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Hochlenert D, Bogoclu C, Cremanns K, Gierschner L, Ludmann D, Mertens M, Tromp T, Weggen A, Otten H. Sensor-Assisted Wound Therapy in Plantar Diabetic Foot Ulcer Treatment: A Randomized Clinical Trial. J Diabetes Sci Technol 2023:19322968231213095. [PMID: 38006228 DOI: 10.1177/19322968231213095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND Offloading is the cornerstone of treatment of plantar diabetic foot ulcers. It limits mobility with consequent psychological and cardiovascular side effects, and if devices are removed, healing is delayed. METHODS We developed three non-removable techniques with increasing offloading potential (multilayer felt sole, felt-fiberglass sole, or total contact casts with ventral windows) and sensors built within. Smartwatch and web apps displayed pressure, temperature, humidity, and steps. They alerted patients, staff, and a telemedicine center when pressure limits (125 kPa) were exceeded. Patients were advised to walk as much as they had done before the ulcer episode. To evaluate the potential of this intervention, we enrolled 20 ambulatory patients in a randomized clinical trial. The control group used the same offloading and monitoring system, but neither patients nor therapists received any information or warnings. RESULTS Three patients withdrew consent. The median time to healing of ulcers was significantly shorter in the intervention group compared with controls, 40.5 (95% confidence interval [CI] = 28-not applicable [NA]) versus 266.0 (95% CI = 179-NA) days (P = .037), and increasing ulcer area was observed less frequently during study visits (7.9% vs 29.7%, P = .033). A reduction of wound area by 50% was reached at a median of 10.2 (95% CI = 7.25-NA) versus 19.1 (95% CI = 13.36-NA) days (P = .2). Participants walked an average of 1875 (SD = 1590) steps per day in intervention group and 1806 (SD = 1391) in the control group. CONCLUSIONS Sensor-assisted wound therapy may allow rapid closure of plantar foot ulcers while maintaining patient's mobility during ulcer therapy.
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Affiliation(s)
- Dirk Hochlenert
- Ambulantes Zentrum für Diabetologie, Endoskopie und Wundheilung, Köln, Germany
- CID GmbH, Köln, Germany
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Lullove E. Use of fetal bovine dermal repair scaffold in diabetic foot ulcers with recidivism: an open-label prospective clinical study. J Wound Care 2023; 32:S10-S16. [PMID: 36744738 DOI: 10.12968/jowc.2023.32.sup2.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to establish the effectiveness of fetal bovine dermal scaffold (FBDS) application with multilayer offloading (standard of care) over that of traditional therapies in the treatment of diabetic foot ulcers (DFUs). METHOD Patients from a single centre in South Florida, US were recruited for this research. All patients underwent a run-in period of standardised care and vascular testing to determine and control the ability to heal. Patients were placed in multilayer offloading total contact cast (TCC) systems with application of FBDS every four weeks. Wound measurements and efficacy of offloading were monitored weekly. RESULTS In an older population with diabetes and above-normal body mass index (BMI), use of FBDS was successful in wound closure, with average time to closure of 7.85 weeks for the 20 patients in this study. It should be noted that surface wound area was reduced by approximately 40% by week 4 and by almost 83% by week 9. Follow-up at three and six months showed no residual or recurrent ulcerations in this study population for 19/20 patients. CONCLUSION Total wound closure of hard-to-heal DFUs in this patient series study was achieved with local surgical debridement, TCC offloading and application(s) of a FBDS in older patients with above-normal BMI and in wounds of >4 weeks non-progressive healing. Furthermore, at three and six months, 19/20 patients' wounds remained closed and did not re-ulcerate.
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Affiliation(s)
- Eric Lullove
- West Boca Center for Wound Healing, Coconut Creek, FL, US
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Al Khalifa A, Al Khalifa M, Khan RM, Awoke A, Cherry A, Halai M, Daniels TR. Offloading Plantar Pressures in Healthy Adults: Stirrup Cast vs Total Contact Cast. Foot Ankle Int 2022; 43:620-627. [PMID: 35135373 DOI: 10.1177/10711007211064623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetic foot ulcers are associated with significant morbidity and mortality while posing a challenge for healthcare professionals. Offloading is considered the mainstay of treatment. Total contact casting (TCC) is widely used but does not effectively offload the hindfoot. Some studies suggest that a metal stirrup is effective at offloading midfoot and hindfoot ulcers. The primary purpose of this study is to compare the offloading mechanism of TCC to a stirrup cast. METHODS A pilot observational study assessing 12 healthy volunteers who underwent casting with a TCC or stirrup cast. A sensor (Pedar; Novel GmbH) that measures maximum force, peak pressure, and contact time and area of each foot region, was placed inside the cast to assess the offloading mechanisms of the 2 interventions. RESULTS We measured a reduction in all plantar foot loading parameters from the TCC to the stirrup cast. The highest reductions of 85% to 96% (±5%-13%) were noted in maximum force and peak pressure under the forefoot (P < .0001) and found reductions in maximum force, the contact area of all regions of the foot, peak pressure and contact time of the forefoot and midfoot, and contact area of the hindfoot (P < .05). CONCLUSION In this experimental trial of healthy adults, the stirrup cast was more effective than the TCC by offloading the foot mostly in the forefoot and midfoot.
