scholarly journals Diabetic Foot Infection Impostors

2016 ◽  
Vol 3 (2) ◽  
pp. 88-91
Author(s):  
Radhika Jindal ◽  
Subhash K Wangnoo ◽  
Mohammad A Siddiqui
Keyword(s):  
Diabetic Foot ◽  
Erythema Nodosum ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Venous Ulcer ◽  
Asia Pacific ◽  
Thromboangiitis Obliterans ◽  
Therapeutic Approaches ◽  
Diabetic Foot Infection ◽  
Foot Complications

ABSTRACT Diabetic foot complications continue to be the main reason for diabetes-related hospitalization and lower extremity amputations. Most can be cured if managed properly. But improper diagnostic and therapeutic approaches result in many patients needlessly undergoing amputations. There are many other conditions “imposing” as a diabetic foot, which may mislead the diagnosis and management. One should be aware of these conditions and keep a watchful eye for them as well in a diabetic patient. Every ulcer in a diabetic need not be a diabetic foot ulcer. Some of these diabetic foot infection imposters are discussed herewith and these include pyoderma gangrenosum, squamous cell carcinoma in a chronic ulcer, venous ulcer, bullosis diabeticorum, necrobiosis lipoidica diabeticorum, malignant melanoma, thromboangiitis obliterans (TAO), superficial thrombophlebitis, erythema nodosum, and granuloma annulare. How to cite this article Wangnoo SK, Jindal R, Siddiqui MA. Diabetic Foot Infection Impostors. J Foot Ankle Surg (Asia- Pacific) 2016;3(2):88-91.

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

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.

Exploring Diabetic Foot Exam Performance in a Specialty Clinic

2016 ◽  
Vol 26 (1) ◽  
pp. 82-92 ◽  
Author(s):  
Jesse Pocuis ◽  
Sam Man-Hoi Li ◽  
Mary M. Janci ◽  
Hilaire J. Thompson
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Exam Performance ◽  
Specialty Clinic ◽  
Foot Complications ◽  
Improve Compliance ◽  
And Performance ◽  
Self Examination ◽  
Record Review

Detection of diabetic foot complications is key to amputation prevention. This study used survey and retrospective record review to examine the relationship between frequency and performance of clinician’s diabetic foot examinations on performance of patient home self-foot examinations. An additional aim was to assess clinician performance of annual foot examination per American Diabetes Association (ADA) guidelines in a specialty clinic. The relationships between demographic characteristics, diabetic foot ulcer beliefs, health literacy, HbA1c level, and foot self-exam performance was also examined. No relationship was found between the performance frequency of foot examinations by providers and patient self-examination ( N = 88). The presence of specific barriers to self-management was significantly higher in those patients who did not complete daily home self-foot examinations. Only 16% of patients’ charts reviewed met the ADA criteria for a complete annual foot exam. Motivational interviewing during patient visits could be a strategy to break down barriers to self-foot exam performance. Furthermore, the development of an Electronic Medical Record (EMR)–based diabetic foot exam template to improve provider documentation may improve compliance with ADA recommendations.

Predicting diabetic foot ulcer infection using the neutrophil-to-lymphocyte ratio: a prospective study

2019 ◽  
Vol 28 (9) ◽  
pp. 601-607 ◽  
Author(s):  
Fatma Aybala Altay ◽  
Semanur Kuzi ◽  
Mustafa Altay ◽  
İhsan Ateş ◽  
Yunus Gürbüz ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Early Stage ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Neutrophil To Lymphocyte Ratio ◽  
Vascular Intervention ◽  
Diabetic Foot Infection ◽  
Lymphocyte Ratio ◽  
A Prospective Study

Objective: To investigate whether the neutrophil-to-lymphocyte ratio (NLR) may be used in the early stage risk assessment and follow-up in diabetic foot infection Methods: Over a five-year study, NLR values on admission and day 14 of treatment were matched with their laboratory and clinical data in a cohort study. Patients were followed-up or consulted in several clinics or polyclinics (infectious diseases). Results: Admission time NLR was higher, in severe cases as indicated by both Wagner and PEDIS infection scores (severe versus mild Wagner score NLR 6.7 versus 4.2; p=0.04; for PEDIS score NLR 6.3 versus 3.6; p=0.03, respectively). In patients who underwent vascular intervention (12.6 versus 4.6; p=0.02); amputation indicated (9.2 versus 4.1; p=0.005) and healed afterwards (6.9 versus 4.3; p<0,001), when matched with others. NLR was also found to be correlated with duration of both IV antibiotic treatment (r=0.374; p=0.005) and hospitalisation (r=0.337; p=0.02). Day 14 NLR was higher in patients who underwent vascular intervention (5.1 versus 2.9; p=0.007) when matched to others. Conclusion: Patients with higher NLR values at admission had more severe diabetic foot infection, higher risk for amputation, need for long-term hospitalisation and aggressive treatment. However, they also have more chance of benefit from treatment.

