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Tseng SL, Kang L, Li ZJ, Wang LQ, Li ZM, Li TH, Xiang JY, Huang JZ, Yu NZ, Long X. Adipose-derived stem cells in diabetic foot care: Bridging clinical trials and practical application. World J Diabetes 2024; 15:1162-1177. [DOI: 10.4239/wjd.v15.i6.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/03/2024] [Accepted: 04/19/2024] [Indexed: 06/11/2024] Open
Abstract
Diabetic foot ulcers (DFUs) pose a critical medical challenge, significantly im-pairing the quality of life of patients. Adipose-derived stem cells (ADSCs) have been identified as a promising therapeutic approach for improving wound healing in DFUs. Despite extensive exploration of the mechanical aspects of ADSC therapy against DFU, its clinical applications remain elusive. In this review, we aimed to bridge this gap by evaluating the use and advancements of ADSCs in the clinical management of DFUs. The review begins with a discussion of the classification and clinical management of diabetic foot conditions. It then discusses the current landscape of clinical trials, focusing on their geographic distribution, reported efficacy, safety profiles, treatment timing, administration techniques, and dosing considerations. Finally, the review discusses the preclinical strategies to enhance ADSC efficacy. This review shows that many trials exhibit biases in study design, unclear inclusion criteria, and intervention protocols. In conclusion, this review underscores the potential of ADSCs in DFU treatment and emphasizes the critical need for further research and refinement of therapeutic approaches, with a focus on improving the quality of future clinical trials to enhance treatment outcomes and advance the field of diabetic wound care.
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Affiliation(s)
- Song-Lu Tseng
- Department of Plastic and Reconstructive Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lin Kang
- Biomedical Engineering Facility, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing 100021, China
| | - Zhu-Jun Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li-Quan Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zi-Ming Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Tian-Hao Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jie-Yu Xiang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiu-Zuo Huang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Nan-Ze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao Long
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Abstract
Participants who received Pies Sanos, a 15-min intervention designed to improve diabetes self-efficacy and foot self-care behaviors in adult patients with type 2 diabetes who lived in a predominantly Mexican American community, performed more-complete foot self-care 1 month later in their homes. Recruited when they presented for nonurgent care to the emergency department in two community hospitals near the U.S.-Mexico border, participants were randomized into one of three groups. At follow-up, there was a significant difference in observed foot self-care behaviors between groups, F(2, 135) = 2.99, p < .05, as well as a significant difference within the intervention, t (47) = -4.32, p < .01, and control group, t (46) = -2.06, p < .05, for baseline and follow-up self-reported foot self-care behaviors. Baseline diabetes self-efficacy was significantly and positively correlated with both baseline (r = .335, p < .001) and follow-up ( r = .174, p < .05) foot self-care behaviors.
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Long JT, Klein JP, Sirota NM, Wertsch JJ, Janisse D, Harris GF. Biomechanics of the double rocker sole shoe: gait kinematics and kinetics. J Biomech 2007; 40:2882-90. [PMID: 17467718 DOI: 10.1016/j.jbiomech.2007.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 11/23/2022]
Abstract
The use of footwear with contoured soles is common in treatment and care of patients with diabetes; these rocker sole shoes are designed to alleviate loading in key areas on the plantar surface of the foot, reducing pressure in key areas and alleviating pain, and potential soft tissue damage. While investigations of pressure changes have been conducted, no quantitative study to date has addressed the three-dimensional (3D) kinematic and kinetic changes that result from using these shoes. Forty subjects were tested wearing both unmodified and double rocker sole shoes, and the resulting motion patterns were compared to assess change caused by the rocker sole. Overall walking speed remained unchanged throughout testing; slightly increased flexion (<5 degrees ) was apparent at the hip, knee, and ankle during early and mid-stance. These results demonstrate the maintenance of gait function with minimal kinematic changes when using the rocker sole shoe. Investigations of multisegmental foot motion may reveal additional information about the contour effects; analysis of contour variations may also be warranted to investigate the possibility of controlling motion based on rocker sole parameters.
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Affiliation(s)
- Jason T Long
- Orthopaedic and Rehabilitation Engineering Center (OREC), Medical College of Wisconsin/Marquette University, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Myers KA, Long JT, Klein JP, Wertsch JJ, Janisse D, Harris GF. Biomechanical implications of the negative heel rocker sole shoe: gait kinematics and kinetics. Gait Posture 2006; 24:323-30. [PMID: 16300949 DOI: 10.1016/j.gaitpost.2005.10.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 10/16/2005] [Indexed: 02/02/2023]
Abstract
Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus to prescription rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee and ankle) with the application of a negative heel rocker sole shoe under controlled lab conditions. Forty normal adults volunteered for gait evaluations using controlled baseline and prescription negative heel rocker sole shoes. Three-dimensional motion analysis techniques were used to acquire kinematic and kinetic data using a six-camera Vicon 370 motion system and two AMTI force plates. No significant change in walking speed or stride length was seen with the negative heel rocker shoe, although cadence was increased. The most significant kinematic changes with the application of the negative heel shoe occurred at the ankle in the sagittal plane with increased plantarflexion at terminal stance. Significant hip and knee changes were also noted with increased mid-stance hip extension and knee flexion. The most significant kinetic effects were seen in the transverse plane followed by changes in the sagittal and coronal planes. Changes in power were mostly noted in the sagittal plane. Other statistically significant changes in gait kinematics and kinetics were observed, although the magnitudes and durations were limited and as a result were not considered clinically significant. The study results indicated the negative heel rocker shoe significantly altered proximal joint metrics (hip and knee). The most significant distal joint alterations were seen in sagittal plane ankle kinetics. These kinematic and kinetic changes, along with previously studied effects of pressure relief at the metatarsal heads, should aid medical professionals in prescribing prophylactic footwear.
