scholarly journals Risk assessment of patients with diabetes for foot ulcers according to risk classification consensus of international working group on diabetic foot (IWGDF)

2013 ◽  
Vol 29 (3) ◽  
Author(s):  
Hajieh Shahbazian ◽  
Leila Yazdanpanah ◽  
Seyed Mahmuod Latifi
Keyword(s):  
Risk Assessment ◽  
Diabetic Foot ◽  
Working Group ◽  
Risk Classification ◽  
Foot Ulcers ◽  
International Working Group ◽  
Patients With Diabetes

scholarly journals Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene

2021 ◽  
Vol 9 ◽  
pp. 205031212110291
Author(s):  
Targ Elgzyri ◽  
Jan Apelqvist ◽  
Eero Lindholm ◽  
Hedvig Örneholm ◽  
Magdalena Annersten Gershater
Keyword(s):  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Foot Ulcer ◽  
Major Amputation ◽  
Severe Form ◽  
Foot Ulcers ◽  
Vascular Intervention ◽  
Co Morbidity ◽  
Patients With Diabetes

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3–234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35–95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3–234) weeks; for auto-amputated, 48 (10–228) weeks; for minor amputated, 48 (6–234) weeks; and for major amputation, 32 (3–116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

Plantar Pressures, Plantar Forces, and Their Influence on the Pathogenesis of Diabetic Foot Ulcers

2013 ◽  
Vol 103 (4) ◽  
pp. 322-332 ◽  
Author(s):  
Jérôme Patry ◽  
Richard Belley ◽  
Mario Côté ◽  
Marie-Ludivine Chateau-Degat
Keyword(s):  
Shear Stress ◽  
Mechanical Stress ◽  
Diabetic Foot ◽  
Threshold Value ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Plantar Pressures ◽  
Manual Search ◽  
Patients With Diabetes ◽  
Full Text Review

Background: Clinical recommendations for the prevention and healing of diabetic foot ulcers (DFUs) are somewhat clear. However, assessment and quantification of the mechanical stress responsible for DFU remain complex. Different pressure variables have been described in the literature to better understand plantar tissue stress exposure. This article reviews the role of pressure and shear forces in the pathogenesis of plantar DFU. Methods: We performed systematic searches of the PubMed and Embase databases, completed by a manual search of the selected studies. From 535 potentially relevant references, 70 studies were included in the full-text review. Results: Variables of plantar mechanical stress relate to vertical pressure, shear stress, and temporality of loading. At this time, in-shoe peak plantar pressure (PPP) is the only reliable variable that can be used to prevent DFU. Although it is a poor predictor of in-shoe PPP, barefoot PPP seems complementary and may be more suitable when evaluating patients with diabetes mellitus and peripheral neuropathy who seem noncompliant with footwear. An in-shoe PPP threshold value of 200 kPa has been suggested to prevent DFU. Other variables, such as peak pressure gradient and peak maximal subsurface shear stress and its depth, seem to be of additional utility. Conclusions: To better assess the at-risk foot and to prevent ulceration, the practitioner should integrate quantitative models of dynamic foot plantar pressures, such as in-shoe and barefoot PPPs, with the regular clinical screening examination. Prospective studies are needed to evaluate causality between other variables of mechanical stress and DFUs. (J Am Podiatr Med Assoc 103(4): 322–332, 2013)

Surgical Off-loading of the Diabetic Foot

2010 ◽  
Vol 100 (5) ◽  
pp. 369-384 ◽  
Author(s):  
Robert G. Frykberg ◽  
Nicholas J. Bevilacqua ◽  
Geoffrey Habershaw
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Diabetic Foot ◽  
Surgical Intervention ◽  
Surgical Decompression ◽  
Foot Ulcers ◽  
Foot Surgery ◽  
Patients With Diabetes

Surgical intervention for chronic deformities and ulcerations has become an important component in the management of patients with diabetes mellitus. Such patients are no longer relegated to wearing cumbersome braces or footwear for deformities that might otherwise be easily corrected. Although surgical intervention in these often high-risk individuals is not without risk, the outcomes are fairly predictable when patients are properly selected and evaluated. In this brief review, we discuss the rationale and indications for diabetic foot surgery, focusing on the surgical decompression of deformities that frequently lead to foot ulcers. (J Am Podiatr Med Assoc 100(5): 369–384, 2010)

scholarly journals Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance

2020 ◽  
Vol 8 (10) ◽  
pp. 1580
Author(s):  
Cassandra Pouget ◽  
Catherine Dunyach-Remy ◽  
Alix Pantel ◽  
Sophie Schuldiner ◽  
Albert Sotto ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Biofilm Formation ◽  
Chronic Infection ◽  
Current Knowledge ◽  
Bacterial Species ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Main Role ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes

