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)

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.

scholarly journals THE EFFECTIVENESS OF NEURAXIAL ANESTHESIA TECHNIQUES IN DIABETIC FOOT SURGERY

2017 ◽  
Vol 11 (2) ◽  
pp. 90-97
Author(s):  
Stanislav V. Zayashnikov ◽  
A. E Bautin ◽  
A. S Iakovlev ◽  
M. N Gurin ◽  
V. S Glebov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Retrospective Study ◽  
Blood Glucose ◽  
Spinal Anesthesia ◽  
Diabetic Foot ◽  
Foot Surgery ◽  
Patients With Diabetes ◽  
Maximum Decrease ◽  
Anesthesia Technique ◽  
Group 10

Introduction. Common is considered that surgical procedures in patients with diabetes mellitus (DM) must be performed at a stable level of blood glucose and at a stable hemodynamic. Aim. Determine effective anesthesia technique for diabetic foot (DF).surgery. Materials and methods. 30 patients (59.5 (53; 67) yr old, 16 female and 14 male) with DM and DF surgery were included in a retrospective study. Spinal anesthesia was used in 10 patients (SA group). In the presence of contraindications to spinal anesthesia we used the blockade of the sciatic nerve (SNB group, 10 patients), or general anesthesia with tracheal intubation (GA group, 10 patients). Data are presented as median (25th, 75th percentile). Results. In the SA group mean arterial pressure (MAP) decreased from baseline by more than 20% in 80% of patients, in the SNB group - in 30% (p = 0,03) and in the GA group - in 60% of patients (ns). The median of maximum decrease in MAP during anesthesia was 25 (20; 27)% for the SA group, 16 (13; 22)% for the SNB group (p = 0,03) and 21 (15; 24)% for the GA group (ns). Infusion volume was lower In SNB group than in the SA group (500 (500; 750) vs 1500 (1500; 2000) ml, p

scholarly journals Impact of diabetic (diabetes mellitus) patients immune factors on the skin cell viability in vitro

2020 ◽  
Vol 17 (3) ◽  
pp. 263-274
Author(s):  
M. A. Mashkova ◽  
T. V. Mokhort ◽  
V. A. Goranov
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Culture System ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Skin Culture ◽  
Patients With Diabetes ◽  
Immune Factors ◽  
3D Skin

At the moment, a lot of scientific research focused on the role of immune mechanisms in diabetic foot ulcers development and impaired healing. A 3D skin culture system as a relevant skin model may prove valuable in investigating these mechanisms and may be a useful tool to study interactions between different cell types such as keratinocytes, fibroblasts, and immune cells. The aim of our research was to study keratinocytes and fibroblasts viability in co-culture with immune factors of patients with diabetes mellitus type 2 (DM2) and patients with diabetes and chronic foot ulcers in a 3D skin culture system. In this study, the multilayer 3D immunocompetent model of human skin comprising keratinocytes, fibroblasts, and mononuclears in an agarose-fibronectin gel was used. The human immortalized keratinocyte cell line, HaCaT, and primary fibroblast cell culture isolated from skin samples of healthy man in abdominal surgery were used for the 3D system. For the experiment 20 % serum of 9 patients with chronic diabetic foot ulcers (without active inflammation signs), 9 diabetic type 2 patients and 9 healthy people, and mononuclears of the same groups of patients were used. 9 experimental series with 3 repeats were carried out. Mononuclears of patients with DM2 and DM2 and diabetic foot syndrome (DFS) had a greater inhibitory effect on fibroblasts, significantly inhibiting their proliferation to a level of 83.78 [79.03; 89.53] % vs 70.18 [66.38; 72.10] % vs 95.40 [91.75; 99.05] %, H = 21.259, p <0.001 – DM2, DFS, and the control group, respectively. There was no significant difference in the cytoinhibitory effect of mononuclears on keratinocytes between different groups: 96.40 [92.82; 100.50] % vs 93.61 [86.80; 97.10] % vs 92.87 [85.15; 95.25] %, H = 4.459, p = 0.108 – control, DM2 and DFS group, respectively. Adding serum to the culture system influenced significantly the viability of neither keratynocytes – 99.40 [95.35; 102.05]  % vs 98.60 [90.55; 100.40] % vs 94.79 [91.65; 98.16] %, H = 3.030, p = 0.220 nor of fibroblasts – 95.61 [92.39; 100.19] % vs 95.80 [88.99; 102.15] % vs 96.20 [99.69; 88.70] %, H = 0.353, p = 0.838, control, DM2 and DFS group, respectively. It was determined that the fibroblasts vialability significantly decreases after introducing mononuclears of patients with DM and patients with DM and chronic diabetic foot ulcers to the co-culture system. Adding serum of these patient groups to the culture system doesn’t influence significantly the viability of skin cells.