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Affiliation(s)
- K A Myers
- Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, Milwaukee, WI 53233, USA
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Van Bogart JJ, Long JT, Klein JP, Wertsch JJ, Janisse DJ, Harris GF. Effects of the toe-only rocker on gait kinematics and kinetics in able-bodied persons. IEEE Trans Neural Syst Rehabil Eng 2005; 13:542-50. [PMID: 16425836 DOI: 10.1109/tnsre.2005.858460] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus on prescription of rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee, and ankle) with the application of a toe-only rocker sole shoe under controlled laboratory conditions. Forty (40) normal adults volunteered for gait analysis using controlled baseline and prescription toe-only rocker sole shoes. Three-dimensional motion analysis techniques were used to acquire kinematic and kinetic data using a six camera Vicon 370 motion system and two AMTI force plates. While significant changes from baseline to toe-only rocker were noted in cadence (increased) and stride length (decreased), no significant change in walking speed was observed. The most significant kinematic changes with the application of the toe-only shoe occurred at the ankle and knee in the sagittal plane during stance. The most significant kinetic effects were observed in the hip and knee during swing phase. Changes in power were noted at all joints, mostly in terminal stance. These kinematic and kinetic changes, along with previously studied effects of pressure relief at the metatarsal heads, should aid medical professionals in prescribing prophylactic footwear.
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Affiliation(s)
- James J Van Bogart
- Orthopaedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee 53233, USA
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Trepman E, Bracilovic A, Lamborn KK, Shields NN, Pinzur MS, Lutter LD. Diabetic foot care: multilingual translation of a patient education leaflet. Foot Ankle Int 2005; 26:64-107. [PMID: 15680120 DOI: 10.1177/107110070502600110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The American Orthopaedic Foot and Ankle Society "Diabetic Foot Care" patient education leaflet was revised to improve the layout and emphasis of key concepts of preventive care. This included review of daily foot and shoe examination, danger signs, daily washing and foot care, shoe fitting, medical care, and avoidance of dangerous acts. The leaflet was expanded to occupy two sides of a page, retaining the capability of production in tear-off sheet format to facilitate distribution to patients in the clinical office. Furthermore, the leaflet was translated into 19 other languages for diabetic patients in the United States and around the world with limited English language comprehension.
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Affiliation(s)
- Elly Trepman
- American Orthopaedic Foot and Ankle Society, Seattle, WA, USA
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Pinzur MS. Editorial. Re: Diabetic foot. Foot Ankle Int 2005; 26:3-4. [PMID: 15680111 DOI: 10.1177/107110070502600101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Burzykowski T, Molenberghs G, Abeck D, Haneke E, Hay R, Katsambas A, Roseeuw D, van de Kerkhof P, van Aelst R, Marynissen G. High prevalence of foot diseases in Europe: results of the Achilles Project. Mycoses 2004; 46:496-505. [PMID: 14641624 DOI: 10.1046/j.0933-7407.2003.00933.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide an insight into the prevalence of foot disease in Europe, and to include an assessment of the prevalence of predisposing factors and their correlation with foot disease. DESIGN Large population-based survey conducted in 16 European countries. SETTING The project consisted of two parts (study I and study II), in which all patients presenting to general practitioners and dermatologists over a defined time period were invited to participate. Patients. In study I, 70,497 patients presenting to dermatologists or general practitioners were recruited, and in study II 19,588 patients presenting to dermatologists were recruited. MAIN OUTCOME MEASURE The feet of all participants were examined for signs of foot disease. The assessors also recorded relevant details such as the age and sex of patients, and the presence of predisposing factors for foot disease. In addition, patients in study II were offered a free mycological examination of the toenails and skin on the feet. RESULTS In study I, 57.0% of patients had at least one foot disease. In study II, 61.3% had at least one foot disease. The proportions of patients with fungal foot disease and non-fungal foot disease in study I were 34.9% and 38.4%, respectively, and in study II were 40.6% and 41.7%, respectively. Orthopedic conditions and metatarsal corns were the most frequently reported non-fungal foot diseases, and onychomycosis and tinea pedis were the most frequently observed fungal infections. CONCLUSIONS This large-scale survey suggests that the prevalence of fungal and non-fungal foot disease is higher than previously estimated.
