Tag: diabetic foot

Limb salvage in Charcot deformity correction: A case series of 20 limbs

by Jordan James Ernst, DPM, MS, FACPM; Dalton Ryba, DPM; Alan Garrett, DPM, FACFAS
Charcot arthropathy is a disabling complication of peripheral neuropathy, with progressive osseous destruction often necessitating operative intervention to prevent ulceration and even amputation. The prospect of a stable, plantigrade foot is one that is best sought through timely intervention. While a host of procedures and techniques for Charcot reconstruction have been described in the literature, no clear consensus has been reached on a superior method or modality, nor on what factors most significantly affect outcomes and complications. We present a case series of 18 patients (20 limbs) operatively treated at our institution and followed for an average of 3 years for Charcot deformity … read more

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Predictors of Foot Ulcers Among Diabetic Patients at a Tertiary Care Center, Egypt

Diabetes mellitus (DM) is a major public health problem worldwide and is considered one of the main global health emergencies of the 21st century.1 The prevalence of DM is increasing in both developed and developing countries, recent estimates indicate that there were 463 million adults living with diabetes in 2019 which is projected to increase to 642 million in 2040.2,3 In the Middle East and North Africa (MENA) region, the number of patients with diabetes is expected to increase from 34.6 million in 2013 to 67.9 million by 2035.2 The International Diabetes Federation (IDF) classified Egypt among the top 10 countries in the world with the highest prevalence of diabetes, where about 9 million adults between 20 and 79 years of age were living with DM in 2019. The number of patients with DM in Egypt has increased rapidly from about 4.5 million in 2007 to 7.5 million in 2013, and is expected to increase to 13.1 million by 2035.4 … read more

The Biomechanics of Diabetic Foot Amputation

According to the International Diabetes Federation, approximately 463 million adults live with diabetes mellitus (DM), a number projected to increase to 700 million by 2045; a diabetic foot ulcer (DFU) will occur in about 15% of that population. Multiple factors contribute to the development of those wounds including diabetic peripheral neuropathy, biomechanical imbalances, trauma, and peripheral vascular disease. In addition, 85% of all lower limb amputations in patients with diabetes are preceded by a DFU resulting in significant biomechanical challenges for these patients, many of who never become ambulatory again. Prior to surgical intervention, patients come with inherited and acquired biomechanical imbalances or weaknesses such as equinus, severe pronation/supination, mid and forefoot deformities, and muscle weakness unrelated to their other diseases. Surgeons may not take these into consideration when making decisions about amputation level … read more

Extremity Gangrene Caused by HBV-Related Cryoglobulinemia Vasculitis in a Patient with Diabetes – A Case Report

We presented a case of hepatitis B virus (HBV)-related type III cryoglobulinemia vasculitis (CryoVas) characterized by extremity gangrene in a patient with diabetes. The 60-year-old female had a 10-year history of poorly controlled type 2 diabetes mellitus. She complained of sudden onset pain and swelling of toes which quickly progressed to gangrene, with fingers becoming pain and dark violet. The patient was initially misdiagnosed as diabetic foot (DF). Although DF is one of the common chronic complications of diabetes, it rarely involves the hand. What is more, the ischemic manifestations of the extremity were not consistent with the results of the vascular examination and immune system changes. The patient had Raynaud’s phenomenon, arthralgia, and extremity gangrene. Test results showed cryoglobulinemia multiple positive, polyclonal immunoglobulin with rheumatoid factor negative, lower complement 3, leukocytoclastic vasculitis, and HBV infection. HBV-related type III CryoVas was finally diagnosed, and a conservative therapy strategy was given … continue

Study: Diabetic Foot Complications Among The Top 10 Causes Of Disability

David G. Armstrong DPM MD PhD

 

Diabetes-related lower extremity complications are a major cause of global disability, according to a recent study in Diabetic Medicine.

 

The study notes that of the 435 million people worldwide estimated to have diabetes, about 19 to 34 percent will experience a foot ulcer during their lifetimes.1 My coauthors and I note that diabetic foot complications are a leading cause of infection, hospitalization and amputation throughout the world although evidence-based care can prevent these outcomes … read more

Imaging, surgical techniques may advance treatment of the diabetic foot

BARCELONA, Spain — The usual practices of orthopedic surgeons to manage the diabetic foot, including taking a team approach to this condition, have not changed but imaging and new technology and surgical approaches are playing a greater role in helping patients with a diabetic or Charcot foot joint recover, according to a presentation by Önder I. Kilicoglu, MD, at the EFORT Annual Congress.

 

“This is the real trend: The percent of diabetic patients is increasing in the Mediterranean area,” Kilicoglu, a professor at Istanbul University, said … read more

Peripheral arterial disease and the diabetic foot

Miranda Tawfik

Peripheral arterial disease (PAD) is a term used to describe atherosclerotic vessels in the periphery, mostly affecting the lower extremities. The blocked vessels impair blood and oxygen perfusion to the lower limbs and may lead to increased risk of ulceration, wounds and amputations. PAD is also associated with increased risk of coronary and cerebrovascular incidents. More than 50% of people living with PAD may not have any clinical symptoms, posing a challenge to diagnosis and management. This article will discuss the aetiology, presentation, risk factors, and management of PAD as related to the lower extremities … read more

Lower Extremity Amputation and Reamputation Predictors

Temple University School of Podiatric Medicine Journal Review Club
Editor’s note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article Title: Predictors of Lower Extremity Amputation and Reamputation Associated With the Diabetic Foot
Authors: Erdinc Acar MD, Burkay Kutluhan Kacıram, MS
Journal name and issue: The Journal of Foot & Ankle Surgery 56 (2017) 1218–1222
Reviewed by: Anthony Samaan, Class of 2018, Temple University School of Podiatric Medicine

Introduction

A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.