Foot infections are the main disabling complication in patients with diabetes mellitus. These infections can lead to lower-limb amputation, increasing mortality and decreasing the quality of life. Biofilm formation is an important pathophysiology step in diabetic foot ulcers (DFU)—it plays a main role in the disease progression and chronicity of the lesion, the development of antibiotic resistance, and makes wound healing difficult to treat. The main problem is the difficulty in distinguishing between infection and colonization in DFU. The bacteria present in DFU are organized into functionally equivalent pathogroups that allow for close interactions between the bacteria within the biofilm. Consequently, some bacterial species that alone would be considered non-pathogenic, or incapable of maintaining a chronic infection, could co-aggregate symbiotically in a pathogenic biofilm and act synergistically to cause a chronic infection. In this review, we discuss current knowledge on biofilm formation, its presence in DFU, how the diabetic environment affects biofilm formation and its regulation, and the clinical implications.

The Physical Characteristics of Materials Used in the Manufacture of Orthoses for Patients with Diabetes

2007 ◽  
Vol 28 (10) ◽  
pp. 1057-1063 ◽  
Author(s):  
Joanne Paton ◽  
Ray B. Jones ◽  
Elizabeth Stenhouse ◽  
Graham Bruce
Keyword(s):  
Physical Properties ◽  
Diabetic Foot ◽  
Performance Indicator ◽  
Practical Method ◽  
Relevant Information ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes ◽  
Properties Of Materials ◽  
Materials Used

Background: Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues can be modified. Orthotic therapy is one practical method commonly used to maintain tissue integrity. Orthotic design must consider the materials chosen for use in fabrication and profile of the device because both aspects influence the performance and durability of the device. Published research evaluating the physical properties of materials commonly used in the manufacture of orthoses for patients with diabetes is limited. This study investigated the physical properties of materials used to fabricate orthoses designed for the prevention of neuropathic diabetic foot ulcers. Methods: Fifteen commonly used orthotic materials were selected for testing: four specifications of 6.4-mm Poron® (Rogers Corp., Gent, Belgium), 3.2-mm Poron®, three densities of 12-mm Ethylene Vinyl Acetate (EVA), 12-mm low-density plastazote, two depths (6.4-mm, 3.2-mm) of Cleron™ (Algeo Ltd., Liverpool, UK), Professional Protective Technology (PPT), and MaxaCane (Algeo Ltd, Liverpool, UK). The density, resilience, stiffness, static coefficient of friction, durability, and compression set of each material were tested, ranked, and allocated a performance indicator score. Results: The most clinically desirable dampening materials tested were Poron® 96 (6-mm) and Poron® 4000 (6-mm). High density EVA (Algeo Ltd., Liverpool, UK) and Lunacell Nora® EVA (Freudenberg, Weinhein, Germany) possessed the properties most suitable to achieve motion control. The data present a simple and useful comparison and classification of the selected materials. Conclusions: Although this information should not be used as a single indicator for assessing the suitability of an orthotic material, the results provide clinically relevant information relating to the physical properties of orthotic materials commonly used in the prevention of neuropathic diabetic foot ulcers.

Effectiveness of various materials in reducing plantar shear forces. A pilot study

2000 ◽  
Vol 90 (7) ◽  
pp. 346-353 ◽  
Author(s):  
M Curryer ◽  
ED Lemaire
Keyword(s):  
Diabetes Mellitus ◽  
Pilot Study ◽  
Diabetic Foot ◽  
Shear Force ◽  
Foot Ulcers ◽  
Shear Forces ◽  
Patients With Diabetes ◽  
Force Data ◽  
Precipitating Factor ◽  
Better Than

Vertical plantar forces are known to be a major precipitating factor in the development of foot pathology. It is also postulated that shear forces are important in the pathogenesis of foot ulcers in patients with diabetes mellitus. Various materials are used in insoles designed to reduce forces on the foot. While many foam materials have been tested for their ability to dissipate vertical forces, few studies have tested the effect of these materials on shear forces. This study assessed the effectiveness of five different materials in reducing plantar shear forces and compared two new gel materials with three of the more conventional foam materials. Four subjects were tested while walking over a force platform with one of the five materials taped to the surface. Peak force, impulse, and resultant shear force data were analyzed. The gel materials were significantly better than the foam materials at reducing shear forces. Thus the use of gel materials in insoles may be indicated for the reduction of plantar shear forces on the diabetic foot.

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