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Milman MH, Leme CB, Borelli DT, Kater FR, Baccili EC, Rocha RC, Senger MH. Pé diabético: avaliação da evolução e custo hospitalar de pacientes internados no conjunto hospitalar de Sorocaba. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0004-27302001000500007] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O pé diabético é uma das principais complicações do diabetes mellitus (DM), sendo causa freqüente de internações hospitalares. Os custos destas internações e o ônus social constituem um grave problema de saúde. Com o objetivo de avaliar diabéticos portadores de lesões podais internados, estudamos 23 pacientes (14M, 9F; 39-80 anos de idade), no período de abril a novembro de 1999. Todos tinham DM tipo 2 e 48% deles foram internados com glicemia <200mg/dL. As lesões estavam assim distribuídas (segundo classificação de Wagner): grau 1: 26%; grau 2: 17%; grau 3: 13%; grau 4: 35%; grau 5: 9%. Evoluíram para amputação 65% dos pacientes, sendo 30% de coxa. O tempo mediano de internação foi de 14 dias. O custo mediano das internações foi de R$1.004,59 e em 24% delas foi superior a R$2.000,00. Somado ao custo médio de próteses (R$1.900,00), totaliza-se um ônus próximo a R$3.000,00. Na amostra, 9 pacientes estavam na faixa etária economicamente ativa. Os pacientes portadores de lesões nos pés são responsáveis por internações prolongadas e de custo elevado, o que não é compatível com o sistema público de saúde do nosso país. Assim, a prevenção é um dos pontos fundamentais para melhorar o prognóstico desta patologia.
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Harwell TS, Helgerson SD, Gohdes D, McInerney MJ, Roumagoux LP, Smilie JG. Foot care practices, services and perceptions of risk among medicare beneficiaries with diabetes at high and low risk for future foot complications. Foot Ankle Int 2001; 22:734-8. [PMID: 11587391 DOI: 10.1177/107110070102200909] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A cohort of Medicare beneficiaries with diabetes was identified from inpatient and outpatient claims data and their risk for foot complications was estimated based on claims reflecting services for recent foot problems. A telephone survey of a random sample from this cohort was conducted to assess their foot care practices, barriers, and perceptions of risk. Eight percent of respondents reported a history of foot ulcers and 7% a history of lower extremity amputation. Based on claims data, 30% of respondents were at high risk for future foot complications. Compared to those at low risk, those at high risk were more likely to report having an annual foot exam, using protective footwear, and perceiving themselves to be high risk for future foot complications. However, 50% of those with claims indicating a high risk perceived themselves to be at low risk for future foot complications. Overall, 20% of respondents seldom checked their feet daily for sores or irritations. Among this group, 60% felt that it was unimportant and 9% reported they were limited by poor vision or physical problems. Our findings suggest that strategies are needed to improve the delivery of preventive foot care services to older persons with diabetes. Additionally, emphasis is needed to help individuals understand their risk and seek and perform appropriate preventive foot care.
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Affiliation(s)
- T S Harwell
- Montana Diabetes Project, Montana Department of Public Health and Human Services, Helena, 59620-2951, USA.
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Abstract
The purpose of this study was to examine the foot and ankle care patterns and shoe wear habits in patients with clinically proven diabetes mellitus who were attending diabetes education classes for the first time. One hundred subjects were recruited from outpatient adult diabetes education classes. No attempts were made to select patients on the basis of disease duration or severity. Each subject completed a questionnaire assessing life-style, shoe wear habits, health care status and interaction with healthcare providers. Thirty-seven percent of the subjects reported prior foot problems. Twenty percent had their feet examined regularly and 59% had never had their feet examined. Foot problems reported were: corns 11%, calluses 11%, bunions 3%, ulcers 1%, gout 1%. Sensation was tested using the 5.07 Semmes Weinstein monofilament across seven zones of the plantar surface of the foot. Subjects unable to feel this varied from 5% to 20% in each of the zones. Shoe wear was assessed for fit and style. Thirty percent of the patients had shoes that were too narrow and 81% of the patients with poorly fitting shoes were women. Shoe wear history and factors influencing shoe selection were recorded. Diabetes mellitus is a common disease, often affecting the feet. Preventive care can help patients deal with the manifestations of diabetic neuropathy. This study showed that a low percentage of subjects with diabetes regularly have their feet examined and that a relatively high percentage (31%) wear shoes that are too narrow. Identifying these patients early may allow modification of habits that put their feet at risk.
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Affiliation(s)
- G T Reveal
- Wright State University, Department of Orthopaedic Surgery, Dayton, OH 45409, USA
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Provision with orthopaedic shoes in patients with diabetes mellitus. Eur Surg 2001. [DOI: 10.1007/bf02949463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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