Methods

The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included …  read more

Caring for the Diabetic Foot in Long-Term Care Facilities

 

By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

 

As a Director of Nursing (DON) in a long-term care facility, do you know where the awareness level of diabetes and its complications is for your staff? Do they realize diabetes doesn’t stop? It is 24/7, 365 days a year. Knowing this reality of diabetes and understanding the disease process may assist with preventing serious health problems such as heart disease, stroke, blindness, kidney disease, and nerve damage that can lead to amputation.

 

Education is key. We cannot talk about this enough. Assuming someone knows or that common sense will tell people how to take care of these residents is a huge mistake. I don’t believe in common sense; I believe in common knowledge, but it is only common once it is taught. So, teach about diabetes and the care of residents with diabetes often.

 

Knowing the Risk of Diabetic Foot Ulcers and Diabetic Peripheral Neuropathy
In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes. The percentage of Americans age 65 and older remains high, at 25.2%, or 12.0 million seniors (diagnosed and undiagnosed).1Diabetic foot ulcer (DFU) is the number one risk factor contributing to non-traumatic foot amputations in persons with diabetes. Limb amputations are preceded by DFUs 58% of the time. The primary risk factor for the DFU is loss of protective sensations or diabetic peripheral neuropathy (DPN) … read more

The management of diabetic foot: A clinical practice guideline by the Society ….

A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine

 

Diabetes is one of the leading causes of chronic disease and limb loss worldwide, currently affecting 382 million people. It is predicted that by 2035, the number of reported diabetes cases will soar to 592 million.1 This disease affects the developing countries disproportionately as >80% of diabetes deaths occur in low- and middle-income countries. As the number of people with diabetes is increasing globally, its consequences are worsening. The World Health Organization projects that diabetes will be the seventh leading cause of death in 2030.3 A further effect of the explosive growth in diabetes worldwide is that it has become one of the leading causes of limb loss. Every year, >1 million people with diabetes suffer limb loss as a result of diabetes. This means that every 20 seconds, an amputation occurs in the world as an outcome of this debilitating disease. Diabetic foot disease is common, and its incidence will only increase as the population ages and the obesity epidemic continues … read more

Caring for the Diabetic Foot in Long-Term Care Facilities

by Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

 

As a Director of Nursing (DON) in a long-term care facility, do you know where the awareness level of diabetes and its complications is for your staff? Do they realize diabetes doesn’t stop? It is 24/7, 365 days a year. Knowing this reality of diabetes and understanding the disease process may assist with preventing serious health problems such as heart disease, stroke, blindness, kidney disease, and nerve damage that can lead to amputation.

 

Education is key. We cannot talk about this enough. Assuming someone knows or that common sense will tell people how to take care of these residents is a huge mistake. I don’t believe in common sense; I believe in common knowledge, but it is only common once it is taught. So, teach about diabetes and the care of residents with diabetes often.

 

Knowing the Risk of Diabetic Foot Ulcers and Diabetic Peripheral Neuropathy
In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes … read more

The Diabetic Foot Syndrome (book)

Frontiers in Diabetes, Vol. 26

 

In recent years, “diabetic foot” has become the common name given to chronic complications of diabetes mellitus in the lower limb. This book provides an up-to-date picture of the clinical scenario, the latest understanding of the mechanisms in regard to pathology, the current standards of therapy, and the organizational tasks that a modern approach to such a complex pathology warrants. All contributors have delivered articles that are as informative and straight-to-the point as possible, including not only their own experience in the field, but also giving a wider picture to link each article to the other. The Diabetic Foot Syndrome is not only relevant to specialists, but also to all the caregivers involved in the management of the patients at risk for developing the pathology, those affected, and those who are at risk of recurrences.

Peripheral arterial disease and the diabetic foot

In peripheral arterial disease (PAD), atherosclerotic vessels in the periphery impair blood and oxygen perfusion to the lower limbs and may lead to increased risk of ulceration, wounds and amputations. PAD is also associated with increased risk of coronary and cerebrovascular incidents (Meru et al, 2006).

 

The main risk factors for PAD include smoking, diabetes, high cholesterol and family history (Meru et al, 2006). More than 50% of people living with PAD may not show any clinical symptoms, hence proper diagnosis and management is challenging (Hirsch et al, 2007; Norgren et al, 2007). This article will discuss the aetiology, presentation, risk factors, and management of PAD as related to the lower extremities.

 

Aetiology and presentation
PAD is a macrovascular complication of diabetes mainly caused by atherosclerosis, whereby fatty plaque deposits progressively narrow the lumen of the arteries and decrease vascular perfusion to the lower limbs … read more

Spend a Minute, Save a Life

Inlow’s 60-Second Diabetic Foot Screen

 

Boulton states that “throughout our medical training, we are taught how to manage patients who present with symptoms, which usually leads to a clinical examination, a diagnosis, and a treatment and management plan. However, virtually no time is spent on teaching how to manage patients who have no symptoms because they have lost the ability to feel pain; that is, they have peripheral neuropathy.”1 Clinical experience and the literature1 have shown us that the lack of symptoms Boulton referred to in those with or at risk for diabetic foot complications can have devastating effects on the person, their family and health systems. As clinicians, we have the opportunity, and the obligation, to step in and fill the gap left when peripheral neuropathy is present, or potentially present, in any of our patients. The key is a simple, quick procedure: foot screening … read more

Lower Extremity Amputation and Reamputation Predictors ….

Review: Lower Extremity Amputation and Reamputation Predictors in Patients with Diabetic Foot Wounds

 

A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.

 

The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included … read more