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Affiliation(s)
- Ahmed Al Khalifa
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Muneera Al Khalifa
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan M Khan
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | - Adam Awoke
- Orthopaedic Research, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | - Ahmed Cherry
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | - Mansur Halai
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.,St. Michael's Hospital, Toronto, Ontario, Canada
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Berhane T, Jeyaraman K, Hamilton M, Falhammar H. Pressure relieving interventions for the management of diabetes-related foot ulcers: a study from the Northern Territory of Australia. ANZ J Surg 2022; 92:723-729. [PMID: 35040542 DOI: 10.1111/ans.17431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Offloading intervention is an important component in the management of diabetes-related foot ulcer (DFU). The NT population is unique with certain distinctive challenges. Potential advantages of and barriers to optimal offloading methods in our setting were investigated. METHODS Consecutive patients with DFU treated with offloading devices between 2003 and 2015 at the Multidisciplinary Foot Clinic (MDFC), Royal Darwin Hospital were included. The outcome measures were healing, amputation and discontinuation. Risk factors for offloading failure were studied. RESULTS Total contact cast (TCC) was the most common offloading used (n = 175). The other removable non-TCC devices used were therapeutic footwear (n = 74), CamWalker (n = 35), and orthotic devices (n = 43). The overall healing rate was 88.7%. Healing rates were higher (93.2% versus 83.5%, P < 0.05) and amputation rates were lower (4.0% versus 7.3%, P = 0.026) in the TCC group than in the removable non-TCC group. The mean duration of offloading was longer in the TCC group (3.6 ± 1.5 versus. 3.2 ± 1.5 months, P = 0.008). Wagner grade ≥ 2 and removable non-TCC devices were significant risk factors for offloading failure. CONCLUSION Patients treated with TCC had higher healing rates than those treated with removable non-TCC devices. The duration of offloading was longer than reported in other studies. Higher Wagner grade and removable non-TCC devices were risk factors for offloading failure. Non-removable offloading devices are the first choice in diabetes-related neuropathic ulcers.
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Affiliation(s)
- Thomas Berhane
- Department of Prosthetics and Orthotics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kanakamani Jeyaraman
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Mark Hamilton
- Department of Vascular Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Abstract
BACKGROUND Irremovable total contact casts (TCCs) are the gold standard to offload diabetic foot ulcers (DFUs) and to immobilize feet with active Charcot neuro-osteoarthropathy (CN). They do not allow checks of the foot and are contraindicated in people with peripheral arterial disease (PAD). Frequently, removable TCCs and other removable devices are used because they allow wound care, modifications of the inner surface of the cast, and checks of the foot. The authors propose TCCs with ventral windows (VW-TCCs) whenever patients with high-risk conditions show poor adherence to wearing a removable cast all the time and access to the foot is necessary. METHODS This retrospective study compares treatments with bivalved, removable TCCs applied prior to the introduction of the novel design (from 1 January 2016 to 1 July 2017, "c") to treatments in the following period (t) with both bivalved removable TCCs and VW-TCCs in use. RESULTS Forty-five treatments after introduction (17 with the VW-TCC) showed a 52.8% lower median time to reach remission of the DFS than 41 controls (128/267 days, log-rank test P = .013). Reasons given for not using the novel design were: sufficient offloading with a removable TCC (16), patient preference (six), anatomical conditions (two), casts applied as a service for other facilities (three), and calf ulcers (one). Adverse effects from both designs were uncommon and not severe. CONCLUSIONS VW-TCCs combine advantages of both removable and irremovable TCCs. Complications do not limit the use, even in patients with PAD.
