kładki 24, 80-822 Gdańsk, Poland
| | - Joanna Jakóbkiewicz-Banecka
- University of Gdańsk, Faculty of Biology, Department of Medical Biology and Genetics, Wita Stwosza 59, 80-308 Gdańsk, Poland.
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Galeazzi Rech AL, Stüve Y, Toepfer A, Schimke KE. Missing the boat: fatal ending to a missed case of Charcot arthropathy. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200013. [PMID: 32554824 PMCID: PMC7354711 DOI: 10.1530/edm-20-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 01/22/2023] Open
Abstract
SUMMARY Acute Charcot neuropathic osteoarthropathy (CN) is a clinical entity which can easily go unrecognized in its acute early stages due to lack of awareness and unspecific presentation. However, missing early diagnosis can lead to severe complications. We present the case of a 72-year-old male patient who went through the natural course of the disease unnoticed before the very eyes of his physicians leading to a tragic end. We aim to raise awareness for this rare diabetic complication, emphasizing the necessity of early diagnosis and adequate, interdisciplinary treatment. LEARNING POINTS Clinical signs and symptoms of acute Charcot neuropathic osteoarthropathy (CN). Red flags. Importance of early diagnosis and correct treatment. Diagnostic challenges of acute CN. Awareness of high morbidity and mortality.
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Affiliation(s)
- Anna Luiza Galeazzi Rech
- Kantonsspital Sankt Gallen, Klinik für Allgemeine Innere Medizin/Hausarztmedizin, Sankt Gallen, Switzerland
| | - Yvon Stüve
- Kantonsspital Sankt Gallen, Klinik für Allgemeine Innere Medizin/Hausarztmedizin, Sankt Gallen, Switzerland
| | - Andreas Toepfer
- Kantonsspital Sankt Gallen, Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparts, Sankt Gallen, Switzerland
| | - Katrin E Schimke
- Kantonsspital Sankt Gallen, Klinik für Allgemeine Innere Medizin/Hausarztmedizin, Sankt Gallen, Switzerland
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Pérez-Panero AJ, Ruiz-Muñoz M, Cuesta-Vargas AI, Gónzalez-Sánchez M. Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines: A systematic review. Medicine (Baltimore) 2019; 98:e16877. [PMID: 31464916 PMCID: PMC6736276 DOI: 10.1097/md.0000000000016877] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/26/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
AIM Diabetic foot complications are the main reason for hospitalization and amputation in people with diabetes and have a prevalence of up to 25%. Clinical practice guidelines are recommendations based on evidence with the aim of improving health care. The main aim of this study was to carry out a systematic review of the levels of the evaluation and treatment strategies that appear in the clinical practice guidelines focus on diabetic foot or diabetes with diabetic foot section. Another objective of this study was to perform an analysis of the levels of evidence in support of the recommendations made by the selected clinical practice guidelines. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and a quality assessment by the Appraisal of Guidelines for Research and Evaluation (AGREE II) were performed. The databases checked were "NICE", "Cinahl", "Health Guide", "RNAO", "Sign", "PubMed", "Scopus" and "NCG". The search terms included were "diabetic foot", "guideline(s)", "practice guideline(s)" and "diabetes." RESULTS Twelve articles were selected after checked inclusion criteria and quality assessment. A summary and classification of the recommendations was completed. CONCLUSIONS The heterogeneity of levels of evidence and grades of recommendation of the CPGs included regarding the management, approach and treatment of DF makes it difficult to interpret and assume them in clinical practice in order to select the most correct procedures. Despite this and according to the detailed study of the guidelines included in this work, it can be concluded that the highly recommendable interventions for DF management are debridement (very high level of evidence and strongly recommended), foot evaluation (moderate level of evidence and fairly recommended) and therapeutic footwear (moderate level of evidence and fairly recommended).
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Affiliation(s)
| | | | - Antonio I. Cuesta-Vargas
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
| | - Manuel Gónzalez-Sánchez
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
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Wang J, Gao L. [New progress in the treatment of chronic wound of diabetic foot]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:832-837. [PMID: 30129304 DOI: 10.7507/1002-1892.201806058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Diabetic foot is one of the serious complications of diabetic patients. It is caused by diabetes combined with different degrees of lower extremity vascular lesions and neuropathy, and the wound can not heal for a long time. The serious results can cause bone marrow infection, bone destruction, and have high disability and death rate. At present, there are various treatment methods for diabetic foot chronic wound. On the basis of internal medicine controlling blood sugar, anti infection, lowering blood lipid, improving microcirculation and nourishment nerve, the surgical method is adopted, including the debridement of the necrosis in a short time to prevent the infection from spreading; maggot biological debridement and ozone chemical debridement will promote the growth of granulation tissue while controlling infection. Skin grafting, skin flap transplantation, skin distraction closure can be used to repair soft tissue defects, or fat transplantation, platelet-rich plasma, and rich blood are used for the refractory wound after infection control. In patients with diabetic foot, the reconstruction of lower limb blood supply is beneficial to the recovery of chronic ischemic wounds. It is feasible to improve the blood supply of the lower extremities, improve the blood supply of the lower extremity artery bypass grafting, and improve the microcirculation of the peripheral vessels around the lower extremities. Lower extremity vascular bypass pressure perfusion therapy for vascular network expansion, tibia lateral moving technique for lower limb microcirculation reconstruction. For diabetic foot ulcer caused by peripheral neuropathy, such as Charcot foot, while the application of external fixator, total contact cast technology of affected foot for reducing treatment to promote wound healing; the preparation of orthopedic shoes can play a maximum protective effect on the healing of diabetic foot wound healing.
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Affiliation(s)
- Jiangning Wang
- Department of Orthopaedics, Beijing Shijitan Hospital, CMU, Beijing, 100038,
| | - Lei Gao
- Department of Orthopaedics, Beijing Shijitan Hospital, CMU, Beijing, 100038, P.R.China
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Diabetic osteoarthropathy care in Sweden - Need for improvement: A national inventory. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 9:32-37. [PMID: 29067267 PMCID: PMC5651304 DOI: 10.1016/j.jcte.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022]
Abstract
79% of the clinics had no guidelines for managing patients with osteoarthropathy. Only two clinics presented acceptable guidelines. Plain X-ray, was the common diagnostic method.
Aims Osteoarthropathy, a rare foot complication in patients with diabetes mellitus, calls for immediate and optimal management to prevent irreversible bone/joint destruction and risk of amputation. Awareness of the condition and adequate guidelines would minimize the consequences and the costs, both for the patient and for the society. We investigated the diabetic osteoarthropathy care in Swedish orthopedic clinics. Methods A questionnaire was distributed to 63 Swedish hospitals with emergency department for orthopedic patients. There was a 95% response rate. Results Most of the respondents (79%) specified absence of established procedures including guidelines for managing patients with osteoarthropathy. The most common diagnostic method was clinical diagnosis and plain X-ray (95%). MRI or scintigraphy was used by 19% and 10.5% respectively. As treatment method, 84% used a total contact cast, while 38% used orthoses. Treatment duration <3 months was reported in 4%, 3–6 months in 53% and 6–12 months in 28% of the clinics. Four clinics reported treatment duration >12 months and two clinics provided no treatment. Conclusion Our national inventory indicates a need for improvement in knowledge as well as guidance and organization at orthopedic clinics regarding optimal care of patients with diabetic osteoarthropathy.
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