scholarly journals Orthoses in diabetic foot treatment and prevention

2013 ◽  
Vol 94 (4) ◽  
pp. 536-541
Author(s):  
I V Klyushkin ◽  
K A Koreyba
Keyword(s):  
Diabetes Mellitus ◽  
Elastic Material ◽  
Diabetic Foot ◽  
Silver Ions ◽  
Cost Effective ◽  
Diabetic Foot Syndrome ◽  
Treatment And Prevention ◽  
Positive Treatment ◽  
Orthopedic Shoes

Aim. To define the role of orthoses in the treatment and rehabilitation of patients with diabetic foot syndrome. Methods. The review of the literature addressing the use of special orthopedic shoes in the treatment and rehabilitation of patients with complicated diabetes mellitus was performed. Results. The common requirements for orthopedic shoes for patients with complicated diabetes mellitus are the following: (1) rigid sole with an artificial curvature; (2) boot-tree elevated by 8 mm due to arch supporter, adequate volume, wide sole, removable insole; (3) insole without functional memory; (4) thermally variable elastic material, advisably with silver ions, for the lining; (5) minimal number of sutures at the lining; (6) no elastic material at the front of the shoe and at the lining at the toes; (7) increased volume and enough space for the toes; (8) front slant of 15°; (9) potential ability to adjust the inner volume of the shoe; (10) hard counter - stabilizing hard back with additional softening at the lining side; (11) heel with a front slant or a solid sole without a heel; (12) smooth non-traumatic surface suitable for scrubbing including cleansing with antiseptics. The indications for orthopedic relief in patients with diabetic foot syndrome are explained. Economic superiority of organ-preserving approaches in such patients is shown. There is an opposition for conservative methods of treatment of patients with diabetic foot syndrome, nevertheless, an amputation can not be estimated as a positive treatment outcome in such patients. Almost 70-90% of ulcers in this group of patients are healed without amputation. Limb-saving treatment and the use of specially selected shoes are cheaper and more cost-effective compared to the limb loss. Conclusion. The use of orthopedic shoes in patients with diabetic foot syndrome is used both for treatment and rehabilitation. This technique can reduce the risk of ulceration and prevent organ-sparing surgeries.

scholarly journals DIABETIC FOOT SYNDROME

2021 ◽  
pp. 139-143
Author(s):  
H.A. Bliznets ◽  
◽  
I.A. HadjiIsmail ◽  
A.C. Shuleiko ◽  
V.M. Shyshko ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Premature Mortality ◽  
Cost Effective ◽  
Diabetic Foot Syndrome ◽  
Vascular Lesions ◽  
Modern World ◽  
Common Disease ◽  
Cost Effective Treatment ◽  
Working Age

In the modern world, diabetes mellitus is a common disease with multiple consequences, the main complications are vascular lesions (macroangiopathy) and nerves, which are the cause of many complications, such as chronic renal failure and blindness and amputations in patients of working age, which leads to early disability and premature mortality. In the treatment of diabetes mellitus, most of the costs are for the treatment of complications, and the most cost-effective treatment is still treatment for ulcers of the feet. The article defines the essence and classification of diabetic foot syndrome, highlights the stages of diagnosis, as well as the main approaches to its treatment, describes the basics of prevention.

scholarly journals NITRIC OXIDE ROLE IN DEVELOPMENT OF THE ENDOTHELIAL DYSFUNCTION IN DIABETIC FOOT SYNDROME

2019 ◽  
Vol 43 (4) ◽  
pp. 26-30
Author(s):  
O.O. Bilyayeva ◽  
H. P. Kozynets ◽  
O. I. Osadcha ◽  
Ye. Ye. Kryzhevskyy ◽  
M. A. Knivets
Keyword(s):  
Nitric Oxide ◽  
Diabetes Mellitus ◽  
Endothelial Dysfunction ◽  
Diabetic Foot ◽  
Nitrogen Monoxide ◽  
Clinical Results ◽  
Diabetic Foot Syndrome ◽  
Capillary Zone ◽  
Endothelial Dysfunctions