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Affiliation(s)
- Dirk Hochlenert
- Ambulantes Zentrum für Diabetologie, Endoskopie und Wundheilung, Köln, Germany
- Dirk Hochlenert, MD, Ambulantes Zentrum für Diabetologie, Endoskopie und Wundheilung, Merheimer Str. 217 Köln, 50733, Germany.
| | - Claudia Fischer
- Department of Diabetology, Endocrinology and Woundhealing, Vinzenz Hospital Cologne, Köln, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
This study compared the treatment of total contact casting (TCC) with traditional dressing treatment (TD) in the management of neuropathic diabetic plantar ulcers. Thirty-one patients with plantar ulcers without any gross infection, osteomyelitis or gangrene were randomly assigned to the TCC group (n = 15) or TD group (n = 16). In the experimental group, TCC was applied on the initial visit and subjects were instructed to limit ambulation to one-third of their usual activity. Subjects in the control group (TD) were prescribed dressing changes and were advised against bearing weight on the involved extremity. Ulcers were considered healed if they showed complete skin closure with no drainage. Ulcers were considered not healed if they showed no decrease in size by 6 weeks or if infection developed requiring hospitalization. In the TCC group, 12 of 15 ulcers healed in 48 ± 7 days; in the TD group, 10 of 16 ulcers healed in 58 ± 9 days. Comparatively higher rate of ulcer healing with fewer infections was seen in the TCC group. We conclude TCC is a more effective method than dressing for treating diabetic plantar ulcers reducing the risks of amputation.
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Affiliation(s)
- Biswajit Sahu
- Department of Orthopaedics, VIMSAR, Burla, Odisha, India
| | - Alok Prusty
- Department of Orthopaedics, VIMSAR, Burla, Odisha, India
| | - Barsha Tudu
- Department of Orthopaedics, VIMSAR, Burla, Odisha, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Blakely M. The Use of Best Practice in the Treatment of a Complex Diabetic Foot Ulcer: A Case Report. Healthcare (Basel) 2016; 4:E18. [PMID: 27417606 DOI: 10.3390/healthcare4010018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/19/2016] [Accepted: 02/17/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Published guidelines for effective management of diabetic foot ulcers (DFU) include total contact casting (TCC). The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU) in a complex patient where TCC offloading could not be utilized. CASE DESCRIPTION The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot. Treatment included sharp and ultrasound debridement, the use of a silver hydrofiber dressing, edema management via compression therapy, negative pressure wound therapy, offloading via customized 1/4 inch adhesive-backed felt applied to the plantar foot in addition to an offloading boot and use of a wheelchair, patient education regarding diabetes management, and the application of a bilayered living skin-equivalent biologic dressing. OUTCOMES At 15 weeks the wound was closed and the patient was transitioned into diabetic footwear. DISCUSSION The felt offloading was a beneficial alternative to TCC. The patient's longer than average healing rate may have been complicated by the duration of her wound, her 41 year history of diabetes, and the fact that gold standard offloading (TCC) was not able to be used. Further research is needed regarding the use of felt for offloading, such as application technique for wounds on different areas of the foot, comparison of different types of felt, and the use of felt in conjunction with various offloading devices.
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Caravaggi CMF, Sganzaroli AB, Bona F, Galenda P, Ferraresi R, Gherardi P, Reho A. Square, Random Fasciocutaneous Plantar Flaps for Treating Noninfected Diabetic Plantar Ulcers: A Patient Series. J Foot Ankle Surg 2016; 55:1100-5. [PMID: 26905252 DOI: 10.1053/j.jfas.2016.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Indexed: 02/03/2023]
Abstract
In patients with diabetes, the off-loading cast has not been widely used to treat plantar ulcers because of its poor acceptance by patients and the high risk of side effects. We evaluated the safety and efficacy of an alternative surgical treatment: a square, fasciocutaneous random plantar flap to cover plantar ulcers. From December 2012 to February 2013, we enrolled 23 consecutive diabetic patients with deep neuropathic or neuroischemic plantar ulcers. Of these 23 patients, 9 underwent percutaneous transluminal angioplasty, 10 had the metatarsal removed, 3 underwent dorsiflexory, distal metatarsal osteotomies, 2 underwent first metatarsophalangeal joint resection and ray stabilization with Kirschner wires, and 1 each underwent midfoot exostectomy, sesamoidectomy, and partial calcanectomy. A square random fasciocutaneous plantar flap was created for all 23 patients. Two patients were excluded from the analysis for weightbearing on the involved foot within 24 hours of surgery. The healing rate was 100% for the remaining 21 patients, with healing by first intention in 15 (mean ± standard deviation time to healing 30 ± 13 days), by second intention in 5 (86 ± 40 days), and by surgical revision in 1. The overall mean healing time was 44 ± 31 days. During a mean follow-up of 724 ± 275 days, no ulcer recurred; however, 1 transfer ulcer appeared on an adjacent metatarsal head. The use of a square random fasciocutaneous plantar flap is a safe and effective surgical option for treating neuropathic plantar ulcers, offering a high healing rate, a short healing time, and a low rate of recurrence.
