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Lockhart M, Dinneen SF, O'Keeffe DT. Plantar pressure measurement in diabetic foot disease: A scoping review. J Diabetes Investig 2024; 15:990-999. [PMID: 38634342 PMCID: PMC11292392 DOI: 10.1111/jdi.14215] [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] [Received: 03/06/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
AIMS/INTRODUCTION Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence. MATERIALS AND METHODS Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis - Scoping Review protocol. Peer-reviewed, English-language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field. RESULTS A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review. CONCLUSIONS Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real-world settings, and with improved technology.
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Affiliation(s)
- Michael Lockhart
- Center for Endocrinology, Diabetes and MetabolismGalway University HospitalsGalwayIreland
- Health Innovation via Engineering (HIVE) Laboratory, Lambe InstituteUniversity of GalwayGalwayIreland
| | - Sean F Dinneen
- Center for Endocrinology, Diabetes and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
| | - Derek T O'Keeffe
- Center for Endocrinology, Diabetes and MetabolismGalway University HospitalsGalwayIreland
- Health Innovation via Engineering (HIVE) Laboratory, Lambe InstituteUniversity of GalwayGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
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2
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Shen Q, Li B, Chen H, Gao S, Hu Y, Sun Y, Li G. Podiatrist intervention could reduce the incidence of foot ulcers in patients with diabetes: a hospital survey in China. J Wound Care 2024; 33:S25-S32. [PMID: 38573950 DOI: 10.12968/jowc.2024.33.sup4.s25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of podiatrists in preventing diabetic foot ulcers (DFUs) in China. METHOD The study was a prospective investigation. A total of 300 patients were enrolled from May 2016 to May 2018 in Handan Central Hospital, China. All patients who participated in this study had been diagnosed with type 2 diabetes, according to the International Classification of Diseases (ICD-10). All participants underwent our survey, which included basic patient data and information about DFUs. The patients were followed for one year, during which time they received appropriate intervention from podiatrists, including lifestyle guidance, callus resection, tinea grinding and ingrown nail correction. At the end of the year all the patients were surveyed again. The data before and after the year were statistically compared. RESULTS The results showed that the incidence of DFUs in patients with diabetes was significantly decreased after one year of intervention from podiatrists (20.7% versus 6.7%, p<0.001). Additionally, there was a negative correlation between the number of intervention visits and the number of DFU occurrences (Spearman correlation coefficient: -0.496, p<0.001). Furthermore, we found that 68 patients with a history of DFUs or amputation had an obviously reduced incidence of DFUs after intervention by a podiatrist (89.7% versus 27.9%, p<0.001). We also investigated other foot risk factors in all participants, such as limb neuropathy (76.3%), lower extremity vascular disease (65.7%) and foot paralysis (43.7%). CONCLUSION The results of this study help in understanding the situation of patients with diabetes in China and to prove that standardised podiatrist intervention has an important role in inhibiting the occurrence and development of DFUs.
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Affiliation(s)
- Qian Shen
- School of Foreign Studies of Zhongnan University of Economics and Law; Wuhan, China
| | - Binghui Li
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huating Chen
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suwen Gao
- Department of Endocrinology, Handan Central Hospital, Handan, China
| | - Yingyue Hu
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Sun
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongchi Li
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Zhang X, Teng Z, Geng X, Ma X, Chen WM. A fluoroscopic imaging-guided computational analyses to inform internal tissue loads within fat pad of the diabetic foot during gait. J Biomech 2023; 157:111744. [PMID: 37535986 DOI: 10.1016/j.jbiomech.2023.111744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
To accurately predict internal tissue loads for early diagnostics of diabetic foot ulcerations, a novel data-driven computational analysis was conducted. A dedicated dual fluoroscopic system was combined with a pressure mat to simultaneously characterize foot motions and soft tissue's material properties during gait. Finite element (FE) models of the heel pad of a diabetic patient were constructed with 3D trajectories of the calcaneus applied as boundary conditions to simulate gait events. The tensile and compressive stresses occurring in the plantar tissue were computed. Predictions of the layered tissue FE model with anatomically-accurate heel pad structures (i.e., fat and skin) were compared with those of the traditional lumped tissue (i.e., homogeneous) models. The influence of different material properties (patient-specific versus generic) on internal tissue stresses was also investigated. The results showed the peak tensile stresses in the layered tissue model were predominantly found in the skin and distributed towards the circumferential regions of the heel, while peak compressive stresses in the fat tissue-bone interface were up to 51.4% lower than those seen in the lumped models. Performing FE analyses at four different phases of walking revealed that ignorance of layered tissue structures resulted in an unphysiological increase of peak-to-peak value of stress fluctuation in the fat and skin tissue components. Thus, to produce more clinical-relevant predictions, foot FE models are suggested to include layered tissue structures of the plantar tissue for an improved estimation of internal stresses in the diabetic foot in gait.
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Affiliation(s)
- Xingyu Zhang
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, China
| | - Zhaolin Teng
- Department of Orthopaedics, Huashan Hospital affiliated to Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xiang Geng
- Department of Orthopaedics, Huashan Hospital affiliated to Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xin Ma
- Department of Orthopaedics, Huashan Hospital affiliated to Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Wen-Ming Chen
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, China.
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Withers RV, Perrin BM, Landorf KB, Raspovic A. Offloading effects of a removable cast walker with and without modification for diabetes-related foot ulceration: a plantar pressure study. J Foot Ankle Res 2023; 16:27. [PMID: 37170147 PMCID: PMC10173588 DOI: 10.1186/s13047-023-00625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Removable cast walkers (RCWs), with or without modifications, are used to offload diabetes-related foot ulcers (DRFUs), however there is limited data relating to their offloading effects. This study aimed to quantify plantar pressure reductions with an RCW with and without modification for DRFUs. METHODS This within-participant, repeated measures study included 16 participants with plantar neuropathic DRFUs. Walking peak plantar pressures at DRFU sites were measured for four conditions: post-operative boot (control condition), RCW alone, RCW with 20 mm of felt adhered to an orthosis, and RCW with 20 mm of felt adhered to the foot. RESULTS Compared to the control condition, the greatest amount of peak plantar pressure reduction occurred with the RCW with felt adhered to the foot (83.1% reduction, p < .001). The RCW with felt adhered to the foot also offered greater peak plantar pressure reduction than the RCW alone (51.3%, p = .021) and the RCW with felt adhered to an orthosis (31.4%, p = .009). CONCLUSION The largest offloading effect recorded was with the RCW with felt adhered to the foot. High-quality randomised trials are now needed to evaluate the effectiveness of this device for healing DRFUs.
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Affiliation(s)
- Rebekah V Withers
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia
| | - Byron M Perrin
- La Trobe Rural Health School, La Trobe University - Bendigo Campus, Flora Hill, 3552, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia.
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Liu M, Wei X, Zheng Z, Li Y, Li M, Lin J, Yang L. Recent Advances in Nano-Drug Delivery Systems for the Treatment of Diabetic Wound Healing. Int J Nanomedicine 2023; 18:1537-1560. [PMID: 37007988 PMCID: PMC10065433 DOI: 10.2147/ijn.s395438] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Diabetes mellitus (DM) induced wound healing impairment remains a serious health problem and burden on the clinical obligation for high amputation rates. Based on the features of wound microenvironment, biomaterials loading specific drugs can benefit diabetic wound treatment. Drug delivery systems (DDSs) can carry diverse functional substances to the wound site. Nano-drug delivery systems (NDDSs), benefiting from their features related to nano size, overcome limitations of conventional DDSs application and are considered as a developing process in the wound treatment field. Recently, a number of finely designed nanocarriers efficiently loading various substances (bioactive and non-bioactive factors) have emerged to circumvent constraints faced by traditional DDSs. This review describes various recent advances of nano-drug delivery systems involved in mitigating diabetes mellitus-based non-healing wounds.
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Affiliation(s)
- Mengqian Liu
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xuerong Wei
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Zijun Zheng
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Yicheng Li
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Mengyao Li
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jiabao Lin
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Lei Yang
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Correspondence: Lei Yang, Department of Burns, Nanfang Hospital, Southern Medical University, Jingxi Street, Baiyun District, Guangzhou, 510515, People’s Republic of China, Tel +86-20-6164-1841, Email
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Jorgetto JV, Oggiam DS, Gamba MA, Kusahara DM. Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy. J Diabetes Metab Disord 2022; 21:1577-1589. [PMID: 36404815 PMCID: PMC9672143 DOI: 10.1007/s40200-022-01104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 10/14/2022]
Abstract
Abstract Diabetic neuropathy is one of the main complications of Diabetes Mellitus, which can lead to loss of protective sensation, motor, and plantar pressure alteration, generating deformities, abnormal gait and mechanical trauma to the feet. Objective to evaluate the distribution of plantar pressure, sensorimotor changes, balance and associated factors to plantar pressure changes in people with peripheral diabetic neuropathy. Method Cross-sectional study conducted with individuals registered in the primary public health service of a city in the east of São Paulo - Brazil. The sample was composed by people with Diabetes Mellitus and Peripheral Neuropathy identified by the Michigan Screening Instrument. It were investigated variables such as sensory-motor changes, static and dynamic plantar pressure using baropodometry and balance using the Berg scale. A significance level of 5% was adopted for all tests used. Results Of the 200 individuals evaluated, 52.55% had no plantar protective sensitivity, the static evaluation did not demonstrated changes in the peak of plantar pressure, however in the dynamics the mean in the right foot was 6.0 (±2) kgf/cm2 and 6,7 (±1.62) kgf/cm2 on the left foot, the center of static pressure on the right foot was lower (10.55 ± 3.82) than on the left foot (11.97 ± 3.90), pointing hyper plantar pressure. The risk of falling was high, ranging from 8 to 56 points, with an average of 40.9 (±10.77). Conclusion The absence of protective plantar sensitivity, increased pressure, biomechanical changes lead to loss of balance and are predictive of complications in the feet due to diabetic neuropathy.
