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... one author suggests that amputation may be a marker not only for disease severity but also for disease management, it is clear that amputation remains a global problem for all persons with diabetes (32,143). The same risk factors that predispose to ulceration can also generally be considered contributing causes of amputation, albeit with several modifications (Fig 3). ...
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... majority of wounds are caused by Staphylococcus aureus, beta-hemolytic streptococci, and other gram posi- tive cocci (Fig 9) (151, 438, 439). Although community- acquired cases of resistant bacterial infections have been ...
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... is good evidence suggesting that the effects of neu- ropathy combined with associated vascular response are involved in the development of Charcot arthropathy (479,482). Additionally, recent findings suggest that type 1 dia- betes may have a greater preponderance of decreased bone density than type 2 diabetes (130, 483). Furthermore, the age of onset for acute Charcot arthropathy appears to be lower for type 1 than type 2 diabetes. ...
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... popular classification system is based on five anatomic sites of involvement but does not describe disease activity (129, 136) (Fig 13). Several other classification schemes are described in the literature, but none has been found to be superior or predictive of outcome (500, 504- 506). ...
Citations
... Evidence of previous foot surgery was also noted. [7][8] The study subjects were told to bring their regular foot wears during the pre-recruitment process, these footwear were then examined during the recruitment process to determine whether they were appropriate or not. ...
... Inability to feel the prick was considered positive for loss of pain perception. 7 Tactile Sensation: This was assessed twice with a cotton wool applied on dermatomes L4, L5 and S1. Inability to feel it was considered positive for loss of touch sensation. ...
... Inability to feel cold or no response was considered positive for loss of temperature sensation. 7 Joint position sense, protective sensation and vibration perception were also examined using standard protocol after explaining to the patient what to expect. ...
Background: Foot complications account for more hospital admissions than any other Diabetes Mellitus (DM) complications with adverse outcomes being foot ulcers and amputation.
Objective:To determine the prevalence and risk factors of diabetic foot ulcers in Kano, Northwestern Nigeria.
Methods: A descriptive cross-sectional study was conducted in the diabetes outpatient clinics, medical and surgical wards of two hospitals in Kano, Nigeria. Data was collected on Socio – demographic characteristics, type and duration of DM. The study subjects were assessed for presence and risk factors for foot ulcers.
Results: We recruited 394 patients with DM (163 males and 231 females) with mean (SD) age and duration of DM of 50.8±12.5years and 7.72±6.65years respectively. Type 2DM was present in 95% of the study subjects. Diabetic foot ulcer (DFU) was present in 57(14.5%) of the patients. Risk factors associated with DFU assessed using univariate analysis were older age, longer duration of DM, presence of Peripheral neuropathy(PN), Peripheral arterial disease(PAD), diabetic retinopathy, nephropathy, foot deformities, previous DFU and poor glycemic control. The independent determinants of DFU were previous DFU, foot deformities, retinopathy, PN, PAD and poor glycemic control.
Conclusion: DFU can be relatively found in our setting and the predominant risk factors for DFU are common and still remain unchanged in our environment. This study therefore buttresses the effect of early detection and treatment of DM in preventing the complications that arise from the disease.
... Peripheral arterial occlusive disease (PAOD) is a major disease that limits active aging in elderly people. Complications of PAOD are the leading cause of hospitalization and amputation for people with lower limb ischemia, and account for billion-dollar expenditures annually in the United States (Frykberg et al., 2017). ...
... CLI has important functional implications and a major impact on the quality of life with high morbidity and mortality rates. The quality of life indices of patients with CLI have been reported to be similar to those of terminal cancer patients (Frykberg et al., 2017). ...
... In early stages of DM specific changes of cardiovascular system (in cellular level) can be noticeable [3]. The most common complications of DM (blindness, kidney failure, and non-traumatic amputation) are mainly caused by metabolic and cardiovascular pathologies [6]. Detection of early stage cardiovascular pathology may reduce development of DM complications [7]. ...
... Conclusions and discussion. Diagnostic of early stage vascular pathology is a key to overcome the complications of diabetes: blindness, kidney failure, neuropathy, and non-traumatic amputation [6]. ...
The diabetes is associated with increased death risk from cardiovascular disease. The change of elastic properties of arteries is a potential diagnostic indicator to determine a risk of cardiovascular pathologies. Although many non-invasive diagnostic methods can be used for screening of cardiovascular pathology, there is lack of evidence that screening data could be used for revealing risk of diabetes and/or pre-diabetes stage in human. It is shown that average pulse amplitude of PPG signal increased after leg occlusion in healthy subjects and decreased in subjects with diagnosed DM. The results showed a possibility to use those changes of arteries of healthy subjects and subject with diagnosed diabetes for screening purposes.
