scholarly journals Physician expert in diabetes is the natural team leader for managing diabetic patients with foot complications. A position statement of the Italian Diabetic Foot Study Group

2019 ◽  
Vol 22 (3) ◽  
pp. 108
Author(s):  
Anichini, R.
Keyword(s):  
Diabetic Foot ◽  
Complex Disease ◽  
Arterial Disease ◽  
Position Statement ◽  
Team Leader ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Patient Centered ◽  
Foot Complications ◽  
Podiatric Surgery

Diabetic Foot Syndrome (DFS) is a complex disease to be managed by a Multi Disciplinary Team (MDT). Nevertheless, a Team Leader (TL) should be designated to collaborate with members of the MDT in a patient-orientated approach. A TL should know and manage diabetes, related complications and comorbidities. The TL should have deep knowledge of peripheral neuropathy and arterial disease and be able to diagnose and manage foot infections, including prompt surgical treatment when needed. In Italy, after the pioneering phase in which diabetologists began managing medical and surgical aspects of DFS to fill unmet needs, nowadays there is a network of Diabetic Foot (DF) clinics managed by diabetologists. Italy is one of the countries belonging to Organization for Economic Cooperation and Development (OECD) with the lowest amputation rate in diabetic patients. In addition to the special attention to the care of diabetes, the unique expertise of diabetologists involved in DF management may have been a contributing factor. They all share a “patient centered model” of care mainly related to their internal medicine background and have skills in podiatric surgery to manage the specific needs of DF patients with acute or chronic conditions in a timely manner. In Italy, specific training courses and university master programs have been developed in recent years, to prepare internists (diabetologists/endocrinologists) to become TL’s. This has allowed DF care to move from the initial pioneering phase to a more structured phase, with the creation of specific pathways and roles. KEY WORDS diabetes; diabetic foot; multidisciplinary Team; Team Leader

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.

Diabetic Foot and Footwear

2015 ◽  
Vol 19 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Luximon Ameersing ◽  
Ganesan Balasankar ◽  
Younus Abida
Keyword(s):  
Diabetic Foot ◽  
Plantar Pressure ◽  
Arterial Disease ◽  
Sensory Loss ◽  
Foot Deformities ◽  
Diabetic Patients ◽  
Body Parts ◽  
Foot Ulceration ◽  
Materials Used ◽  
Peripheral Arterial

Diabetes mellitus is one of the most common diseases around the world, and mainly affects the foot among the human body parts. The main causes of the diabetic foot are neuropathy, peripheral arterial disease and foot deformities; it leads to foot ulceration. Generally, sensory loss, high plantar pressure, foot deformities, inappropriate footwear, blindness, and age are the causing risk factors for developing foot ulceration in diabetic patients. Foot ulceration will result in prolonged hospitalization, high medical expenses, and serious complications with lower extremity amputation. For a long time, appropriate footwear has been recommended by physicians for reducing plantar pressure to prevent foot ulceration, the risk of amputation, and re-ulceration. A review is provided in this article towards the existing literature on the causes and prevalence of the diabetic foot, foot ulceration, off-loading pressure, footwear modification for different types of diabetic foot deformities, and types of footwear and textile materials used in footwear insoles for healing purposes.

scholarly journals Prevention and treatment of diabetic foot ulcers

2017 ◽  
Vol 110 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Jonathan Zhang Ming Lim ◽  
Natasha Su Lynn Ng ◽  
Cecil Thomas
Keyword(s):  
Diabetic Foot ◽  
Healthcare Access ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Care ◽  
Healthcare Provision ◽  
Foot Complications

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

AN APPROACH TO DIAGNOSIS AND MANAGEMENT OF DIABETIC FOOT

2021 ◽  
pp. 21-23
Author(s):  
Anil Kumar ◽  
Md Aiman Khursheed ◽  
Debarshi Jana
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Patients ◽  
The West ◽  
Metabolic Complications ◽  
Medical College ◽  
The North ◽  
Foot Complications ◽  
Strict Glycemic Control ◽  
Peripheral Pulse