Abstract Introduction. Diabetes mellitus causes many acute and chronic complications, including diabetic foot syndrome (DFS) – a serious complication that can be a test for patients and directly affect their quality of life.One of the most effective treatments for DFS is the use of nitric oxide (NO). The main advantage of using NO-therapy is the effect of polyfunctional nitrogen monoxide on all phases of purulent-inflammatory process. Purpose of the study. The nitric oxide effect features on the development of endothelial dysfunctions in patients with diabetic foot syndrome are explored. Materials and methods. In the department of purulent surgery at Kyiv City Clinical Hospital No. 6 in 2019 from January to June, 76 patients with DFS in stages II–V were treated by F. Wagner. In 47 (61.8%) patients the neuropathic form of DFS was observed, and 29 (38,2%) were neuroichemic form. According to the DFS rates of F. Wagner patients were distributed: II – 24 (31,7%) patient, III – 29 (38,1%) patient, IV – 15 (19,7%) and V stages – 8 (10,5%).All patients were studied in the capillary zone of necrotic lesions of the content of NO, the activity of superoxide dismutase (SOD). Results and discussion. The signaling role of NO in cells is highly dependent on the level of superoxide. The balance between systems that synthesize NO and superoxide determines the regulatory orientation of the signals, and its disruption contributes significantly to inflammation in diabetes. Conclusions. The use of NO-therapy helps to optimize the processes of regulation of the induction of nitric oxide and to improve the clinical results in the treatment of diabetic foot syndrome. Keywords: diabetes mellitus, diabetic foot syndrome, nitric oxide, NO-therapy, endothelial dysfunction.

COMPARATIVE ANALYSIS CLINICAL CASES WITH DIABETIC FOOT SYNDROME

2021 ◽  
pp. 11-14
Author(s):  
Б.С. ДУЙСЕМБАЕВА ◽  
А.Б. БАЙЖУМА ◽  
Н.Е. АСКАРОВА ◽  
Б. АЛИБЕКОВ ◽  
Ш.Н. КЕРЕЙ ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Comparative Analysis ◽  
Conservative Treatment ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Foot Deformities ◽  
Complications Of Diabetes ◽  
Major Factors ◽  
Clinical Cases

В обзоре рассмотрены вопросы осложнения Сахарного диабета (СД) , как синдром диабетической стопы (СДС). Охарактеризована роль деформаций стоп и инфицирования поврежденных тканей как основных факторов развития СДС. Особое внимание уделено консервативному лечению и исходам хирургического вмешательства, такие как, ампутация и прочие операции. This review deals with complications of diabetes mellitus (DM) as diabetic foot syndrome (DFS). The role of foot deformities and infection of damaged tissues as major factors in the development of DFS is characterized. Particular attention is paid to conservative treatment and surgical maneuver such as amputation and other surgeries.

scholarly journals Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome

2019 ◽  
Vol 74 (4) ◽  
pp. 283-288
Author(s):  
Petr A. Gerasimchuk ◽  
Alexander V. Shidlovskyi ◽  
Dmitriy B. Fira ◽  
Andrey V. Pavlyshyn
Keyword(s):  
Diabetes Mellitus ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Chronic Wound ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Vacuum Therapy ◽  
Social Significance ◽  
Number Of Patients ◽  
Bed Days

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.625% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 1525% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy. Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion. Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 20142017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound. Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 7080 mm Hg, which makes it possible to stop pain during the day. At 23 days of the postoperative period, negative pressure is established at standard values. Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.31.7) bed-days, and patients with ischemic form ― on average (4.11.9) bed-days, which has both medical and social significance.

scholarly journals Pedographic assessment of the impact of off-the-shelf orthopedic shoes on the load distribution under the feet in patients with a high risk of developing diabetic foot syndrome

2021 ◽  
Vol 23 (5) ◽  
pp. 442-451
Author(s):  
Vadim B. Bregovskiy ◽  
Oleg V. Udovichenko ◽  
Anastasia G. Demina ◽  
Eugenia Aleksandrovna Berseneva ◽  
Irina A. Karpova
Keyword(s):  
High Risk ◽  
Diabetic Foot ◽  
Load Distribution ◽  
Objective Assessment ◽  
Daily Basis ◽  
Diabetic Foot Syndrome ◽  
Lateral Part ◽  
Plantar Surface ◽  
The Impact ◽  
Orthopedic Shoes