... Alrededor del 30% al 50% del hueso debe estar destruido para que la osteomielitis sea diagnosticada radiográficamente, para esto deben haber transcurrido más de 15 días de la enfermedad (22)(23)(24). Se requiere un alto índice de sospecha clínica para realizar el diagnóstico correcto en las primeras etapas de la enfermedad. También es importante para la valoración de cuerpos extraños o amputaciones previas (22). ...
Charcot's neuroarthropathy (CN) is a progressive disabling complication of diabetes mellitus, usually seen 10 years after diagnosis of diabetes. There is widespread destruction of affected joint and bones around it leading to severe deformity and loss of function. Its treatment may require multiple corrective surgeries or even amputation apart from application of cast, glycemic control and bisphosphonates. Here, we report such a case of CN, which was treated with multiple strategies aggressively to a good outcome.
Foot ulceration due to diabetes mellitus is a major problem affecting
12-25% of diabetic subjects in their lifetime. An untreated ulcer
further gets infected which causes necrosis leading to amputation of
lower extremities. Early identification of risk factors and treatment
for these chronic wounds would reduce health care costs and improve the
quality of life for people with diabetes. Recent clinical investigations
have shown that a series of factors including reduced oxygen delivery
and disturbed metabolism have been observed on patients with foot
ulceration due to diabetes. Also, these factors can impair the wound
healing process. Optical techniques based on diffuse reflectance
spectroscopy provide characteristic spectral finger prints shed light on
tissue oxygenation levels and morphological composition of a tissue.
This study deals with the application of diffuse reflectance intensity
ratios based on oxyhemoglobin bands (R542/R580), ratios of oxy- and
deoxy-hemoglobin bands (R580/R555), total hemoglobin concentration and
hemoglobin oxygen saturation between normal and diabetic foot ulcer
sites. Preliminary results obtained are found to be promising indicating
the application of reflectance spectroscopy in the assessment of foot
ulcer healing.
The surgical repair of unstable acute and chronic Charcot foot and ankle deformities remain a challenge with little guidance available in the medical literature regarding surgical intervention with the use of external fixation devices and specifically the Taylor Spatial Frame. The authors present a brief review of the diabetic Charcot neuropathic osteoarthropathy process and a detailed review of their approach to surgical intervention using the Taylor Spatial Frame. In this regard, a detailed “step-by-step” guide through the foot specific Taylor Spatial Frame computer-based system is provided.
Tissue-engineered skin substitutes such as Apligraf® have emerged over the past 20 years as among the most carefully studied and efficacious of the advanced wound modalities. These products have been proven as effective enhancements to general wound care, promoting wound closure particularly in instances where conventional wound care fails. Marketed for hard-to-heal wounds since 1998, Apligraf® has become part of standard wound care in many wound centers across the United States. Despite this situation, few general wound care guidelines incorporate advanced and active wound-healing technologies, such as tissue-engineered skin products. Because of this deficiency, appropriate patient selection and proper use of these product remain largely unaddressed within the general wound care community. Here, we describe the development of guidelines surrounding optimal use of the bilayered living cell therapy, Apligraf®, in the treatment of the two types of lower extremity ulcers for which the product is FDA approved: venous leg ulcer and diabetic foot ulcer. The guidelines detailed in this article focus on the identification and selection of patients who are at risk for failure of standard wound care therapy and thus appropriate for Apligraf® treatment. The intended audience for these guidelines is the general wound care practitioner, for whom the developed treatment algorithms and accompanying figure legends should provide practical, user-friendly direction simplifying both patient selection and appropriate use of Apligraf® within the context of good wound-healing practice.
There is a fatalist perception of diabetic foot because the argument of "small-vessel disease" prevails. This is the report of a cohort study of patients facing a formal recommendation for major foot amputation to assess how many can be saved with a conventional treatment, defined as debridement, pressure alleviation, metabolic control, and antibiotics. The primary efficacy measurement was the salvage of the limb at the follow-up visit between 25 and 35 days after the first consultation. The secondary efficacy measurement was the subsequent epithelization of the ulcerative lesions, following patients for up to 270 days. The cohort consisted of 105 type 2 diabetic patients; 87 (83%) had severe lesions. A total of 71 patients (68%) required hospitalization. By the intention-to-treat analysis, 89 patients (85%) avoided major amputation. A total of 88 patients were evaluated for complete epithelization, reaching median success by day 120. Overall, 51 patients (49%) underwent minor amputations. It was concluded that there is a high rate of unnecessary major foot amputations, because a diabetic foot can be salvaged across the continuum of severity when patients receive care in a multidisciplinary wound clinic.
Surgical intervention for chronic deformities and ulcerations has become an important component in the management of patients with diabetes mellitus. Such patients are no longer relegated to wearing cumbersome braces or footwear for deformities that might otherwise be easily corrected. Although surgical intervention in these often high-risk individuals is not without risk, the outcomes are fairly predictable when patients are properly selected and evaluated. In this brief review, we discuss the rationale and indications for diabetic foot surgery, focusing on the surgical decompression of deformities that frequently lead to foot ulcers.
