Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration

Background Nerve entrapment, common in diabetes, is considered an associated phenomenon without large consequence in the development of diabetes complications such as ulceration, infection, amputation, and early mortality. This prospective analysis, with controls, of the ulcer recurrence rate after operative nerve decompression (ND) offers an objective perspective on the possibility of frequent occult nerve entrapment in the diabetic foot complication cascade. Methods A multicenter cohort of 42 patients with diabetic sensorimotor polyneuropathy, failed pharmacologic pain control, palpable pulses, and at least one positive Tinel's nerve percussion sign was treated with unilateral multiple lower-leg external neurolyses for the indication of pain. All of the patients had healed at least one previous ipsilateral plantar diabetic foot ulceration (DFU). This group was retrospectively evaluated a minimum of 12 months after operative ND and again 3 years later. The recurrence risk of ipsilateral DFU in that period was prospectively analyzed and compared with new ulcer occurrence in the contralateral intact, nonoperated control legs. Results Operated legs developed two ulcer recurrences (4.8%), and nine contralateral control legs developed ulcers (21.4%), requiring three amputations. Ulcer risk is 1.6% per patient per year in ND legs and 7% in nonoperated control legs (P = .048). Conclusions Adding operative ND at lower-leg fibro-osseous tunnels to standard postulcer treatment resulted in a significantly diminished rate of subsequent DFU in neuropathic high-risk feet. This is prospective, objective evidence that ND can provide valuable ongoing protection from DFU recurrence, even years after primary ulcer healing.

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Health-related quality of life in patients with diabetic foot ulceration: study protocol for adaptation and validation of patient-reported outcome measurements (PROMs) in Dutch-speaking patients

BMJ Open ◽

10.1136/bmjopen-2019-034491 ◽

2019 ◽

Vol 9 (12) ◽

pp. e034491 ◽

Cited By ~ 1

Author(s):

Wahid Rezaie ◽

Flora Lusendi ◽

Kris Doggen ◽

Giovanni Matricali ◽

Frank Nobels

Keyword(s):

Quality Of Life ◽

Lower Extremity ◽

Diabetic Foot ◽

Patient Reported Outcome ◽

Health Related Quality ◽

Foot Ulceration ◽

Patient Reported ◽

Related Quality ◽

Health Related

IntroductionDiabetic foot ulceration (DFU) is a common late-stage complication of diabetes with a large impact on health status and quality of life. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients’ views on their well-being. The DFU Scale Short Form (DFS-SF) is a validated disease-specific PROM for measuring health-related quality of life among DFU patients. The Lower Extremity Functional Scale (LEFS) is another PROM that can be used to measure physical functioning in patients with lower extremity disorders. The LEFS is not yet validated for DFU. Both instruments are not validated in the Dutch language. The purpose of this study is to culturally adapt and validate the DFS-SF and LEFS questionnaires for Belgian Dutch-speaking patients with DFU.Methods and analysisThis study will be conducted as a monocentre observational cohort study in DFU patients presenting at a hospital-based multidisciplinary diabetic foot clinic. Data will be collected from the medical electronic files and from DFS-SF, LEFS and five-level EuroQol five-dimension questionnaires that will be presented to the patients at defined time points. Reproducibility, internal consistency, floor and ceiling effects, construct validity and responsiveness will be assessed for the DFS-SF and LEFS.Ethics and disseminationThe study protocol has been approved by the Medical Ethics Committee of Onze-Lieve-Vrouw Hospital (Aalst, Belgium). The results of the study will be disseminated through peer-reviewed publications and conference presentations.