INTRODUCTION India has the dubious distinction of becoming the diabetic capital of the world within the next few years; with its attendant complications it is going to burden the resources of the country. In the past, the diabetics succumbed to the metabolic complications like ketoacidosis, but now they survive long enough to develop and succumb to the diabetic nephropathy and diabetic foot complications. AIMS AND OBJECTIVES The various predisposing factors for diabetic foot with respect to North Bihar population. To analyse the different ways of clinical presentation of diabetic foot in our hospital. To evaluate the usefulness of surgical management available with special emphasis on strict glycemic control. To determine commonest microorganism/s infecting the diabetic foot patients in the North Bihar Population. MATERIALS AND METHODS Department of General Surgery, DARBHANGA MEDICAL COLLEGE AND HOSPITAL, LAHERIASARAI. Diabetic patients with foot ulcers admitted in this hospital, according to the WHO criteria, were selected for this study for 1 Year 8 month (April 2019 to December 2020). RESULTS AND ANALYSIS We found peripheral Pulse of 37.9% of the patients was absent. Infection was present in 86.2% of the cases which was signicantly higher (Z=10.23;p<0.0001). Ulcers were mostly at dorsum (22.4%) (Z=1.58;p=0.11) followed by fore foot (13.8%) and great toe (13.8%). Ulcers were mostly right sided (67.2%) followed by left sided (31.0%) (Z=5.12;p<0.001). Only 1(1.7%) patients had bilateral infection. CONCLUSION The prevalence of risk factors for foot ulcer and infections, viz., neuropathy and vasculopathy, are different from the Western literature. Studies from India, suggest predominantly neuropathic ulcers unlike the West where neuroischemia is the most important predisposing factor.As compared to the West, which have predominant Gram-positive infections, centers throughout India have reported a consistent Gramnegative bacterial preponderance in DFI.

Medical management of the diabetic patient during podiatric surgery

1994 ◽  
Vol 84 (9) ◽  
pp. 432-438 ◽  
Author(s):  
SB Lewis ◽  
CF Biondo ◽  
JC Page
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Diabetic Foot ◽  
Postoperative Care ◽  
Medical Management ◽  
Perioperative Management ◽  
Diabetic Patients ◽  
Foot Surgery ◽  
Podiatric Surgery ◽  
Enhance Wound Healing

Diabetes mellitus commonly causes complications of the foot that can lead to surgery. The appropriate perioperative management of diabetic patients can reduce the morbidity and mortality associated with diabetic foot surgery and enhance wound healing. The authors review the effects of hyperglycemia, detail preoperative, intraoperative, and postoperative care, and describe anesthetic choices. An algorithm for management of hypoglycemia is offered.

scholarly journals Local Antibiotic Delivery Systems: Current and Future Applications for Diabetic Foot Infections

2018 ◽  
Vol 17 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Konstantinos Markakis ◽  
Alan Robert Faris ◽  
Hamed Sharaf ◽  
Barzo Faris ◽  
Sharon Rees ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Blood Perfusion ◽  
Arterial Disease ◽  
Major Amputation ◽  
Delivery Systems ◽  
Systemic Absorption ◽  
Diabetic Patients ◽  
Routine Practice ◽  
Natural Polymers ◽  
Diabetic Foot Infections

Foot infections are common among diabetic patients with peripheral neuropathy and/or peripheral arterial disease, and it can be the pivotal event leading to a minor or major amputation of the lower extremity. Treatment of diabetic foot infections, especially deep-seated ones, remains challenging, in part because impaired blood perfusion and the presence of biofilms can impair the effectiveness of systemic antibiotics. The local application of antibiotics is an emerging field in the treatment of diabetic foot infections, with demonstrable advantages. These include delivery of high concentrations of antibiotics in the affected area, limited systemic absorption, and thus negligible side effects. Biodegradable vehicles, such as calcium sulfate beads, are the prototypical system, providing a good elution profile and the ability to be impregnated with a variety of antibiotics. These have largely superseded the nonbiodegradable vehicles, but the strongest evidence available is for calcium bead implantation for osteomyelitis management. Natural polymers, such as collagen sponge, are an emerging class of delivery systems, although thus far, data on diabetic foot infections are limited. There is recent interest in the novel antimicrobial peptide pexiganan in the form of cream, which is active against most of the microorganisms isolated in diabetic foot infections. These are promising developments, but randomized trials are required to ascertain the efficacy of these systems and to define the indications for their use. Currently, the role of topical antibiotic agents in treating diabetic foot infections is limited and outside of routine practice.