Management of Diabetic Foot Ulcer by Nishadi Yoga Avachoornana - A Case Study

2017 ◽  
Vol 2 (06) ◽  
Author(s):  
Chiranth Kumar R. ◽  
Syeda Ather Fathima
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Life Style ◽  
Genetic Factor ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Complications ◽  
Scientific Approach

Diabetes is considered as ‘ice burg’ of diseases as only 1/3rd of its manifestations can be made out clinically, though the exact cause is not known following are the theories put forth to explain diabetes mellitus - Genetic factor, Life style disorder, Autoimmune cause. Slight injury to glucose laden tissue will cause infection which is precipitated by an ulcer and it tends to a state of non - healing. Main stay of treatment includes antibiotics, debridement, local wound care. Inspite of these treatments there is less reduction in the statistics of diabetic foot complications and amputations. In Sushrutha Samhitha we get the most scientific approach for the management of Vrana, where Sushrutha has mentioned 60 Upakrama’s (modalities of treatment) of which Avachoornana (dusting) is one modality, seen to be effective in the management of diabetic non healing ulcers (Madhu Mehaja Dusta Vrana).

scholarly journals Sonication of Kirschner Wire as a Tool for the Microbiological Diagnosis of Diabetic Foot Infection – Preliminary Results

2021 ◽  
Author(s):  
Rodrigo Paes Cuiabano Leme ◽  
Jéssica Chaves ◽  
Luiz Carlos Gonçalves ◽  
Leonardo César Alvim ◽  
João Roberto Chaves de Almeida ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Steel Wire ◽  
Statistical Significance ◽  
Kirschner Wire ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Culture Method ◽  
Wilcoxon Test ◽  
Tissue Samples ◽  
Diabetic Foot Infection

Background: Diabetic foot infection (DFI) is the commonest diabetic problem requiring hospital admission. Culture yield can be challenging, particularly in the presence of biofilms. Literature confirms biofilms are ubiquitous in diabetic foot ulcer, although, there is not a microbiologic diagnostic approach regarding biofilm disruption on DFI. We postulated sonicating a stainless-steel wire along with tissue samples into the thioglycollate broth media (TBM) may improve the diagnosis of DFI. Method: Pro-spective unicentric study that assessed patients with DFI who underwent surgical debridement. The vascular surgery team collected tissue fragments and inoculated the specimens into three TBM to execute the conventional culture method (CCM), and ad-ditional fragments to place into other TBM along with a Kirschner wire (K-wire &ndash; Kw method). The microbiologist processed the samples and the resultant sonication fluid in aerobic sheep-blood agar after 24 hours, 5 and 10 days of incubation. Both methods were compared (Wilcoxon test; p &lt; 0.05). Results: The number of pathogens isolated in each method was not statistically significant (p = 0.414): CM = 1.67 (&plusmn; 0.92); KwM = 1.75 (&plusmn; 0.94). The KwM was not inferior to CCM. In addition, despite the absence of statistical significance, the KwM detected more pathogens than CCM.

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

scholarly journals Epidemiology of Diabetic Foot Infection in the Metro-Detroit Area With a Focus on Independent Predictors for Pathogens Resistant to Recommended Empiric Antimicrobial Therapy

2018 ◽  
Vol 5 (11) ◽  
Author(s):  
Oryan Henig ◽  
Jason M Pogue ◽  
Raymond Cha ◽  
Paul E Kilgore ◽  
Umar Hayat ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Treatment Guidelines ◽  
Medical Center ◽  
Foot Ulcer ◽  
Care Facility ◽  
Diabetic Foot Ulcer ◽  
Current Treatment ◽  
Term Care ◽  
Diabetic Foot Infection ◽  
History Of

Abstract Background The polymicrobial nature of diabetic foot infection (DFI) and the emergence of antimicrobial resistance have complicated DFI treatment. Current treatment guidelines for deep DFI recommend coverage of methicillin-resistant Staphylococcus aureus (MRSA) and susceptible Enterobacteriaceae. This study aimed to describe the epidemiology of DFI and to identify predictors for DFI associated with multidrug-resistant organisms (MDROs) and pathogens resistant to recommended treatment (PRRT). Methods Adult patients admitted to Detroit Medical Center from January 2012 to December 2015 with DFI and positive cultures were included. Demographics, comorbidities, microbiological history, sepsis severity, and antimicrobial use within 3 months before DFI were obtained retrospectively. DFI-PRRT was defined as a DFI associated with a pathogen resistant to both vancomycin and ceftriaxone. DFI-MDRO pathogens included MRSA in addition to PRRT. Results Six-hundred forty-eight unique patients were included, with a mean age of 58.4 ± 13.7 years. DFI-MDRO accounted for 364 (56%) of the cohort, and 194 (30%) patients had DFI-PRRT. Independent predictors for DFI-PRRT included history of PRRT in a diabetic foot ulcer, antimicrobial exposure in the prior 90 days, peripheral vascular disease, and chronic kidney disease. Long-term care facility residence was independently associated with DFI due to ceftriaxone-resistant Enterobacteriaceae, and recent hospitalization was an independent predictor of DFI due to vancomycin-resistant Enterococcus. Conclusions An unexpectedly high prevalence of DFI-PRRT pathogens was identified. History of the same pathogen in a prior diabetic foot ulcer and recent antimicrobial exposure were independent predictors of DFI-PRRT and should be considered when selecting empiric DFI therapy.

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