Irregularity in Plantar Fascia, Muscle Edema and Tendon Thickness in Patients with High-Risk for Diabetic Foot

2021 ◽  
Author(s):  
Busra Yurumez Korkmaz ◽  
Mujde Akturk ◽  
Murat Ucar ◽  
Alev Eroglu Altınova ◽  
Mehmet Ali Can ◽  
...  
Keyword(s):  
High Risk ◽  
Surface Area ◽  
Diabetic Foot ◽  
Plantar Fascia ◽  
Arterial Disease ◽  
Tibialis Posterior ◽  
Flexor Hallucis Longus ◽  
Tendon Thickness ◽  
Muscle Edema ◽  
Peripheral Arterial

Abstract Aim To investigate the alterations in the plantar fascia (PF), intrinsic muscles, and tendons in the feet of patients at high risk for developing diabetic foot. Methods The healthy feet of 22 patients with type 2 diabetes, who had developed diabetic foot ulcers on a single foot without any pathology on the contralateral extremity, and those of 22 healthy volunteers were evaluated by magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF, and edema of intrinsic foot muscles were examined. Results Nineteen patients (86%) had irregularity in the PF, whereas none of the healthy controls had any (p<0.001). Intrinsic muscle edema was more common in the group with diabetes (p=0.006). The volume of AT and the surface area of PF were decreased in patients with peripheral arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but without PAD had a larger surface area of PF than that of controls (p<0.05). There were no differences in the volume of AT, the surface area of the PF, and other tendon thickness between the groups. Conclusion Irregularity in the PF and muscle edema may indicate a high risk for the diabetic foot. The presence of PAD may lead to regression in the structure of AT and PF.

scholarly journals IMPLEMENTATION OF DIABETIC FOOT RISK ASSESSMENT (DIAFORA) SCORE TO STUDY DIABETIC FOOT AND PREDICT AMPUTATION: AN INDIAN PERSPECTIVE

2020 ◽  
pp. 1-3
Author(s):  
Mridusmita Khataniar ◽  
Aanchal Sawhney ◽  
Roopal Verma
Keyword(s):  
High Risk ◽  
Peripheral Arterial Disease ◽  
Blood Sugar ◽  
Diabetic Foot ◽  
Risk Group ◽  
Risk Groups ◽  
Arterial Disease ◽  
Low Risk ◽  
Medium Risk ◽  
Peripheral Arterial

BACKGROUND-Diabetic foot is a wound failing to heal after 4 weeks of onset which can result from trauma, peripheral arterial disease and/or sensory neuropathy affecting the feet in diabetes mellitus. METHODS- With that background we aim to predict the functionality of a relatively new score called DIAFORA in the North Indian population, by studying parameters like neuropathy, presence of foot deformity, peripheral arterial disease, multiple ulcers, infection, gangrene, bone involvement along with blood sugar levels and culture results. We classified patients with diabetic foot into 3 risk groups- low risk, medium risk and high risk to predict lower limb amputation. RESULTS-With a 41:8 male-female ratio, our study subject’s mean age was 55.38+/- 11 years. Examining patients 90 days post enrollment in our study, 70% of the 30 cases in the high risk group required amputation, 40% of the 5 cases in medium risk groups underwent amputation whereas amputation was redundant in all 15 cases belonging to the low risk group. According to our study, the DIAFORA score has a sensitivity of 91.3% and specificity of 66.7%. CONCLUSION- With a prevalence of approximately 15% diabetic foot in India, this study is a paradigm to predict the amputation in high risk patients. Along with stringent blood sugar control we recommend utilization of DIAFORA score in regular clinical practice by clinicians to predict and prevent amputation in Diabetics and hence improve their quality of life.

scholarly journals Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

2020 ◽  
Vol 29 (03) ◽  
pp. 143-148
Author(s):  
Ranjit Kumar Nath ◽  
Siva Subramaniyan ◽  
Neeraj Pandit ◽  
Deepankar Vatsa
Keyword(s):  
High Risk ◽  
Peripheral Arterial Disease ◽  
Femoral Artery ◽  
Lower Limb ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Retrograde Approach ◽  
Femoral Access ◽  
Antegrade Approach ◽  
Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

2020 ◽  
Author(s):  
Erika Vainieri ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
Daina Walton ◽  
Chris Manu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Emergency Admission ◽  
Arterial Disease ◽  
Major Amputation ◽  
Outcome Data ◽  
High Rate ◽  
Free Survival ◽  
Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