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Affiliation(s)
- Juliana Vallim Jorgetto
- Department of Public Health in the Collective Dimension, Federal University of São Paulo – UNIFESP, Octávio Parreira Street, 100, Jardim das Paineiras / São João da Boa Vista-SP, São Paulo, CEP: 13,874-720 Brazil
| | - Daniella Silva Oggiam
- Department of Public Health in the Collective Dimension, Federal University of São Paulo – UNIFESP, Octávio Parreira Street, 100, Jardim das Paineiras / São João da Boa Vista-SP, São Paulo, CEP: 13,874-720 Brazil
| | - Mônica Antar Gamba
- Retired teacher of Administration Applied to Nursing and Collective Health, School of Nursing, Federal University of São Paulo – UNIFESP, São Paulo, Brazil
| | - Denise Miyuki Kusahara
- PhD Nurse, Adjunct Professor from Department of Pediatric Nursing of the Paulista School of Nursing, Federal University of São Paulo - UNIFESP - Brazil, São Paulo, Brazil
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Tekale S, Varma A, Tekale S, Kumbhare U. A Review on Newer Interventions for the Prevention of Diabetic Foot Disease. Cureus 2022; 14:e30591. [DOI: 10.7759/cureus.30591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
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Sykes G. Offloading the foot with a wound: a holistic approach. Br J Community Nurs 2022; 27:S34-S36. [PMID: 36205408 DOI: 10.12968/bjcn.2022.27.sup10.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Gill Sykes
- Advanced Podiatrist, Harrogate and District NHS Trust
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Shi QQ, Li PL, Yick KL, Jiao J, Liu QL. Influence of Contoured Insoles with Different Materials on Kinematics and Kinetics Changes in Diabetic Elderly during Gait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12502. [PMID: 36231798 PMCID: PMC9566611 DOI: 10.3390/ijerph191912502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Alterations in the lower limb kinematics and kinetics of diabetic patients have been reported in previous studies. Inappropriate choices of orthopedic insole materials, however, fail to prevent diabetic foot ulcers and modify abnormal gait. The aim of this study was to quantitatively compare the effects of contoured insoles with different materials on the kinematics of and kinetics changes in the diabetic elderly during gait. METHODS There were 21 diabetic patients who participated in this study. Three-dimensional (3D) experimental contoured insoles constructed of soft (i.e., Nora Lunalastik EVA and PORON® Medical 4708) and rigid (i.e., Nora Lunalight A fresh and Pe-Lite) materials with Langer Biomechanics longitudinal PPT® arch pads were adopted. An eight-camera motion capture system (VICON), two force plates, and an insole measurement system-Pedar® with 99 sensors-were utilized to obtain the kinematics and kinetics data. The plug-in lower body gait model landmarks were used for dynamic data acquisition during gait. The corresponding data from five gait cycles were selected and calculated. RESULTS The range of motions (ROMs) of the ankle joint (p = 0.001) and knee joint (p = 0.044) were significantly influenced when the contoured insoles were worn in comparison to the barefoot condition. The joint moments of the lower limbs with maximum ankle plantarflexion during the loading response and maximum knee and hip flexions were significantly influenced by the use of contoured insoles with different materials in the diabetic elderly. The peak plantar pressure (PPP) of the forefoot (p < 0.001), midfoot (p = 0.009), and rearfoot (p < 0.001) was significantly offloaded by the contoured insoles during the stance phase, whilst the PPP of the rearfoot (p < 0.001) was significantly offloaded during the swing phase. CONCLUSIONS The contoured insoles, especially those constructed with soft materials, significantly offloaded the PPP during gait-hence accommodating certain abnormal gait patterns more effectively compared to going barefoot.
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Affiliation(s)
- Qiu-Qiong Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Pui-Ling Li
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Kit-Lun Yick
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Jiao Jiao
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China
| | - Qi-Long Liu
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
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Armstrong DG, Orgill DP, Glat PM, Galiano RD, Rasor ZL, Isaac A, Carter M, Zelen CM. A single arm prospective feasibility study evaluating wound closure with a unique wearable device that provides intermittent plantar compression and offloading in the treatment of non-healing diabetic foot ulcers. Int Wound J 2022; 20:853-860. [PMID: 36054243 PMCID: PMC9927907 DOI: 10.1111/iwj.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
The incidence and economic burden of diabetic foot ulcers continues to rise throughout the world. In this prospective study, a unique device designed to offload the wound, enhance circulation and monitor patient compliance was evaluated for safety and efficacy. The device provides offloading and intermittent plantar compression to improve the pedal flow of oxygenated blood and support wound healing while recording patient use. Ten patients with non-healing diabetic foot ulcers UTgrade 1A/Wagner grade 1 were treated weekly for up to 12 weeks. The primary endpoint was complete wound closure at 12 weeks, and secondary endpoints included healing time, percent area reduction and changes in pain using the visual analogue pain scale. Eight out of ten wounds healed within 12 weeks(80%), and the mean healing time was 41 days(95% CI:24.3-58.3). The percent area reduction was 75(SD:53.9). The baseline visual analogue pain scale was 4.5(2.9) as compared with 3.3(3.4) at end of study. No device-related or serious adverse events were reported. This unique intermediate plantar compression and offloading device may be considered as an alternative for safe and effective for treatment of non-healing diabetic foot ulcers. During treatment, wound healing was significantly accelerated, and pain was improved. Larger randomised controlled trials are underway to validate these early findings.
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Affiliation(s)
- David G. Armstrong
- Division of Surgery, Keck School of MedicineUniversity of Southern CaliforniaCaliforniaLos AngelesUSA
| | - Dennis P. Orgill
- Division of ResearchProfessional Education and Research InstituteRoanokeVirginiaUSA
| | - Paul M. Glat
- Departtment of SurgeryDrexel University School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Robert D. Galiano
- Division of Plastic Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Zachary L Rasor
- Foot and Ankle Specialists of the Mid‐Atlantic (FASMA)FrederickMarylandUSA
| | - Adam Isaac
- Foot and Ankle Specialists of the Mid‐Atlantic (FASMA)FrederickMarylandUSA
| | | | - Charles M. Zelen
- Division of ResearchProfessional Education and Research InstituteRoanokeVirginiaUSA
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Hagde P, Pingle P, Mourya A, Katta CB, Srivastava S, Sharma R, Singh KK, Sodhi RK, Madan J. Therapeutic potential of quercetin in diabetic foot ulcer: Mechanistic insight, challenges, nanotechnology driven strategies and future prospects. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El Hage R, Knippschild U, Arnold T, Hinterseher I. Stem Cell-Based Therapy: A Promising Treatment for Diabetic Foot Ulcer. Biomedicines 2022; 10:1507. [PMID: 35884812 PMCID: PMC9312797 DOI: 10.3390/biomedicines10071507] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetic foot ulcer (DFU) is a severe complication of diabetes and a challenging medical condition. Conventional treatments for DFU have not been effective enough to reduce the amputation rates, which urges the need for additional treatment. Stem cell-based therapy for DFU has been investigated over the past years. Its therapeutic effect is through promoting angiogenesis, secreting paracrine factors, stimulating vascular differentiation, suppressing inflammation, improving collagen deposition, and immunomodulation. It is controversial which type and origin of stem cells, and which administration route would be the most optimal for therapy. We reviewed the different types and origins of stem cells and routes of administration used for the treatment of DFU in clinical and preclinical studies. Diabetes leads to the impairment of the stem cells in the diseased patients, which makes it less ideal to use autologous stem cells, and requires looking for a matching donor. Moreover, angioplasty could be complementary to stem cell therapy, and scaffolds have a positive impact on the healing process of DFU by stem cell-based therapy. In short, stem cell-based therapy is promising in the field of regenerative medicine, but more studies are still needed to determine the ideal type of stem cells required in therapy, their safety, proper dosing, and optimal administration route.
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Affiliation(s)
- Racha El Hage
- Department of Vascular Surgery, Universitätsklinikum Ruppin-Brandenburg, Medizinische Hochschule Branderburg Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
| | - Uwe Knippschild
- Department of General and Visceral Surgery, Surgery Center, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (U.K.); (T.A.)
| | - Tobias Arnold
- Department of General and Visceral Surgery, Surgery Center, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (U.K.); (T.A.)
| | - Irene Hinterseher
- Department of Vascular Surgery, Universitätsklinikum Ruppin-Brandenburg, Medizinische Hochschule Branderburg Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Berlin Institute of Health, Vascular Surgery Clinic, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Fakultät für Gesundheitswissenschaften Brandenburg, Gemeinsame Fakultät der Universität Potsdam, der Medizinischen Hochschule Brandenburg Theodor Fontane und der Brandenburgischen Technischen Universität Cottbus—Senftenberg, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
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Maharana P, Sonawane J, Belehalli P, Ananthasuresh GK. Self-offloading therapeutic footwear using compliant snap-through arches. WEARABLE TECHNOLOGIES 2022; 3:e7. [PMID: 38486896 PMCID: PMC10936371 DOI: 10.1017/wtc.2022.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/09/2022] [Accepted: 03/06/2022] [Indexed: 03/17/2024]
Abstract
In diabetic peripheral neuropathy, offloading high-plantar-pressure areas using statically offloaded customized insoles or expensive sensors and actuators are commonly-followed treatment procedures. In this article, we propose the concept of dynamically self-offloading therapeutic footwear that operates mechanically without using sensors and actuators. We achieve this by using an array of snapping arches. When a load higher than a bespoke value is applied, these arches enter negative-stiffness regime and offload the high-pressure region by snapping to a different shape. They again return to their initial shape when the load disappears. Thus, they serve as both sensors and actuators that get actuated by person's body weight. We present an analytical method to compute the switching load and the switchback time of such arches and use them to customize the footwear according to the person's body weight, gait speed, and foot size. We identify the high-pressure regions from the clinical data and place the arches such that these high-pressure regions get dynamically offloaded, and the pressure gets redistributed to other regions. We considered 200 kPa as a limiting pressure to prevent the prolonged effects of high plantar pressure. To check the efficacy of the concept, a complete 3D-printed prototype made of thermoplastic polyurethane was tested and compared with barefoot and in-shoe plantar pressure for subjects recruited at a clinical facility. We notice that the self-offloading insole shows the plantar pressure reduction at all the foot regions, and significant offloading of 57% is observed at the forefoot region.
