Tag: diabetic foot ulceration

Diabetic foot ulceration: an avoidable complication

At present, more than 380 million people worldwide have diabetes. By 2035, this will rise to 592 million. Some 77% of these people live in low- and middle-income countries.1 In emerging countries, in particular, health-care services are often difficult to access, and finding suitable therapies for diabetes can be challenging. Inadequate treatment of diabetes leads to complications such as diabetic foot syndrome (DFS). For an individual with diabetes, the lifetime risk of developing foot ulcers is at least 15%.2 In western countries, DFS remains the most common reason for hospitalisation of patients with diabetes. In addition, DFS is the major cause of non-traumatic lower limb amputation. This supplement aims to improve understanding of DFS and to present essential aspects of prevention, diagnosis and treatment … read more

Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies

Development of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR’s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis … read more

Total Contact Cast Use in Patients With Peripheral Arterial Disease

As the majority of diabetic foot ulcerations (DFUs) occur on the plantar foot, excessive pressure is a major contributing factor to delayed healing. The gold standard for offloading is the total contact cast (TCC); yet, TCC use is contraindicated in patients with ischemia. Lower extremity ischemia typically presents in the more severe end stages of peripheral arterial disease (PAD). As PAD exists on a severity spectrum from mild to severe, designation of a clear cutoff where TCC use is an absolute contraindication would assist those who treat DFUs on a daily basis. Objective. The aim of this study is to determine if a potential cutoff value for PAD where TCC use would be an absolute contraindication could be ascertained from a retrospective case series and a systematic literature review of patients with PAD in which treatment included TCC use … read more