Healing Rate of Diabetic Foot Wounds When Treated with Serial Debridement in the Presence of Antithrombotic Therapy

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Jack Route
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Antithrombotic Therapy ◽  
Healing Rate ◽  
Standard Of Care ◽  
Significant Negative Correlation ◽  
Arterial Disease ◽  
Wound Area ◽  
Negative Effect ◽  
Peripheral Arterial

Background Previous study indicates that pharmacologic antithrombotic therapy may be an inhibitory factor for wound healing and should merit consideration among the other core factors in wound healing optimization. Methods This study provides a retrospective analysis of the effect of antithrombotic therapy on wound healing rates of uncomplicated diabetic foot ulcerations. Wounds treated with standard of care in the presence of clinical anticoagulation were compared to control wounds. Results The results indicate a statistically significant negative correlation between antithrombotic therapy and diabetic foot wound healing rate. This represents the first study focusing on this correlation in the uncomplicated diabetic foot wound. Conclusions This retrospective study demonstrates that antithrombotic therapy has a statistically significant negative effect on healing rates of uncomplicated diabetic foot ulcerations. Both wound area and depth improvement over 4 weeks was significantly better in treated patients who were not on antithrombotic therapy for comorbidity not associated with peripheral arterial disease.

Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽  
2021 ◽  
pp. 000331972110426
Author(s):  
Martyna Schönborn ◽  
Patrycja Łączak ◽  
Paweł Pasieka ◽  
Sebastian Borys ◽  
Anna Płotek ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Arterial Disease ◽  
Angiogenic Factors ◽  
Diabetic Foot Syndrome ◽  
Tissue Loss ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Impaired Wound Healing ◽  
Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

scholarly journals SKRINING KAKI DIABTES UNTUK DETEKSI DINI LUKA KAKI DIABETES PADA PASIEN DIABETES

2020 ◽  
Vol 6 (2) ◽  
pp. 192-198
Author(s):  
Juhelnita Bubun ◽  
Saldy Yusuf ◽  
Yuliana Syam ◽  
Wahyu Hidayat ◽  
Suharno Usman
Keyword(s):  
Peripheral Arterial Disease ◽  
Scoping Review ◽  
Diabetic Foot ◽  
Full Text ◽  
Arterial Disease ◽  
Key Word ◽  
Diabetic Foot Screening ◽  
Peripheral Arterial

Latar Belakang: Prognosis LKD yang tidak dirawat dengan baik akan berdampak buruk yaitu amputasi bahkan kematian sehingga dibutuhkan tindakan pencegahan yaitu skrining kaki diabetes. Tujuan dari review ini, untuk mengetahui metode skrining kaki diabetes untuk mencegah terjadi luka kaki diabetes (LKD). Metode database yang digunakan pada pencarian artikel yaitu pubmed, wiley dan science direct. Hasil: kata kunci yang digunakan diabetic foot screening OR diabetes foot screening jumlah artikel yang didapatkan   39 artikel dari tiga database dan artikel yang menjadi kriteria inklusi artikel, artikel tahun 2013-2018, merupakan hasil penelitian, sesuai tema  scoping review dan artikel full text, sehingga terdapat empat artikel yang terinklusi. Dari artikel tersebut dua artikel yang membahas metode skrining kaki diabetes untuk mendeteksi neuropati dan dua artikel yang membahas metode skrining kaki diabetes untuk mendeteksi angiopati. Skrining kaki diabetes untuk mendeteksi neuropati dapat menggunakan metode sudoscan yang dapat mendeteksi 34% tidak ada neuropati, tanpa gejala 69% dan dengan gejala 61,7%. Metode Ipswich touch test (IpTT) dapat digunakan oleh tenaga non professional di rumah dan klinik dalam mendeteksi neuropati dengan sensitivitas 78,3% dan 81,2%, spesifitas 93,9% dan 96,4%. Metode dalam mendeteksi angiopati adalah ankle brachialis index (ABI). Kombinasi hasil palpasi nadi yang lemah /hilang dan ABI yang abnormal menghasilkan sensitivitas dan nilai prediksi negatif tertinggi (92,3 % dan 89,8%) penyebab peripheral arterial disease (PAD). Kesimpulan: metode skrining kaki diabetes untuk mendeteksi neuropati terdiri atas beberapa metode yang aman untuk digunakan. ABI dapat digunakan mendeteksi PAD. Key word: skrining kaki diabetes, neuropati, angiopati

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