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Affiliation(s)
| | - Jyoti Sonawane
- Mechanical Engineering, Indian Institute of Science, Bengaluru, India
| | - Pavan Belehalli
- Department of Podiatry, Karnataka Institute of Endocrinology and Research, Bengaluru, India
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Morley R, Rothwell M, Stephenson J, McIlvenny L, Webb F, Barber A. Complex Foot Infection Treated With Surgical Debridement and Antibiotic Loaded Calcium Sulfate-A Retrospective Cohort Study of 137 Cases. J Foot Ankle Surg 2022; 61:239-247. [PMID: 34364760 DOI: 10.1053/j.jfas.2021.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/12/2021] [Accepted: 07/11/2021] [Indexed: 02/03/2023]
Abstract
Complex foot infections involving bone and soft tissue in patients with co-morbidities such as diabetes and peripheral arterial disease (PAD) are a cause of significant hospital admission. They are associated with substantial economic costs to health services worldwide. Historically, severe foot infection has been treated with surgical debridement and prolonged courses of systemic antibiotics. Prolonged systemic antibiotic use increases the risk of drug side effects, antimicrobial resistance and Clostridium difficile infection. The purpose of this study was to investigate whether surgical debridement and implantation of antibiotic loaded calcium sulfate is effective in the resolution of foot infection and wound healing. A retrospective cohort study of 137 consecutive cases of osteomyelitis (127) or significant soft tissue infection (10) over 62 months from 02/2013 to 04/2018 was conducted following local ethical approval. All cases of infection were treated with surgical debridement and local antibiotic-loaded calcium sulfate. The primary outcomes of infection resolution, time to healing and duration of postoperative antibiotics were measured. In 137 cases, 88.3% of infections resolved. Infection was eradicated in 22 patients without postoperative systemic antibiotics. About 82.5% of wounds healed, with an average healing time of 11.3 weeks. Healing time was significantly increased for the co-morbidities of diabetes and PAD (p =< .05) and for those requiring prolonged systemic postoperative antibiotics. Conservative surgical debridement and implantation of local antibiotic impregnated calcium sulfate is safe and effective in managing complex foot infections. We advocate early surgical intervention before deeper tissue involvement to help preserve lower limb structure and function.
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Affiliation(s)
- Robert Morley
- Consultant Podiatric Surgeon, Derbyshire Community Health Services NHS FT, Department of Podiatric Surgery, Buxton Hospital, Buxton, Derbyshire, UK.
| | - Matt Rothwell
- Specialist Registrar in Podiatric Surgery, Department of Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - John Stephenson
- Senior Lecturer in Biomedical Statistics, Department of Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Liza McIlvenny
- Head of Integrated therapies, Stockport NHS FT, Podiatry Department, Stepping Hill Hospital, Poplar Grove, Hazel Grove, Stockport, UK
| | - Frank Webb
- Consultant Podiatric Surgeon, Derbyshire Community Health Services NHS FT, Department of Podiatric Surgery, Buxton Hospital, Buxton, Derbyshire, UK
| | - Aaron Barber
- Specialist Registrar in Podiatric Surgery, Stockport NHS FT, Podiatry Department, Stepping Hill Hospital, Poplar Grove, Hazel Grove, Stockport, UK
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Pathri S, Chemboli M, Rao RB, Pathri C, Paka V. Total contact casting: A forgotten art in the management of neuropathic foot ulcers. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Bartolo E, Giacomozzi C, Coppini DV, Gatt A. The effect of induced joint restriction on plantar pressure during gait - a pilot study. Gait Posture 2021; 90:23-28. [PMID: 34365284 DOI: 10.1016/j.gaitpost.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/14/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to analyse the effect of induced lower limb joint restriction on plantar pressures during gait. Focusing on restricting a single joint, without the effect of other co-morbidities, would provide better understanding as to the resultant plantar loadings during gait, which would be especially beneficial in patients requiring offloading procedures. RESEARCH QUESTION Does induced lower limb joint restriction affect plantar pressure distribution during gait? METHODS A prospective, quasi-experimental study was conducted, recruiting ten healthy, adult participants who were instructed to walk barefoot over a Tekscan HR Mat™. This procedure was repeated after separately inducing restriction of the hip, knee and ankle joints. Mean peak plantar pressure (MPP) and pressure-time integral (PTI) data were analysed to compare between unrestricted and restricted data. RESULTS Significant plantar pressure changes were observed in the heel and first metatarsal regions. Rearfoot PTIs were increased with restriction of the contralateral hip (left p <0.001) (right p =0.02) and knee joints (left p =0.01) (right p =0.04). Both MPPs (left p =0.01; right p =0.01) and PTIs (left p =0.004; right p =0.03) were increased in the first metatarsal when restricting the hip joint of the same limb. MPP was decreased in the left first metatarsal with induced knee (left p =0.01; right p =0.04) and ankle (left and right p <0.001) joint restriction. Finally, MPP was decreased in the right first metatarsal with knee (left and right p =0.01) and ankle (left p =0.04; right p =0.01) joint restriction. SIGNIFICANCE Limited joint mobility may have a direct effect on plantar pressure, particularly with restriction in the hip and knee joints, hence careful attention should be given especially in patients with conditions involving plantar loadings. Results in this study also show that PTI changes during gait should be equally evaluated clinically along with peak plantar pressure analysis.
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Affiliation(s)
- Erica Bartolo
- Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - Claudia Giacomozzi
- Department of Cardiovascular Diseases, Dysmetabolic Diseases & Ageing, Italian National Institute of Health, Rome, Italy.
| | | | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta.
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17
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Afonso AC, Oliveira D, Saavedra MJ, Borges A, Simões M. Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies. Int J Mol Sci 2021; 22:8278. [PMID: 34361044 PMCID: PMC8347492 DOI: 10.3390/ijms22158278] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are a serious complication from diabetes mellitus, with a huge economic, social and psychological impact on the patients' life. One of the main reasons why DFUs are so difficult to heal is related to the presence of biofilms. Biofilms promote wound inflammation and a remarkable lack of response to host defences/treatment options, which can lead to disease progression and chronicity. In fact, appropriate treatment for the elimination of these microbial communities can prevent the disease evolution and, in some cases, even avoid more serious outcomes, such as amputation or death. However, the detection of biofilm-associated DFUs is difficult due to the lack of methods for diagnostics in clinical settings. In this review, the current knowledge on the involvement of biofilms in DFUs is discussed, as well as how the surrounding environment influences biofilm formation and regulation, along with its clinical implications. A special focus is also given to biofilm-associated DFU diagnosis and therapeutic strategies. An overview on promising alternative therapeutics is provided and an algorithm considering biofilm detection and treatment is proposed.
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Affiliation(s)
- Ana C. Afonso
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
- CITAB—Centre for the Research and Technology for Agro-Environment and Biological Sciences, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal;
- CEB—Centre of Biological Engineering, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal
| | - Diana Oliveira
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
- CIQUP, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal
| | - Maria José Saavedra
- CITAB—Centre for the Research and Technology for Agro-Environment and Biological Sciences, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal;
- Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal
| | - Anabela Borges
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
| | - Manuel Simões
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
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Kim K, Mahajan A, Patel K, Syed S, Acevedo‐Jake AM, Kumar VA. Materials and Cytokines in the Healing of Diabetic Foot Ulcers. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202100075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- KaKyung Kim
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Aryan Mahajan
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Kamiya Patel
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Shareef Syed
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Amanda M. Acevedo‐Jake
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Vivek A. Kumar
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
- Department of Chemical, Biological and Pharmaceutical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
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Brousseau-Foley M, Blanchette V, Trudeau F, Houle J. Physical Activity Participation in People with an Active Diabetic Foot Ulceration: A Scoping Review. Can J Diabetes 2021; 46:313-327. [DOI: 10.1016/j.jcjd.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/22/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022]
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Chatzistergos PE, Chockalingam N. A novel concept for low-cost non-electronic detection of overloading in the foot during activities of daily living. ROYAL SOCIETY OPEN SCIENCE 2021; 8:202035. [PMID: 34113451 PMCID: PMC8188001 DOI: 10.1098/rsos.202035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
Identifying areas in the sole of the foot which are routinely overloaded during daily living is extremely important for the management of the diabetic foot. This work showcases the feasibility of reliably detecting overloading using a low-cost non-electronic technique. This technique uses thin-wall structures that change their properties differently when they are repeatedly loaded above or below a tuneable threshold. Flexible hexagonal thin-wall structures were produced using three-dimensional printing, and their mechanical behaviour was assessed before and after repetitive loading at different magnitudes. These structures had an elastic mechanical behaviour until a critical pressure (P crit = 252 kPa ± 17 kPa) beyond which they buckled. Assessing changes in stiffness after simulated use enabled the accurate detection of whether a sample was loaded above or below P crit (sensitivity = 100%, specificity = 100%), with the overloaded samples becoming significantly softer. No specific P crit value was targeted in this study. However, finite-element modelling showed that P crit can be easily raised or lowered, through simple geometrical modifications, to become aligned with established thresholds for overloading (e.g. 200 kPa) or to assess overloading thresholds on a patient-specific basis. Although further research is needed, the results of this study indicate that clinically relevant overloading could indeed be reliably detected without the use of complex electronic in-shoe sensors.