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Affiliation(s)
| | | | - Fosca Bona
- Plastic Surgeon, Diabetic Foot Department, Istituto Clinico Città Studi, Milan, Italy
| | - Paolo Galenda
- Diabetologist, Diabetic Foot Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Roberto Ferraresi
- Interventional Cardiologist, Interventional Cardiovascular Unit, Humanitas Gavazzeni, Milan, Italy
| | - Piero Gherardi
- Plastic Surgeon, Plastic Surgery Division, Istituto Clinico Città Studi, Milan, Italy
| | - Andrea Reho
- Plastic Surgeon, Plastic Surgery Division, Istituto Clinico Città Studi, Milan, Italy
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Schade VL, Andersen CA. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle. Diabet Foot Ankle 2015; 6:26627. [PMID: 25795102 PMCID: PMC4368713 DOI: 10.3402/dfa.v6.26627] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/30/2015] [Accepted: 02/01/2015] [Indexed: 02/06/2023]
Abstract
Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast. Surgical intervention remains controversial. A review of the literature was performed to provide an evidenced-based approach to the conservative and surgical management of acute Charcot neuroarthropathy of the foot and ankle.
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Affiliation(s)
- Valerie L Schade
- Vascular/Endovascular Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Charles A Andersen
- Vascular/Endovascular Surgery, Madigan Army Medical Center, Tacoma, WA, USA;
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Abstract
An increasing body of evidence has implicated obesity as having a negative effect on the development, treatment, and outcome of lower extremity pathologic entities, including diabetic foot disease. The objective of the present study was to increase the body of knowledge with respect to the effects of obesity on foot function. Specifically, we attempted to (1) describe the relationship between an increasing body mass index (BMI) on plantar foot pressures during gait, and (2) evaluate the efficacy of commonly prescribed off-loading devices with an increasing BMI. A repeated measures design was used to compare the peak plantar foot pressures under multiple test conditions, with the volunteers acting as their own controls. The primary outcome measure was the mean peak plantar pressure in the heel, midfoot, forefoot, and first metatarsal, and the 2 variables were modification of patient weight (from "normal" BMI to "overweight," "obese," and "morbidly obese") and footwear (from an athletic sneaker to a surgical shoe, controlled ankle motion walker, and total contact cast). Statistically significant increases in the peak plantar pressures were observed with increasing volunteer BMI weight class, regardless of the off-loading device used. The present investigation has provided unique and specific data with respect to the changes that occur in the peak plantar pressures with variable BMIs across different anatomic levels and with commonly used off-loading devices. From our results, we have concluded that although the plantar pressures increase with increasing weight, it appears that at least some reduction in pressure can be achieved with an off-loading device, most effectively with the total contact cast, regardless of the patient's BMI.
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Affiliation(s)
- Kelly Pirozzi
- Chief Resident, Temple University Hospital Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA
| | - James McGuire
- Associate Professor, Department of Podiatric Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Andrew J Meyr
- Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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Güven MF, Karabiber A, Kaynak G, Oğüt T. Conservative and surgical treatment of the chronic Charcot foot and ankle. Diabet Foot Ankle 2013; 4:21177. [PMID: 23919114 PMCID: PMC3733018 DOI: 10.3402/dfa.v4i0.21177] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/30/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022]
Abstract
Charcot neuroarthropathy (CN) is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, and limb loss. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus. The aim of this manuscript was to evaluate modern concepts of chronic CN through a review of the available literature and to integrate a perspective of management from the authors’ extensive experience.
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Affiliation(s)
- Mehmet Fatih Güven
- Cerrahpasa Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
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Abstract
Technological advances have allowed reconstructive foot and ankle surgeons greater opportunity to provide significant limb salvage options to those patients who present with significant lower extremity deformity due to diabetic Charcot neuroarthropathy. Paradigms that promote the utilization of these advanced modalities have demonstrated significant improved limb salvage outcomes in this challenging patient population and have consequently improved the quality of life for patients. The purpose of this review is to discuss current concepts in Charcot reconstruction.
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Affiliation(s)
| | - Ryan Fitzgerald
- Hess Orthopaedics and Sports MedicinePLC, Harrisonburg, Virginia
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