BACKGROUND: It is known that the so-called “rocker” outsole helps to reduce the load on the forefoot and toes. Such an outsole is available in ready-made orthopedic shoes of some Russian manufacturers, however, an objective assessment of their impact on the load distribution under the foot during walking has not been carried out.AIMS: To study the pressure distribution inside the off-the-shelf orthopedic shoes“Sursil-Ortho” in comparison with the load inside the shoes used by patients on a daily basis.METHODS: We studied 20 patients (40 feet) with a high risk of diabetic foot syndrome. According to clinical data, a risk regions were determined on the plantar surface of the feet. In-shoe pedography (pedar, novel,Germany) was performed in shoes usually worn by the patients, and in orthopedic shoes“Sursil-Orto”(Moscow). The maximum peak pressure (MPP) was calculated. Criterion of efficiency: MPP in the risk region<200 kPa or reducing it by 25% or more.RESULTS: There was a significant decrease of the median MPP in the forefoot and in the risk region. The percentage of feet with MPP >200 kPa in the risk region decreased from 58% to 30% (p=0,014), in any area of the forefoot — from 63% to 30% (p=0,04). The increase in MPP under the midfoot and hindfoot did not exceed +14% (ns). Tested footwear was effective in 71% of cases. Predictors of the insufficient effect were: higher initial MPP in the risk region, risk region on the hallux or in the lateral part of the forefoot.CONCLUSIONS: Shoes with a rigid rocker outsole significantly reduce the pressure under the forefoot and under the toes during walking. The degree of load reduction varies: the lateral part of the forefoot and 2-5 toes are most unloaded, and the hallux and medial forefoot are slightly less.

scholarly journals Peculiarities Of Treatment Of Purulent-Necrotic Complications In Patients With Diabetic Foot Syndrome

2021 ◽  
Vol 03 (06) ◽  
pp. 116-121
Author(s):  
Abdullaev R.N. ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Septic Complications ◽  
Complications Of Diabetes ◽  
Surgical Infection ◽  
Number Of Patients ◽  
Patients With Diabetes

The number of patients with diabetes mellitus in the Andijan region who were registered according to endocrinologists from 2000 to 2015 increased almost fourfold from 26,000 to more than 110,000 in 2016 (14). This also shows that the number of patients with various purulent-necrotic complications of diabetes mellitus also increases proportionally, in addition, there is an increase in patients with severe purulent-septic complications of these processes, with widespread, deep purulent-necrotic fasciitis [3]. Of patients in the department of surgical infection of the ASMI clinic, patients with purulent-necrotic complications of diabetes mellitus account for almost 78%, which indicates a significant increase in the number of these patients. This tendency continues and goes up every year. According to the WHO, by 2030 every 15 people will have diabetes, and by 2050 this figure will be equal to every 6 people.

scholarly journals Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

2021 ◽  
Vol 27 (3) ◽  
pp. 22-28
Author(s):  
Yu.M. Babina ◽  
D.V. Dmyrtriiev ◽  
O.A. Nazarchuk ◽  
P.P. Hormash
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Povidone Iodine ◽  
Local Treatment ◽  
Lower Extremities ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

Stellenwert von mikrozirkulatorischen Untersuchungsmethoden bei Patienten mit diabetischem Fuß-Syndrom

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Lawall ◽  
Amann ◽  
Rottmann ◽  
Angelkort
Keyword(s):  
Diabetic Foot ◽  
Reactive Hyperemia ◽  
Diabetic Polyneuropathy ◽  
Capillary Density ◽  
Diagnostic Methods ◽  
Diabetic Foot Syndrome ◽  
Type I ◽  
Additional Information ◽  
Type Ii Diabetics

Background: Diabetic foot syndrome (DFS) is a frequent complication of long-standing diabetes mellitus, occurring in 10 to 30 percent of all diabetics with a vital risk for the affected limb and high mortality rates. Macroangiopathy, diabetic polyneuropathy and infections are trigger factors for DFS. Recent results imply a pathogenic role of functional and structural microcirculatory changes. The exact role of microangiopathy and the value of microcirculatory diagnostic methods in DFS have not yet been defined. Patients and methods: 78 patients with DFS (28 type I, 50 type II diabetics, mean age 63 years) were evaluated with video capillary microscopy, transcutaneous partial oxygen tension (tcpO2) measurement and laser Doppler fluxmetry (LDF) at the forefoot of the affected leg at admission and after revascularisation. Mean hospital stay was 28 ± 11.7 days. Patients were stratified according to the etiology of DFS in patients with neuropathic lesions, macroangiopathic ulcers and mixed neuropathic-angiopathic lesions. Results: All groups had impaired microcirculation, and significant differences between groups were found in respect to capillary density. Reactive hyperemia, LDF pattern and tcpO2 did not differ significantly. Microcirculatory examinations did not yield additional information to clinical and Doppler sonographic results. Conclusion: In clinical practice, the role of microcirculation evaluation techniques for diabetic foot syndrome is limited.

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