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Affiliation(s)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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21
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D’Amico M, Kinel E, Roncoletta P, Gnaldi A, Ceppitelli C, Belli F, Murdolo G, Vermigli C. Data-driven CAD-CAM vs traditional total contact custom insoles: A novel quantitative-statistical framework for the evaluation of insoles offloading performance in diabetic foot. PLoS One 2021; 16:e0247915. [PMID: 33661973 PMCID: PMC7932531 DOI: 10.1371/journal.pone.0247915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background Elevated plantar pressures represent a significant risk factor for neuropathic diabetic foot (NDF) ulceration. Foot offloading, through custom-made insoles, is essential for prevention and healing of NDF ulcerations. Objective quantitative evaluation to design custom-made insoles is not a standard method. Aims: 1) to develop a novel quantitative-statistical framework (QSF) for the evaluation and design of the insoles’ offloading performance through in-shoe pressure measurement; 2) to compare the pressure-relieving efficiency of traditional shape-based total contact customised insoles (TCCI) with a novel CAD-CAM approach by the QSF. Methods We recruited 30 neuropathic diabetic patients in cross-sectional study design. The risk-regions of interest (R-ROIs) and their areas with in-shoe peak pressure statistically ≥200kPa were identified for each patients’ foot as determined on the average of peak pressure maps ascertained per each stance phase. Repeated measures Friedman test compared R-ROIs’ areas in three different walking condition: flat insole (FI); TCCI and CAD-CAM insoles. Results As compared with FI (20.6±12.9 cm2), both the TCCI (7±8.7 cm2) and the CAD-CAM (5.5±7.3 cm2) approaches provided a reduction of R-ROIs mean areas (p<0.0001). The CAD-CAM approach performed better than the TCCI with a mean pressure reduction of 37.3 kPa (15.6%) vs FI. Conclusions The CAD-CAM strategy achieves better offloading performance than the traditional shape-only based approach. The introduced QSF provides a more rigorous method to the direct 200kPa cut-off approach outlined in the literature. It provides a statistically sound methodology to evaluate the offloading insoles design and subsequent monitoring steps. QSF allows the analysis of the whole foot’s plantar surface, independently from a predetermined anatomical identification/masking. QSF can provide a detailed description about how and where custom-made insole redistributes the underfoot pressure respect to the FI. Thus, its usefulness extends to the design step, helping to guide the modifications necessary to achieve optimal offloading insole performances.
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Affiliation(s)
- Moreno D’Amico
- SMART Lab (Skeleton Movement Analysis and Advanced Rehabilitation Technologies)—Bioengineering & Biomedicine Company Srl, Pescara, Italy
- Department of Neuroscience, Imaging and Clinical Sciences University G. D’Annunzio, Chieti-Pescara, Italy
- * E-mail:
| | - Edyta Kinel
- Department of Rehabilitation, Chair of Rehabilitation and Physiotherapy, University of Medical Sciences, Poznan, Poland
| | - Piero Roncoletta
- SMART Lab (Skeleton Movement Analysis and Advanced Rehabilitation Technologies)—Bioengineering & Biomedicine Company Srl, Pescara, Italy
| | - Andrea Gnaldi
- Guantificio Altotiberino Ecosanit Calzature Snc, Anghiari, Italy
| | - Celeste Ceppitelli
- Department of Medicine, Unit of Endocrinology and Metabolism, S. Maria della Misericordia, Perugia Hospital, Perugia, Italy
| | | | - Giuseppe Murdolo
- Department of Medicine, Unit of Endocrinology and Metabolism, S. Maria della Misericordia, Perugia Hospital, Perugia, Italy
| | - Cristiana Vermigli
- Department of Medicine, Unit of Endocrinology and Metabolism, S. Maria della Misericordia, Perugia Hospital, Perugia, Italy
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22
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Shaulian H, Gefen A, Solomonow-Avnon D, Wolf A. Finite element-based method for determining an optimal offloading design for treating and preventing heel ulcers. Comput Biol Med 2021; 131:104261. [PMID: 33611128 DOI: 10.1016/j.compbiomed.2021.104261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/29/2022]
Abstract
Diabetic heel ulceration, a serious, destructive, and costly complication of diabetes, is often treated by custom-made offloading footwear. One common offloading device is a custom-made insole designed with a hole under the damaged site that is intended to reduce local mechanical loads on the ulcer. However, current devices do not take into account the increasing loads at the wound peripheries, and quantitative assessments and scientific guidelines for the optimal design of the offloading hole are lacking. Here, we develop a novel method to determine the volumetric exposure to mechanical loading of a human heel, at two volume of interests (VOIs) during walking in 150 different finite-element footwear configurations. We defined the two VOIs as (1) the area of the heel soft tissues typically at high risk of ulceration, and (2) the soft tissues surrounding the high risk area. For all model variants, three hole-geometry parameters were defined: (1) radius, (2) radius of curvature (ROC) and (3) depth. We found two combinations of the offloading parameters which minimize heel loads in both VOIs. The first is with a large offloading radius, large ROC and large depth, whereas the second is with a large offloading radius, large depth but relatively small ROC. Our novel practical scientific analysis method, that takes into account the ulcer site as well as the peripheral area, has the potential to optimize development of offloading solutions by streamlining the examination of their biomechanical efficiency, and thus may revolutionize prevention and treatment of diabetic ulcers at any foot location.
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Affiliation(s)
- Hadar Shaulian
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel.
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Deborah Solomonow-Avnon
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel; Neurorehabilitation and Sensorimotor Neuroscience Lab, Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel
| | - Alon Wolf
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel
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Govindasamy K, Raja NR, Gupta P, Anand G, Das P, Darlong F, Darlong J. Computer assisted customized footwear and traditional micro-cellular rubber (MCR) footwear to reduce recurrence of ulcer for patients with loss of sensation due to leprosy. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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The Role of Foot-Loading Factors and Their Associations with Ulcer Development and Ulcer Healing in People with Diabetes: A Systematic Review. J Clin Med 2020; 9:jcm9113591. [PMID: 33171726 PMCID: PMC7694972 DOI: 10.3390/jcm9113591] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
We aimed to comprehensively and systematically review studies associating key foot-loading factors (i.e., plantar pressure, weight-bearing activity, adherence or a combination thereof) with ulcer development and ulcer healing in people with diabetes. A systematic literature search was performed in PubMed and EMBASE. We included studies if barefoot or in-shoe plantar pressure, weight-bearing activity or footwear or device adherence was measured and associated with either ulcer development or ulcer healing in people with diabetes. Out of 1954 records, 36 studies were included and qualitatively analyzed. We found low to moderate quality evidence that lower barefoot plantar pressure and higher footwear and device adherence associate with lower risk of ulcer development and shorter healing times. For the other foot-loading factors, we found low quality evidence with limited or contradictory results. For combined measures of foot-loading factors, we found low quality evidence suggesting that lower cumulative plantar tissue stress is associated with lower risk of ulcer development and higher ulcer healing incidence. We conclude that evidence for barefoot plantar pressure and adherence in association with ulcer outcome is present, but is limited for the other foot-loading factors. More comprehensive investigation in particularly the combination of foot-loading factors may improve the evidence and targeting preventative treatment.
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Eleftheriadou I, Samakidou G, Tentolouris A, Papanas N, Tentolouris N. Nonpharmacological Management of Diabetic Foot Ulcers: An Update. INT J LOW EXTR WOUND 2020; 20:188-197. [PMID: 33073653 DOI: 10.1177/1534734620963561] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus that is associated with increased morbidity and mortality, as well as substantial economic burden for the health care system. The standard of care for DFUs includes pressure off-loading, sharp debridement, and wound moisture balance, along with infection control and management of peripheral arterial disease. A variety of advanced modalities that target distinct pathophysiological aspects of impaired wound healing in diabetes are being studied as possible adjunct therapies for difficult to heal ulcers. These modalities include growth factors, stem cells, cultured fibroblasts and keratinocytes, bioengineered skin substitutes, acellular bioproducts, human amniotic membranes, oxygen therapy, negative pressure wound therapy, and energy therapies. Additionally, the use of advanced biomaterials and gene delivery systems is being investigated as a method of effective delivery of substances to the wound bed. In the present narrative review, we outline the latest advances in the nonpharmacological management of DFUs and summarize the efficacy of various standard and advanced treatment modalities.
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Affiliation(s)
- Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital
| | - Georgia Samakidou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital
| | | | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital
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Colak B, Yormaz S, Ece I, Çalişir A, Körez K, Çınar M, Sahin M. Comparison of Collagen Granule Dressing Versus Conventional Dressing in Patients With Diabetic Foot Ulcer. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2020; 21:279-289. [PMID: 32734790 DOI: 10.1177/1534734620938988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Diabetic foot ulcer (DFU) is a difficult, chronic wound with a significant long-term influence on the morbidity, mortality, and quality of life of patients. There is much information about the biochemical features of collagen and its function in wound healing. The aim of this study was to compare the results of DFU patients treated with and without collagen. Methods. A retrospective evaluation was made of the data of patients with DFU who underwent collagen treatment and physiological serum (PS) treatment. The patients were followed-up for a minimum of 12 weeks, and all complications, healing process, and wound characteristics were recorded. Results. Of the total 64 DFU patients included in the study, 30 were treated with PS and 34 with collagen. Complete closure was achieved in 17 (56.6%) of the PS group patients after 12 weeks of treatment. The rate was 25 (73.5%) in the collagen group. The mean duration of treatment was 9.2 weeks (range = 6-12 weeks) in the PS group and 8.08 weeks (range = 5-12 weeks) in the collagen group. The recovery time and recovery rates were determined to be better in the collagen group than in the PS group. Conclusion. A significant reduction in wound size was seen in the collagen group compared with the PS group. The results of this study demonstrated that collagen dressings are better than conventional dressings with regard to early granulation tissue and shorter hospital stay.