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RISK FACTORS FOR DIABETIC FOOT AND LOWER LIMB AMPUTATION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i9.538 ◽

2019 ◽

Vol 3 (9) ◽

Author(s):

Dr. Uday Prakash ◽

Dr. Kumar Durgeshwar ◽

Dr.R.K. Das ◽

Dr. Lalji Chaudhary

Keyword(s):

Risk Factors ◽

Peripheral Arterial Disease ◽

Lower Extremity ◽

Diabetic Foot ◽

Arterial Disease ◽

Major Amputation ◽

Cardiac Diseases ◽

Foot Ulceration ◽

Duration Of Diabetes ◽

Peripheral Arterial

Introduction: Diabetic foot syndrome (DFS) is the major cause of hospitalization for diabetes-related complications. Protective sensation loss and impaired vision increase the susceptibility for minor feet trauma, which results in diabetic foot ulceration with or without subsequent infection. Peripheral arterial disease is a major cause of impaired ulcer, wound healing and gangrenous diabetic foot. The most important intervention to prevent diabetic foot ulceration and its consequences is early recognition of high-risk patients and their risk factors and referral to appropriate medical departments. There are various risk factors for major lower extremity amputations related to diabetic foot, which includes microvascular diseases, infections, long duration of diabetes, poor glycemic control, peripheral arterial disease, old age and associated cardiovascular comorbidities. Material and Methods: This study was done on the review of medical records of consecutive type 2 diabetic patients. Admitted patients were treated and managed according to the standard protocol of the hospital. History, clinical and physical examination were carried out on each patient. Ulcer characteristics like infection and depth of the ulcer, site of ulcer were assessed. Associated diabetic neuropathy and peripheral arterial disease was assessed by a clinical method. Age, sex, body mass index (BMI), smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases were recorded. The glycated haemoglobin level (HbA1c) were recorded. Results: A total of 128 patients with diabetic foot were included in the study of which 76(59.4%) were male and 52(40.6%) were female. Of the 76 male 6 (4.7%) had major amputation and out of 52 female 4(3.1%) had major amputation, thus total number of major amputations were 10(7.8%). Statistically significant difference was observed in HbA1C and duration of diabetes group in amputation. High HbA1C and more duration of diabetes was associated with the higher number of amputation. The rate of amputation was much higher among patients hypertension, smoking, cardiac diseases and stroke. Conclusion: Poor glycemic controls and duration of diabetes are the important independent risk factors for diabetes-related major lower extremity amputations. Keywords: DFS, BMI, smkoing, DM

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The acutely infected diabetic foot is not adequately evaluated in an inpatient setting

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-87-6-260 ◽

1997 ◽

Vol 87 (6) ◽

pp. 260-265 ◽

Cited By ~ 9

Author(s):

GW Edelson ◽

DG Armstrong ◽

LA Lavery ◽

G Caicco

Keyword(s):

Lower Extremity ◽

Diabetic Foot ◽

Primary Diagnosis ◽

University Teaching ◽

Inpatient Setting ◽

Foot Ulceration ◽

Teaching Institution ◽

Surgical Services ◽

Dichotomous Variables ◽

Protective Sensation

OBJECTIVE To evaluate the standard of evaluation and treatment of the infected diabetic foot ulceration at a 551-bed university teaching institution. DESIGN A retrospective review of a 4-year consecutive sample (1991-1994). POPULATION Two hundred fifty-five patients who were admitted to a hospital for care of an infected diabetic foot ulceration. Patients were subdivided into the following 4 dichotomous variables: (1) whether the patient underwent a lower-extremity amputation, (2) whether the patient was admitted once or multiple times, (3) whether the patient underwent intraoperative debridement, and (4) whether the patient was admitted to medical or surgical services. RESULTS All groups that were evaluated had undergone a less than adequate foot examination. Of the admitted patients, 31.4% did not have their pedal pulses documented; 59.7% of the admitted patients were not evaluated for the presence or absence of protective sensation. Nearly 90% of the wounds were not evaluated for involvement of underlying structures, and foot radiographs were not performed in 32.9% of the patients. There were more blood cultures ordered (62.0%) than wound cultures (51.4%). CONCLUSION The results of this study highlight the need for a systematic, detailed lower-extremity examination for every diabetic patient who is admitted to a hospital, particularly those who are admitted with a primary diagnosis that involves a foot complication.

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