scholarly journals Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

2020 ◽  
Vol 54 (3) ◽  
pp. 207-216
Author(s):  
Ignatius U. Ezeani ◽  
Ejiofor T. Ugwu ◽  
Funmi O. Adeleye ◽  
Ibrahim D. Gezawa ◽  
Innocent O. Okpe ◽  
...  
Keyword(s):  
Wound Healing ◽  
Renal Impairment ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Adverse Outcomes ◽  
Diabetic Patients ◽  
Chi Square ◽  
Grade 3

AbstractObjective. The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU.Methods. The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing.Results. The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004–0.332). This was followed by PAD (OR 0.093; 95% CI 0.028–0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030–0.395), anemia (OR 0.179; 95% CI 0.056–0.571).Conclusion. Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.

scholarly journals Classification of Doppler Ultrasound Blood Flow Signals of Lower Extremity Arteries for the Early Detection of Diabetic Foot

2021 ◽  
Vol 10 (6) ◽  
pp. 210-215
Author(s):  
Suresh KS ◽  
◽  
Prof. (Dr.) Vijayakumar N ◽  
Prof. (Dr.) Sukesh Kumar A ◽  
◽  
...  
Keyword(s):  
Blood Flow ◽  
Lower Extremity ◽  
Diabetic Foot ◽  
Early Stage ◽  
Arterial Disease ◽  
Diagnostic Techniques ◽  
Posterior Tibial Artery ◽  
Machine Learning Algorithms ◽  
Diabetic Patients ◽  
Ultrasound Doppler

Peripheral arterial disease is one of the key indicators of diabetic foot, which can be easily identified by ultrasound diagnostic techniques. The work aims to detect diabetic foot in early stages by classifying the blood flow signals of lower extremity arteries being captured by ultrasound doppler methods. Samples are collected from diabetic patients with and without having probable symptoms of arterial diseases. Doppler examination has been conducted on posterior tibial artery for 354 subjects with a transducer of 8 MHz frequency. The auscultation, method of listening sounds of internal organs, is employed as medical diagnostic tool for identifying pathological conditions. Each artery in the human body has a unique profile of Doppler flow. This fixed profile may be changed with the presence of a particular disease. The received signal has a spectrum of Doppler-shifted signals with respect to the existence of a velocity profile across the vessel lumen. Changes to the shape of this profile is an indicator of the severity of disease. Various features are extracted by using various statistical and signal processing functions. The feature analysis was accomplished with machine learning algorithms. Naïve Bayes, Tree and SVM algorithms are employed with MATLAB Toolboxes. Comparing the performance of these algorithms, the Tree method is found superior than the others. So, the proposed classification methodology can be employed as a key factor for the early stage detection of diabetic foot. As diabetic foot is correlated with many other parameters which effects the pressure and flow velocity of lower extremities, an integrated disease prediction model is proposed by incorporating the ultrasound doppler technique.

New possibilities of maximal revascularization of the foot as a limb salvage procedure in diabetics

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 278-283 ◽  
Author(s):  
Sauvant ◽  
Hüttenmoser ◽  
Soyka ◽  
Rüttimann
Keyword(s):  
Diabetic Foot ◽  
Arterial Disease ◽  
Major Amputation ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Salvage Procedure ◽  
Critical Ischemia ◽  
Peripheral Arterial

Diabetics and patients with chronic renal insufficiency often have severe peripheral arterial disease of the distal lower limbs with obstructions of crural and pedal arteries and the imminent risk of critical ischemia and major amputation. Neuroischemic foot ulcers have been shown to fail to heal even after successful arterial revascularization. We report on two diabetic patients with the neuroischemic diabetic foot syndrome and different clinical outcomes after percutaneous transluminal angioplasty of chronic occluded crural arteries and discuss, whether endovascular revascularisation of infrapopliteal and pedal arteries, if possible with complete plantar arch, could promote ulcer healing in neuroischemic diabetic foot ulcers.

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