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Affiliation(s)
- Bayram Colak
- Selcuk Universitesi Tip Fakultesi, Selçuklu, Konya, Turkey
| | - Serdar Yormaz
- Selcuk Universitesi Tip Fakultesi, Selçuklu, Konya, Turkey
| | - Ilhan Ece
- Selcuk Universitesi Tip Fakultesi, Selçuklu, Konya, Turkey
| | - Akin Çalişir
- Selcuk Universitesi Tip Fakultesi, Selçuklu, Konya, Turkey
| | - Kazım Körez
- Selcuk Universitesi Tip Fakultesi, Selçuklu, Konya, Turkey
| | - Mahmut Çınar
- Selcuk Universitesi Tip Fakultesi, Selçuklu, Konya, Turkey
| | - Mustafa Sahin
- Selcuk Universitesi Tip Fakultesi, Selçuklu, Konya, Turkey
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Lim WT, Robinson H, Jude E, Rajbhandari S. The Real-Life Outcome of VACOped Boot in the Management of Diabetic Foot Ulcers. INT J LOW EXTR WOUND 2020; 21:290-293. [PMID: 32734794 DOI: 10.1177/1534734620942671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The total contact cast (TCC) is considered the gold standard treatment to off-load diabetic foot ulcers (DFUs); however, the use of TCC can be limited due to various reasons such as underlying infections, ischemia, and patient's reluctance. Removable cast walkers are used in such cases, and the VACOped boot is one such device. The aim of this study was to analyze the results of the VACOped boot in the treatment of DFUs in real life. Case records of all patients with DFUs treated with a VACOped from 2011 to 2017 were reviewed retrospectively. Eighty-three episodes of ulcerations in 42 subjects were identified, of which 48 (57.8%) healed in a median duration of 17.5 (95% confidence interval = 15-33) weeks with the use of the VACOped and 35 (42.2%) discontinued its use. The median duration of healing with the VACOped of 17.5 weeks appears to be longer, but this cohort included patients with underlying infection and ischemia, which are often excluded in the clinical trials of off-loading. Our data show that the VACOped application is preferred by many patients and seems to be equally effective to other removable cast walkers.
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Affiliation(s)
- Wee Teck Lim
- The University of Manchester, Manchester, UK
- Lancashire Teaching Hospital NHS Trust, Chorley, UK
| | | | - Edward Jude
- Tameside General Hospital, Ashton-under-Lyne, UK
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28
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Chatwin KE, Abbott CA, Boulton AJ, Bowling FL, Reeves ND. The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration-A comprehensive review. Diabetes Metab Res Rev 2020; 36:e3258. [PMID: 31825163 PMCID: PMC7317473 DOI: 10.1002/dmrr.3258] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/19/2022]
Abstract
The predominant risk factor of diabetic foot ulcers (DFU), peripheral neuropathy, results in loss of protective sensation and is associated with abnormally high plantar pressures. DFU prevention strategies strive to reduce these high plantar pressures. Nevertheless, several constraints should be acknowledged regarding the research supporting the link between plantar pressure and DFUs, which may explain the low prediction ability reported in prospective studies. The majority of studies assess vertical, rather than shear, barefoot plantar pressure in laboratory-based environments, rather than during daily activity. Few studies investigated previous DFU location-specific pressure. Previous studies focus predominantly on walking, although studies monitoring activity suggest that more time is spent on other weight-bearing activities, where a lower "peak" plantar pressure might be applied over a longer duration. Although further research is needed, this may indicate that an expression of cumulative pressure applied over time could be a more relevant parameter than peak pressure. Studies indicated that providing pressure feedback might reduce plantar pressures, with an emerging potential use of smart technology, however, further research is required. Further pressure analyses, across all weight-bearing activities, referring to location-specific pressures are required to improve our understanding of pressures resulting in DFUs and improve effectiveness of interventions.
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Affiliation(s)
- Katie E. Chatwin
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & EngineeringManchester Metropolitan UniversityManchesterUK
| | - Caroline A. Abbott
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & EngineeringManchester Metropolitan UniversityManchesterUK
| | - Andrew J.M. Boulton
- Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Diabetes Research InstituteUniversity of MiamiMiamiFlorida
| | - Frank L. Bowling
- Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Neil D. Reeves
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & EngineeringManchester Metropolitan UniversityManchesterUK
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KangFuXin Liquid in the Treatment of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3678714. [PMID: 31975998 PMCID: PMC6954482 DOI: 10.1155/2019/3678714] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/31/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
Abstract
Background Diabetic foot ulcer (DFU) is one of the most common complications of diabetes mellitus, with the wound not healing as expected and healing slowly. Poor control can develop into gangrene and even amputation. Currently, the existing treatments are not satisfactory enough. In China, KangFuXin liquid (KFXL) has been clinically used to treat DFU and has shown good clinical efficacy. In order to provide more reference to clinicians and experts, evidence of efficacy for it needs to be further rigorously evaluated. Methods Eight electronic databases were searched to identify eligible randomized clinical trials (RCTs) published from construction of the library to April 2019. There is no language or data restriction; 11 trials involving 889 participants met the inclusion criteria. These RCTs compared the total effective rate, cure rate, cure time, and adverse events associated with KFXL. The Cochrane Handbook guidelines were used to assess the risk of bias and to evaluate the methodological quality of eligible studies. The methodological quality of included studies was generally low. Dichotomous and continuous data were presented using risk ratios (RRs) and mean differences (MDs), respectively. Results Compared with the basic treatment, meta-analyses showed that KFXL combined with basic treatment can improve the total effective rate (RR = 1.38; 95% CI = 1.23–1.54; P < 0.00001; fixed effect model: I2 = 32%) and cure rate (RR = 1.67; 95% CI = 1.17–2.38; P=0.005; random effect model: I2 = 65%), and shorten the healing time (MD = −5.73; 95% CI = −6.95 to −4.52; P < 0.00001; random effect model). Moreover, under the same basic treatment, KFXL had a better effect than external use of pharmaceutical medications (RR = 1.95; 95% CI = 1.30–2.93; P=0.001), but the cure rate was not significantly different. Also, KFXL had nothing to do with adverse reactions. Conclusion The evidence confirms that KFXL is an effective treatment for DFU. However, further large-scale, rigorously designed trials and high-quality studies are needed to confirm the role of KFXL in the treatment of DFU.
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Aqueveque P, Osorio R, Pastene F, Saavedra F, Pino E. Capacitive Sensors Array for Plantar Pressure Measurement Insole fabricated with Flexible PCB. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:4393-4396. [PMID: 30441326 DOI: 10.1109/embc.2018.8513383] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diabetic foot is a pathology associated with diabetic neuropathy, where the vast majority of diabetic foot infections terminate in surgical intervention; from debridement to amputation of the involved limb. Commonly, diabetic foot infections come from ulceration produced by high-pressure areas under the foot. For this reason, researchers have been working on a continuous measurement system to detect the high-pressure areas in-shoe in a low cost way. This paper presents the design and implementation of a continuous monitoring device to measure the pressure in-shoe. The pressure sensors are built from commercial flexible PCB and a dielectric sheet. The system measures the pressure distribution in 8 points and sends the information by a wireless Bluetooth link to a personal computer and gives information to the patient in real time.
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Carvalho VF, Ueda T, Paggiaro AO, Nascimento ARF, Ferreira MC, Gemperli R. Comparison of neurosensory devices in detecting cutaneous thresholds related to protective sensibility: A cross-sectional study in São Paulo, Brazil. Diabetes Res Clin Pract 2019; 157:107821. [PMID: 31437560 DOI: 10.1016/j.diabres.2019.107821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 01/07/2023]
Abstract
AIMS To quantify the static and moving cutaneous sensibility threshold of diabetic patients using a neurosensory device for quantitative pressure detection. METHODS Three hundred thirty-four (n = 334) patients with type 2 diabetes and no previous history of wounds on the feet were studied using the one- and two-point static (1SP;2 SP) and one- and two-point moving (1MP;2 MP) tests through the pressure-specified sensory device (PSSD) on the cutaneous territory of the dorsal first web, hallux pulp, and medial calcaneal. In addition, patients were evaluated using the Semmes-Weinstein monofilament (SWM) No. 5.07 and tuning fork (128 Hz), which were used as normality parameters to detect the loss of protective sensibility. The same examinations were used to assess the control group (228 nondiabetic). RESULTS Altered values were observed for the static and moving tests over the three studied nerve territories. In comparing the sensibility threshold between diabetic patients who were sensitive and nonsensitive to SWM 5.07, we observed that this filament is not the most indicated for identifying the loss of sensibility in these patients. The prevalence of patients at risk varied between 85 and 89%. The biochemical marker associated with these high rates was HbA1c (p = 0.02). CONCLUSIONS Numeric quantification of the pressure threshold allowed us to determine the functional deficit of nerve fibers. Our findings suggest that the neurosensory device should be used as an adjuvant tool to evaluate the degree of loss of sensation on the skin.
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Affiliation(s)
- V F Carvalho
- Nursing Postgraduate Program of Guarulhos University, Rua: Antônio Ribeiro de Moraes, 264 - ap: 101-3, 02751-000, Brazil.
| | - T Ueda
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida: Doutor Arnaldo, 455 - sala 1360, 01246-903, Brazil.
| | - A O Paggiaro
- Nursing Postgraduate Program of Guarulhos University, R. Dr. Ramos de Azevedo, 159 - sala 208 - Centro, Guarulhos, SP 07012-020, Brazil
| | - A R F Nascimento
- Nursing Postgraduate Program of Guarulhos University, Praça Tereza Cristina, 229 - Centro, Guarulhos, SP 07023-070, Brazil
| | - M C Ferreira
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua: Barata Ribeiro, 483 - sala 161 - Bela Vista, São Paulo, SP 01308-000, Brazil
| | - R Gemperli
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Pedroso Alvarenga, 1046 - Jardins, São Paulo, SP 04531-004, Brazil.
