Tag: David Armstrong

David G. Armstrong, DPM, MD, PhD

A recent meta-analysis in the International Wound Journal took a closer look at vitamin D deficiency and patients with diabetic foot ulcers (DFUs). Lin and colleagues’ literature search initially included over 7,500 subjects with diabetes.1 They found that those subjects with diabetic foot ulcers had significantly lower levels of vitamin D, higher prevalence of vitamin D deficiency (less than 50 nmoL/L) and more severe vitamin D deficiency than those without DFU … read more

David G. Armstrong, DPM, MD, PhD

Information about foot care provided to people with diabetes with or without their partners can have an impact on recommended foot care behavior. Think about this the next time you’re educating your patient and his/her family!

A recent study published in Applied Psychology: Health and Well-Being looked at these potential behavior differences. In a randomized parallel arm design trial, they split the cohort into two groups: one where providers gave information sheets to patients with diabetes and their spouses (dyad, n=64) and one where the information only went to the patients (individual, n=69). The patients then self-reported how many days a foot check occurred, and how many days foot protection measures took place … read more

David G. Armstrong, Professor of Surgery at the Keck School of Medicine of University of Southern California joined physicians, surgeons, engineers and scientists from around the world for the International Foot and Ankle Biomechanics conference. Originally scheduled for Rio De Janiero, Brazil in April of 2020 and chaired by Prof. Isabelle Sacco, the symposium- known as iFAB- was rescheduled in a virtual format. Armstrong, who gave the lecture outside of the high-risk clinics at the National Rehabilitation Center at Rancho Los Amigos, gave a keynote to participants from 5 continents. It was particularly poignant that the lecture be given at Rancho … read more

Aims The aim of our study was to estimate the overall rate of first hospitalizations for diabetic foot (DF) regardless of the out- come in amputations, as well as the mortality rate with their determinants in the period 2012–2016 in Piedmont Region in Italy. Methods The study included all the subjects registered in the Regional Diabetes Registry and alive as at January 1, 2012. DF cases were identified by record linkage with the regional hospital discharge database. Incident cases of diabetic foot were followed up for mortality … read more

Remission — rather than repair — needs to be the goal of treatment, according to Dr. David Armstrong, whose report on diabetic foot ulcers appears in the New England Journal of Medicine … Foot ulcers are a prevalent complication for millions of people with diabetes. Estimates indicate that as many as one-third of people with the disease will develop at least one foot ulcer over the course of their lifetime. These wounds can lead to further complications such as strokes, heart attacks, infections, loss of limbs and premature death … Yet, the morbidity and mortality directly associated with foot ulcers often go unrecognized by physicians and patients alike. Currently, the clinical focus is on repairing an ulcer’s surrounding tissue and healing the wound … read more

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The authors took a closer look at adherence to footwear usage when patients with diabetes at high-risk for ulceration had custom-made shoes.1 Researchers assessed the percentage of overall steps during which subjects wore their custom-made shoes indoors and outdoors at baseline, 1-, and 12-months post-shoe dispensing. They created two cohorts based on indoor baseline adherence to shoe gear, less than 80% (primary group, n = 23) and greater or equal to 80% (secondary group n = 8). The authors also looked at peak plantar pressures of custom vs. non-custom indoor footwear, patient-related usability of the custom shoes, and ulcer recurrence at 12 months … read more

Patients with a diabetic foot ulcer who received probiotic supplementation for 12 weeks experienced faster wound healing coupled with an improved glycemic and lipid profile compared with patients assigned placebo, according to findings from a randomized controlled trial … Sima Mohseni, of the infectious diseases and tropical medicine research center at Babol University of Medical Sciences in Iran, and colleagues analyzed data from 60 adults aged 40 years to 85 years with grade 3 diabetic foot ulcer, who randomly received either probiotic supplementation (n = 30) or placebo (n = 30) daily for 12 weeks between March and June 2016. Probiotic capsules contained lactobacillus acidophilus, lactobacillus casei, lactobacillus fermentum and Bifidobacterium bifidum. All participants also underwent standard treatment for wound care. Participants provided blood samples at baseline and 12 weeks and 3-day dietary records at baseline. Wound healing and glucose parameters served as the primary outcome … read more

New guidelines recommend healthcare providers develop and implement an individualized nutrition care plan for individuals with diabetes with or at risk of a DFU
New guidelines endorsed by the American Limb Preservation Society highlighted the importance of nutrition in wound healing for adults with diabetes, who also experience diabetic foot ulcers (DFU).

The guidelines stated that nutritional interventions were “recommended for all patients who could benefit now or in the future from nutritional care.” As such, healthcare providers should develop and implement an individualized nutrition care plan for individuals with or at risk of a DFU, who are additionally malnourished or at risk of malnutrition … read more

New guidelines endorsed by the American Limb Preservation Society highlighted the importance of nutrition in wound healing for adults with diabetes, who also experience diabetic foot ulcers (DFU) … The guidelines stated that nutritional interventions were “recommended for all patients who could benefit now or in the future from nutritional care.” As such, healthcare providers should develop and implement an individualized nutrition care plan for individuals with or at risk of a DFU, who are additionally malnourished or at risk of malnutrition … read more

A recent systematic review in the American Journal of Medicine aims to challenge the dogma surrounding antibiotic therapy for certain types of infections, including osteomyelitis.1 This constitutes superb work from Wald-Dickler and coworkers, adding to the growing body of evidence that (to coin a phrase from senior author Brad Spellberg, MD) shorter may be better and oral greater than IV … Researchers set out to evaluate if current data supports long-standing tenets regarding the superiority of IV antibiotics for the full treatment course for osteomyelitis, bacteremia and infective endocarditis. Their review included 7 randomized controlled trials regarding osteomyelitis, specifically. None of the 21 total studies among all examined infections demonstrated superiority of IV-only antibiotic treatment … read more

     in the young and middle-aged adult U.S. population

We are grateful to Linda Geiss and her coworkers at CDC for their always intriguing efforts at revealing the big picture to us. These data– which certainly aren’t welcome news– are supremely important. Do they signal what we’ve posited for some time? Did the increase in the “denominator” of people with diabetes in the mid-1990s initially reduced the proportionate pool of high risk patients (and thereby reduced amputation rates)? Was it better team care? Whatever the explanation, we have yet more data on which to ruminate … read more

Is a histologically hostile environment causing promising treatments for chronic wounds to fail? My coauthor and I tackle this question in a recent review for Nature Reviews Endocrinology.

As we say in the review, “As with so many other areas in medicine, the field of tissue repair and wound healing is littered with early-stage promise in preclinical models followed by late-stage disappointment in human trials.”¹ If we understand that the wound environment is histologically hostile, many of the types of treatments we have endeavored to use in this area come into question … read more

Tuesday, September 25, 2018

Because neuroischemic complications are associated with a high rate of recurrence, this presentation proposes a slight shift in how health care providers counsel and communicate risk to their patients. If the epidemiology of this problem is comparable with that of cancer, and recurrences are common, then perhaps language commensurate with such risks should follow.

After initial healing of an index wound, patients are referred to not as being cured but rather as being “in remission.” This concept is easy for the patient and the rest of the team to understand, and it powerfully connotes the necessity for frequent follow-up and rapid intervention for inevitable minor and sometimes major complications.

This program will review tried-and-true as well as up-to-the-minute advances in biologics, consumer electronics, mechanics, medicine, and surgery that are “pushing the envelope” in extending ulcer-free, hospital-free, and activity-rich days in efforts to make prevention pay.