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Kossioris A, Tentolouris N, Loupa CV, Tyllianakis M. The role of amputative and non-amputative foot deformities severity in the risk for diabetic ulceration classification systems building: a cross-sectional and case-control pilot investigation. Pan Afr Med J 2019; 33:103. [PMID: 31489081 PMCID: PMC6711698 DOI: 10.11604/pamj.2019.33.103.17684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/27/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Foot deformities and amputations are parameters that have been studied as risk factors for diabetic foot ulceration (DFU). However, inclusion of "foot deformities" and "amputations" in a single, broad variable and with reference to the severity of these deformities, may better characterize subjects who are prone to develop DFU. Methods The objective of the study was the examination of amputative and non-amputative foot deformities severity as risk factor for DFU in relation with the other established risk factors. A cross-sectional and case-control study was conducted from October 2005 to November 2016. One hundred and thirty-four subjects with type 1 and 2 diabetes, with and without active foot ulcers, participated. A structured quantitative interview guide was used. Univariate logistic regression analysis for the literature's established risk factors was performed, as well as for two versions of the "amputative and non-amputative foot deformities severity" variable. Subsequently, multivariate logistic regression analysis (MLRA) for three models and receiver operating characteristic (ROC) curve analysis were carried out. Results From the MLRA, only PAD (peripheral arterial disease) was significant (OR 3.56, 95% CI 1.17-10.82, P=0.025 and OR 3.33, 95% CI 1.02-10.08, P=0.033). Concerning the ROC curve analysis of the models, the one with the three categories amputative and non-amputative foot deformities severity variable, had the greatest area under the ROC curve (0.763, P<0.001). Conclusion A united variable for lower extremity amputations and other foot deformities with reference to their severity, could be more helpful to the clinicians in identifying patients with diabetes at risk for foot ulceration.
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Affiliation(s)
- Aristomenis Kossioris
- Department of Neurology, General Hospital of Athens "G. Gennimatas"; School of Medicine, University of Patras, Rio, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Chariclia V Loupa
- "Demetrios Voyatzoglou" Diabetic Foot Clinic, "A. Fleming" General Hospital, Athens, Greece
| | - Minos Tyllianakis
- Department of Orthopaedics, School of Medicine, University of Patras, Rio, Greece
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E-Knitted Textile with Polymer Optical Fibers for Friction and Pressure Monitoring in Socks. SENSORS 2019; 19:s19133011. [PMID: 31288468 PMCID: PMC6651217 DOI: 10.3390/s19133011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/23/2022]
Abstract
The objective of this paper is to study the ability of polymer optical fiber (POF) to be inserted in a knitted fabric and to measure both pressure and friction when walking. Firstly, POF, marketed and in development, have been compared in terms of the required mechanical properties for the insertion of the fiber directly into a knitted fabric on an industrial scale, i.e. elongation, bending rigidity, and minimum bending radius before plastic deformation. Secondly, the chosen optical fiber was inserted inside several types of knitted fabric and was shown to be sensitive to friction and compression. The knitted structure with the highest sensitivity has been chosen for sock prototype manufacturing. Finally, a feasibility study with an instrumented sock showed that it is possible to detect the different phases of walking in terms of compression and friction.
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Behforootan S, Chatzistergos PE, Chockalingam N, Healy A, Naemi R. Localized pressure stimulation using turf‐like structures can improve skin perfusion in the foot. Microcirculation 2019; 26:e12543. [DOI: 10.1111/micc.12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Sara Behforootan
- Department of Surgery & Cancer Faculty of Medicine, Imperial College London London UK
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
| | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
| | - Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
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Kurup R, Ansari AA, Singh J. A review on diabetic foot challenges in Guyanese perspective. Diabetes Metab Syndr 2019; 13:905-912. [PMID: 31336544 DOI: 10.1016/j.dsx.2018.12.010] [Citation(s) in RCA: 5] [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: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diabetes mellitus signifies a major public health threat worldwide. Type 2 diabetes has been reported as the fourth leading cause of death and has affected 15.5% of the adult population in Guyana, South America. Diabetes has also led to major lower extremity amputation at the only referral public hospital in Guyana. Diabetic foot and related complications are known to be multifactorial. CONCLUSION In this review, we highlight the information on the diabetic foot and related complications with an emphasis on Guyanese background.
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Affiliation(s)
- Rajini Kurup
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Abdullah Adil Ansari
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Jaipaul Singh
- School of Pharmacy and Forensic and Investigative Sciences, University of South Lancashire, Preston, Lancashire, United Kingdom.
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Mazur F, Swoboda B, Carl HD, Lutter C, Engelhardt M, Hoppe MW, Hotfiel T, Grim C. Plantar pressure changes in hindfoot relief devices of different designs. J Exp Orthop 2019; 6:7. [PMID: 30729337 PMCID: PMC6367492 DOI: 10.1186/s40634-019-0173-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is frequently observed that overloading the foot can impair bone and soft tissue healing and can lead to harmful sequelae (i.e. ulcers, stress reactions) in context of pre-existing tissue disabilities. In terms of offloading, hindfoot relief devices are commonly applied as a non-operative treatment as well as after various surgical procedures for hindfoot disorders. Despite their common use, there is a paucity of data comparing different orthotic devices with respect to changes in plantar pressure distributions. The aim of this study was to investigate plantar loadings in hindfoot relief devices of different designs. METHODS Twenty-five healthy participants (13 women, 12 men; (mean ± SD) age 37 ± 14 years; BMI 23 ± 4 kg/m2) were recruited. Plantar pressure distributions were collected using i.) a neutral shoe, ii.) a hindfoot relief shoe (HRS) and iii.) a hindfoot relief orthosis (HRO). Peak pressure values were measured via dynamic pedobarography during walking and were analysed from four different plantar regions: the hindfoot, midfoot, metatarsal I-V and forefoot. As a reference standard, the normal walk using neutral shoes served as the condition for full weight-bearing. RESULTS Concerning the hindfoot, using the HRS as well as the HRO resulted in significant decreases in plantar pressures compared to baseline values that were obtained with the neutral shoe (- 52% for the HRS and - 52% for the HRO, p < 0.001). Significant increases in peak pressures were found in the midfoot region for both devices (HRS: 32%, p = 0.002; HRO: 47%, p < 0.001). For the metatarsal region, peak pressures were found to decrease significantly (HRS: - 52%, p < 0.001; HRO: -17%, p = 0.034). With respect to the forefoot, a significant reduction in peak pressures using the HRS (- 41%, p < 0.001) was detected, whereas the HRO did not lead to significant changes (- 4%, p = 0.691). CONCLUSIONS Both the HRO and HRS significantly reduced plantar hindfoot pressure, corresponding to a relative decrease of nearly 50% of the baseline. Nevertheless, the adjacent midfoot zone displayed a significant increase in plantar pressure values for both devices. Supported by these findings, physicians should cautiously consider a substantial increase in midfoot loading, especially in patients affected by additional midfoot injuries or accompanying impairments of tissue healing. LEVEL OF EVIDENCE IV, Case series.
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Affiliation(s)
- F Mazur
- Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Rathsberger Str. 57, D-91054, Erlangen, Germany
| | - B Swoboda
- Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Rathsberger Str. 57, D-91054, Erlangen, Germany
| | - H D Carl
- Department of Orthopaedic and Trauma Surgery, Martha-Maria Hospital, Nuremberg, Germany
| | - C Lutter
- Department of Orthopaedic and Trauma Surgery, Sports Orthopaedics and Sports Medicine, Klinikum Bamberg, Bamberg, Germany
| | - M Engelhardt
- Department of Orthopaedics, Trauma and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany
| | - M W Hoppe
- Department of Orthopaedics, Trauma and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany
- Department of Movement and Training Science, University of Wuppertal, Wuppertal, Germany
| | - T Hotfiel
- Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Rathsberger Str. 57, D-91054, Erlangen, Germany.
| | - C Grim
- Department of Orthopaedics, Trauma and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany
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Sutkowska E, Sutkowski K, Sokołowski M, Franek E, Dragan S. Distribution of the Highest Plantar Pressure Regions in Patients with Diabetes and Its Association with Peripheral Neuropathy, Gender, Age, and BMI: One Centre Study. J Diabetes Res 2019; 2019:7395769. [PMID: 31380446 PMCID: PMC6652074 DOI: 10.1155/2019/7395769] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/18/2019] [Accepted: 05/12/2019] [Indexed: 12/28/2022] Open
Abstract
The abnormal plantar pressure distribution and value play a key role in the formation of plantar calluses and diabetic foot ulcer. The prevalence of the highest pressure different distribution and its association with various factors among patients with diabetes is not well known. The study purpose was to evaluate the prevalence of different regions for the highest pressure on the sole and its association with selected factors among patients with diabetes. Medical records of nonulcer patients were retrospectively analysed. The relationship between pressure patterns on the sole obtained during a pedobarographic test as a semiquantitative assessment with colourful print analysis and neuropathy, gender, age, and BMI was searched. The most common location of the highest pressure was the central part of the forefoot. No association was found between the different highest pressure regions and age, sensory neuropathy, calluses, and foot deformities. The highest pressure on the lateral part of the foot and midfoot was observed more often in females and in patients with a BMI ≥ 35. The prevalence of the highest pressure on the forefoot was more common in patients with a BMI < 35. Conclusions. The most frequent regions of the highest pressure on the sole in patients with diabetes were the central part of the forefoot (2-3 metatarsal heads) with no simple relationship to the assessed variables other than BMI < 35. Female gender and higher BMI seem to be responsible for shifting the place of the highest pressure to other places of the foot.
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Affiliation(s)
- Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Poland
| | - Michał Sokołowski
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Edward Franek
- Mossakowski Clinical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Szymon Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Poland
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Fejfarová V, Pavlů J, Bém R, Wosková V, Dubský M, Němcová A, Jirkovská A, Sixta B, Sutoris K, Thieme F, Armstrong DG, Vrátná E, Hazdrová J, Lánská V. The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care. J Diabetes Res 2019; 2019:5945839. [PMID: 31637262 PMCID: PMC6766149 DOI: 10.1155/2019/5945839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/14/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Off-loading is one of the crucial components of diabetic foot (DF) therapy. However, there remains a paucity of studies on the most suitable off-loading for DF patients under postoperative care. The aim of our study was to evaluate the effect of different protective off-loading devices on healing and postoperative complications in DF patients following limb preservation surgery. METHODS This observational study comprised 127 DF patients. All enrolled patients had undergone foot surgery and were off-loaded empirically as follows: wheelchair+removable contact splint (RCS) (group R: 29.2%), wheelchair only (group W: 48%), and wheelchair+removable prefabricated device (group WP: 22.8%). We compared the primary (e.g., the number of healed patients, healing time, and duration of antibiotic (ATB) therapy) and secondary outcomes (e.g., number of reamputations and number and duration of rehospitalizations) with regard to the operation regions across all study groups. RESULTS The lowest number of postoperative complications (number of reamputations: p = 0.028; rehospitalizations: p = 0.0085; and major amputations: p = 0.02) was in group R compared to groups W and WP. There was a strong trend toward a higher percentage of healed patients (78.4% vs. 55.7% and 65.5%; p = 0.068) over a shorter duration (13.7 vs. 16.5 and 20.3 weeks; p = 0.055) in the R group, as well. Furthermore, our subanalysis revealed better primary outcomes in patients operated in the midfoot and better secondary outcomes in patients after forefoot surgery-odds ratios favouring the R group included healing at 2.5 (95% CI, 1.04-6.15; p = 0.037), reamputations at 0.32 (95% CI, 0.12-0.84; p = 0.018), and rehospitalizations at 0.22 (95% CI, 0.08-0.58; p = 0.0013). CONCLUSIONS This observational study suggests that removable contact splint combined with a wheelchair is better than a wheelchair with or without removable off-loading device for accelerating wound healing after surgical procedures; it also minimises overall postoperative complications, reducing the number of reamputations by up to 77% and the number of rehospitalizations by up to 66%.
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Affiliation(s)
- Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jaroslav Pavlů
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Robert Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Andrea Němcová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Bedřich Sixta
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Karol Sutoris
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Filip Thieme
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), University of Southern California (USC), Los Angeles, USA
| | - Eliška Vrátná
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jitka Hazdrová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Věra Lánská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Abstract
Although there are various types of therapeutic footwear currently used to treat diabetic foot ulcers (DFUs), recent literature has enforced the concept that total-contact casts are the benchmark.Besides conventional clinical tests and imaging modalities, advanced MRI techniques and high-sensitivity nuclear medicine modalities present several advantages for the investigation of diabetic foot problems.The currently accepted principles of DFU care are rigorous debridement followed by modern wound dressings to provide a moist wound environment. Recently, hyperbaric oxygen and negative pressure wound therapy have aroused increasing attention as an adjunctive treatment for patients with DFUs.For DFU, various surgical treatments are currently available, including resection arthroplasty, metatarsal osteotomies and metatarsal head resections.In the modern management of the Charcot foot, surgery in the acute phase remains controversial and under investigation. While conventional fixation techniques are frequently insufficient to keep alignment postoperatively, superconstruct techniques could provide a successful fixation.Retrograde intramedullary nailing has been a generally accepted method of achieving stability. The midfoot fusion bolt is a current treatment device that maintains the longitudinal columns of the foot. Also, Achilles tendon lengthening remains a popular method in the management of Charcot foot. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170073.
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Affiliation(s)
- Önder İ. Kılıçoğlu
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Mehmet Demirel
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Şamil Aktaş
- Department of Underwater and Hyperbaric Medicine, İstanbul University, Istanbul Faculty of Medicine, Turkey
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Alam U, Riley DR, Jugdey RS, Azmi S, Rajbhandari S, D'Août K, Malik RA. Diabetic Neuropathy and Gait: A Review. Diabetes Ther 2017; 8:1253-1264. [PMID: 28864841 PMCID: PMC5688977 DOI: 10.1007/s13300-017-0295-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Indexed: 01/08/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a major sequela of diabetes mellitus and may have a detrimental effect on the gait of people with this complication. DPN causes a disruption in the body's sensorimotor system and is believed to affect up to 50% of patients with diabetes mellitus, dependent on the duration of diabetes. It has a major effect on morbidity and mortality. The peripheral nervous system controls the complex series of events in gait through somatic and autonomic functions, careful balancing of eccentric and concentric muscle contractions and a reliance on the sensory information received from the plantar surface. In this literature review focussing on kinetics, kinematics and posture during gait in DPN patients, we have identified an intimate link between DPN and abnormalities in gait and demonstrated an increased risk in falls for older patients with diabetes. As such, we have identified a need for further research on the role of gait abnormalities in the development of diabetic foot ulceration and subsequent amputations.
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Affiliation(s)
- Uazman Alam
- Diabetes and Endocrinology Research, Department of Eye and Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester and the Manchester Royal Infirmary, Central Manchester Hospital Foundation Trust, Manchester, UK.
| | | | | | - Shazli Azmi
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester and the Manchester Royal Infirmary, Central Manchester Hospital Foundation Trust, Manchester, UK
| | | | - Kristiaan D'Août
- Evolutionary Morphology and Biomechanics Group, Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Rayaz A Malik
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester and the Manchester Royal Infirmary, Central Manchester Hospital Foundation Trust, Manchester, UK
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Evidence based review of literature on detriments to healing of diabetic foot ulcers. Foot Ankle Surg 2017; 23:215-224. [PMID: 29202978 DOI: 10.1016/j.fas.2016.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/15/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetes mellitus places a substantial burden on society worldwide. Diabetic foot ulcers are a challenging problem for clinicians. Seven generally accepted detriments to healing of diabetic foot ulcers were identified: infection, glycaemic control, vascular supply, smoking, nutrition, deformity and offloading. The aim of this paper is to present a comprehensive evidence based review of the literature available on detriments to healing of diabetic foot ulcers. METHOD A research question was generated for each of the detriments to healing and a comprehensive review of the literature was performed using the Pubmed database in July 2014. All articles were assessed for relevancy and a level of evidence was assigned. An analysis of the total body of literature was used to assign a grade of recommendation to each detriment. RESULTS Grade A recommendation was assigned to offloading as there was good evidence supporting this intervention. Grade B recommendation was assigned to deformity as there was fair evidence consistent with the hypothesis. Infection and vascular supply had poor quality evidence supporting the research question and grade C recommendation was assigned. Grade I recommendation was assigned to glycaemic control, smoking and nutrition as there was insufficient and conflicting evidence available. CONCLUSION Our literature review revealed good evidence for some factors and insufficient literature on others. Further studies are needed to provide quality evidence regarding detriments to healing of diabetic ulcers.
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Scarton A, Jonkers I, Guiotto A, Spolaor F, Guarneri G, Avogaro A, Cobelli C, Sawacha Z. Comparison of lower limb muscle strength between diabetic neuropathic and healthy subjects using OpenSim. Gait Posture 2017; 58:194-200. [PMID: 28802220 DOI: 10.1016/j.gaitpost.2017.07.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/06/2017] [Accepted: 07/28/2017] [Indexed: 02/02/2023]
Abstract
Diabetes neuropathy and vasculopathy are the two major complications of diabetes mellitus, leading to diabetic foot disease, of which the worst consequences are plantar ulcers and amputations. Motor impairments like joint stiffness and loss of balance are distinctive effects of diabetes and they have been extensively explored. However, while altered muscle function has been also assessed through experimentally measured surface electromyography, little is known about muscle forces. The objective of this study was to estimate muscle forces in subjects with diabetes and to use these data to identify differences with respect to a population of healthy subjects matched for age and BMI. This was obtained by generating musculoskeletal models of 10 diabetic and 10 control subjects in OpenSim starting from experimentally recorded data. Dynamic simulations of motion were run and hence muscle forces calculated. Student T test (p<0.05) was used to compare joints kinematics, kinetics and muscle forces between the two populations. Significant changes were observed between lower limb muscle forces and activation of diabetic and healthy subjects, as well as between joints kinematics and kinetics. In particular muscles related to foot movements proved to be stronger in the healthy population. The typical ankle rigidity of the diabetic population was confirmed by a lower range of motion registered at the ankle plantar/flexion angle associated with weaker dorsal-plantar flexor muscles. The information provided by this methodology can help planning specific training programs aiming at augmenting muscle strength and joints mobility, and they can also improve the evaluation of the potential benefits.
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Affiliation(s)
- Alessandra Scarton
- Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy.
| | - Ilse Jonkers
- Department of Kinesiology, KU Leuven, Tervuursevest 101 - Box 1501, 3001, Leuven, Belgium.
| | - Annamaria Guiotto
- Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy.
| | - Fabiola Spolaor
- Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy.
| | - Gabriella Guarneri
- Department of Clinical Medicine and Metabolic Disease, University Polyclinic, Via Giustiniani 2, Padova, Italy.
| | - Angelo Avogaro
- Department of Clinical Medicine and Metabolic Disease, University Polyclinic, Via Giustiniani 2, Padova, Italy.
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy.
| | - Zimi Sawacha
- Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy.
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Fernando ME, Crowther RG, Lazzarini PA, Yogakanthi S, Sangla KS, Buttner P, Jones R, Golledge J. Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up. PLoS One 2017; 12:e0181916. [PMID: 28859075 PMCID: PMC5578502 DOI: 10.1371/journal.pone.0181916] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/09/2017] [Indexed: 01/14/2023] Open
Abstract
Objective High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls). Methods Standardised protocols were used to measure mean peak plantar pressure and pressure-time integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen’s d) were used to measure effect size. Results Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites including the toes (p = 0.005, Cohen’s d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (p<0.001, d = 0.42), metatarsal 1 (p = 0.02, d = 0.33) and mid-foot (p = 0.04, d = 0.64) compared to controls throughout follow-up. A reduction in pressure-time integral at multiple plantar sites over time was detected in all participants (p<0.05, respectively). Conclusions Plantar pressures assessed during gait are higher in diabetes patients with chronic foot ulcers than controls at several plantar sites throughout prolonged follow-up. Long term offloading is needed in diabetes patients with diabetes-related foot ulcers to facilitate ulcer healing.
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Affiliation(s)
- Malindu E. Fernando
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Movement Analysis Laboratory, Sports and Exercise Science, James Cook University, Townsville, Australia
- Podiatry Service, Kirwan Community Health Campus, Townsville, Queensland, Australia
- * E-mail:
| | - Robert G. Crowther
- Movement Analysis Laboratory, Sports and Exercise Science, James Cook University, Townsville, Australia
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Saiumaeswar Yogakanthi
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Kunwarjit S. Sangla
- Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia
| | - Petra Buttner
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
| | - Rhondda Jones
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Jonathan Golledge
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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Parasoglou P, Rao S, Slade JM. Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy. Clin Ther 2017; 39:1085-1103. [PMID: 28571613 PMCID: PMC5503477 DOI: 10.1016/j.clinthera.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The present review highlights current concepts regarding the effects of diabetic peripheral neuropathy (DPN) in skeletal muscle. It discusses the lack of effective pharmacologic treatments and the role of physical exercise intervention in limb protection and symptom reversal. It also highlights the importance of magnetic resonance imaging (MRI) techniques in providing a mechanistic understanding of the disease and helping develop targeted treatments. METHODS This review provides a comprehensive reporting on the effects of DPN in the skeletal muscle of patients with diabetes. It also provides an update on the most recent trials of exercise intervention targeting DPN pathology. Lastly, we report on emerging MRI techniques that have shown promise in providing a mechanistic understanding of DPN and can help improve the design and implementation of clinical trials in the future. FINDINGS Impairments in lower limb muscles reduce functional capacity and contribute to altered gait, increased fall risk, and impaired balance in patients with DPN. This finding is an important concern for patients with DPN because their falls are likely to be injurious and lead to bone fractures, poorly healing wounds, and chronic infections that may require amputation. Preliminary studies have shown that moderate-intensity exercise programs are well tolerated by patients with DPN. They can improve their cardiorespiratory function and partially reverse some of the symptoms of DPN. MRI has the potential to bring new mechanistic insights into the effects of DPN as well as to objectively measure small changes in DPN pathology as a result of intervention. IMPLICATIONS Noninvasive exercise intervention is particularly valuable in DPN because of its safety, low cost, and potential to augment pharmacologic interventions. As we gain a better mechanistic understanding of the disease, more targeted and effective interventions can be designed.
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Affiliation(s)
- Prodromos Parasoglou
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York; Center for Advanced Imaging Innovation and Research (CAI(2)R), Department of Radiology, New York University School of Medicine, New York, New York.
| | - Smita Rao
- Department of Physical Therapy, New York University, New York, New York
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, Michigan; Biomedical Imaging Research Center, Michigan State University, East Lansing, Michigan
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Raspovic A, Waller K, Wong WM. The effectiveness of felt padding for offloading diabetes-related foot ulcers, at baseline and after one week of wear. Diabetes Res Clin Pract 2016; 121:166-172. [PMID: 27721122 DOI: 10.1016/j.diabres.2016.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/12/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022]
Abstract
AIM Felt padding is used to offload diabetes-related foot ulceration although limited quality data exists to support its use. This study aimed to quantify pressure offloading from neuropathic plantar foot ulcers in a clinical setting, when felt padding is first applied and after wear. METHODS This study used a within-subjects, repeated measures design. Data was collected in a high-risk foot service. Peak plantar pressures, contact area and contact time were measured in 15 diabetes subjects with 16 non-complicated plantar neuropathic foot ulcers, with: no felt padding, newly applied felt padding and felt padding after one week of wear. RESULTS Statistically significant decreases in peak pressure of 49% and 32% were measured with newly applied felt padding (188.0kPa; p<0.001) and worn felt padding (248kPa; p=0.003) respectively, compared to no padding (367.2kPa). Worn felt offloaded 32% less pressure than new felt however this did not reach statistical significance (p=.069). Corresponding increases in contact area of 18% and 14% occurred with newly applied felt padding (156.9cm2; p<.001) and worn felt padding (150.6cm2; p=0.003) compared to no padding (132.5cm2). Contact time was constant across testing conditions. CONCLUSIONS New felt padding offloaded on average half the pressure applied to sites of plantar neuropathic ulceration, which reduced to one third after wear. Increased contact area under the foot is a possible mechanism contributing to pressure reduction. Further studies are required to evaluate effectiveness of felt padding directly on ulcer healing.
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Affiliation(s)
- Anita Raspovic
- Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne 3086, Australia.
| | - Kate Waller
- Department of Podiatry and High Risk Foot Service, The Northern Hospital, 185 Cooper Street, Epping, Melbourne 3076, Australia.
| | - Wan Mun Wong
- Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne 3086, Australia; Podiatry Department, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore.
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Powers JG, Higham C, Broussard K, Phillips TJ. Wound healing and treating wounds: Chronic wound care and management. J Am Acad Dermatol 2016; 74:607-25; quiz 625-6. [PMID: 26979353 DOI: 10.1016/j.jaad.2015.08.070] [Citation(s) in RCA: 343] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/12/2015] [Accepted: 08/15/2015] [Indexed: 12/15/2022]
Abstract
In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers.
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Affiliation(s)
| | - Catherine Higham
- Vanderbilt School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Karen Broussard
- Division of Dermatology, Vanderbilt University, Nashville, Tennessee
| | - Tania J Phillips
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts; SkinCare Physicians, Chestnut Hill, Massachusetts
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Piaggesi A, Goretti C, Iacopi E, Clerici G, Romagnoli F, Toscanella F, Vermigli C. Comparison of Removable and Irremovable Walking Boot to Total Contact Casting in Offloading the Neuropathic Diabetic Foot Ulceration. Foot Ankle Int 2016; 37:855-61. [PMID: 27083507 DOI: 10.1177/1071100716643429] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite its efficacy in healing neuropathic diabetic foot ulcers (DFUs), total contact cast (TCC) is often underused because of technical limitations and poor patient acceptance. We compared TCC to irremovable and removable commercially available walking boots for DFU offloading. METHODS We prospectively studied 60 patients with DFUs, randomly assigned to 3 different offloading modalities: TCC (group A), walking boot rendered irremovable (i-RWD; group B), and removable walking boot (RWD; group C). Patients were followed up weekly for 90 days or up to complete re-epithelization; ulcer survival, healing time, and ulcer size reduction (USR) were considered for efficacy, whereas number of adverse events was considered for safety. Patients' acceptance and costs were also evaluated. RESULTS Mean healing time in the 3 groups did not differ (P = .5579), and survival analysis showed no difference between the groups (logrank test P = .8270). USR from baseline to the end of follow-up was significant (P < .01) in all groups without differences between the groups. Seven patients in group A (35%), 2 in group B (10%), and 1 in group C (5%) (Fisher exact test P = .0436 group A vs group C) reported nonsevere adverse events. Patients' acceptance and costs were significantly better in group C (P < .05). CONCLUSIONS Our results suggest that a walking boot was as effective and safe as TCC in offloading the neuropathic DFUs, irrespective of removability. The better acceptability and lesser costs of a removable device may actually extend the possibilities of providing adequate offloading. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Alberto Piaggesi
- Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Goretti
- Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Elisabetta Iacopi
- Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giacomo Clerici
- Centro per la Cura del Piede Diabetico, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Fabio Romagnoli
- U.O.C. Centro Piede Diabetico, Istituto nazionale ricovero e cura anziani, Ancona, Italy
| | - Fabrizia Toscanella
- U.O. Piede Diabetico e ferite difficili. Casa di cura accreditata Villa Tiberia Roma, Roma, Italy
| | - Cristiana Vermigli
- Centro Regionale Specialistico per la Diagnosi e Cura del Piede Diabetico. Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
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Marshall J, Branthwaithe H, Chockalingam N. Heel pressures with generic and focused rigid heel cast devices while in a static supine and seated position. J Wound Care 2016; 25:328-34. [DOI: 10.12968/jowc.2016.25.6.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To identify if the choice of material used to make focused rigid cast (FRC) and generic heel cups has an effect on heel pressure in healthy individuals during a static supine and seated position. Method: A repeated measure design was used to compare the effect of two focused rigidity heel devices made from different materials (3M semi-rigid and Benecast FLEX) and a generic polymer gel heel cup device on barefoot heel pressures. Subjects had heel pressures taken while barefoot and with the three different heel devices while in a supine and seated position using the device. Results: We recruited 32 healthy participants (21 females, and 11 males). When comparing Benecast FLEX and 3M semi-rigid focused rigidity casts with barefoot and the generic heel cups significant reductions in pressures were seen in all areas while seated and in the distal area while supine. However, there was no statistical difference between the two FRC devices, or between barefoot and the generic heel cup in either position. Conclusion: This study demonstrates that FRC heel devices effectively reduced heel pressures in healthy individuals and therefore could be used in practice when a reduction in pressure is required for the management of heel pressure ulcers in bedbound or chair-bound patients. Declaration of interest: Materials were supplied from Benecare Medical (who agreed to supply 20 rolls of Benecast FLEX), and the podiatry department of Kent Community Health NHS Trust (who agreed to supply some of the materials).
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Affiliation(s)
- J. Marshall
- Rochester Community, Healthy Living Centre, Medway Community Healthcare, Delce Road, Rochester Kent
| | - H. Branthwaithe
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent
| | - N. Chockalingam
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent
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Elraiyah T, Prutsky G, Domecq JP, Tsapas A, Nabhan M, Frykberg RG, Firwana B, Hasan R, Prokop LJ, Murad MH. A systematic review and meta-analysis of off-loading methods for diabetic foot ulcers. J Vasc Surg 2016; 63:59S-68S.e1-2. [DOI: 10.1016/j.jvs.2015.10.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/08/2015] [Indexed: 12/15/2022]
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