scholarly journals Drugs abuse and increase in referral to hospital to prevent recurrence of diabetic foot ulcer infection

2019 ◽  
Vol 10 (1) ◽  
pp. 89-94
Author(s):  
Mostafa Madmoli ◽  
Yaghoob Madmoli ◽  
Fariba Mobarez ◽  
Hosein Taqvaeinasab ◽  
Pouriya Darabiyan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Drug Abuse ◽  
Significant Relationship ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes ◽  
History Of

Introduction: Diabetic foot ulcer is one of the complications of diabetes. This study was aimed to determine drugs abuse and increase in referral to hospital to prevent recurrence of diabetic foot ulcer infection. Materials and Methods: In this retrospective cross-sectional analytical descriptive study, 1693 patients with diabetes between 2015-17 were enrolled. Files of this number of diabetic patients admitted to khatam-ol-Anbia hospital in shoushtar city were studied. Data were entered into SPSS software version 18 and analyzed using descriptive statistics, analytical tests. Results: In this study 1693 patients with diabetes mellitus with a mean age of 52.13 ± 53.22 years. In the case of diabetic foot ulcers, 9.5% of the patients had diabetic foot ulcers and 4.8% had a history of amputation and 2.4% of the patients had a history of surgery on their diabetic ulcer. In this study, a significant relationship was found between education level and diabetic foot ulcer (p <0.003). Also, there was a significant relationship between limb amputation and drug abuse or smoking (P = 0.009). In this study, patients who had drug and smoking or smoking 4.3% more than those who did not consume, they were referred to the hospital to prevent recurrence of foot ulcer infection. In this study, there was a significant relationship between drug abuse or smoking and the rate of surgery in diabetes mellitus (P = 0.007). Conclusion: Given that in this study, patients who had drug and smoking or smoking 4.3% more than those who did not consume, they were referred to the hospital to prevent recurrence of foot ulcer infection. In this study, there was a significant relationship between drug abuse or smoking and the rate of surgery in diabetes mellitus. Therefore, there is a suggestion to reduce the consumption or abandonment of drugs and smoking.  

Factors associated with pedal ulceration in patients with diabetes mellitus

1997 ◽  
Vol 87 (8) ◽  
pp. 365-369 ◽  
Author(s):  
MR Day ◽  
LB Harkless
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Diabetic Foot ◽  
Successful Management ◽  
Factors Associated ◽  
Patients With Diabetes

Understanding the factors associated with pedal ulceration in patients with diabetes mellitus will increase the successful management of the high-risk diabetic foot and decrease the occurrence of ulcerative events. The authors review the associative factors that have been shown to be involved with pedal ulceration.

scholarly journals Do Patients With Diabetes Mellitus Want Wearable Technology to Prevent Diabetic Foot Ulcers?

2019 ◽  
Vol 13 (4) ◽  
pp. 799-800
Author(s):  
Taylor Novice ◽  
Chandu Vemuri ◽  
Catherine Gilbert ◽  
Anthony Fici ◽  
Elizabeth VanWieren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Wearable Technology ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes

Severe Vitamin D3 Deficiency in the Majority of Patients with Diabetic Foot Ulcers

2018 ◽  
Vol 50 (08) ◽  
pp. 615-619 ◽  
Author(s):  
Joachim Feldkamp ◽  
Karsten Jungheim ◽  
Matthias Schott ◽  
Beatrix Jacobs ◽  
Michael Roden
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Cell Function ◽  
Glycosylated Hemoglobin ◽  
Diabetic Foot Syndrome ◽  
Foot Ulcers ◽  
Control Group ◽  
Diabetic Foot Ulcers ◽  
Healthy Humans ◽  
Patients With Diabetes

AbstractDiabetic foot ulcers are a severe complication in patients with diabetes mellitus. Vitamin D is associated with impaired β-cell function and insulin resistance, and is necessary for wound healing and bone metabolism. We measured the serum concentrations of 25-hydroxyvitamin D3 in 104 patients (63 inpatients, 41 outpatients) with diabetic foot ulcers and compared them to 99 healthy humans (control) and 103 patients with diabetes mellitus type 2 without diabetic foot ulcers. Calcium, creatinine, and parathyroid hormone were measured in patients with diabetic foot ulcers. The data were analysed together with glycosylated hemoglobin A1c and the severity of diabetic foot lesions according to the Armstrong classification. Levels of 25-hydroxyvitamin D3 were lower (11.8±11.3 ng/ml, p<0.001) in patients with diabetic foot ulcers (mean age 70±12 years) than in the control group (27.2±12.2 ng/ml). No difference was found between in- and outpatients. Fifty-eight (55.8%) of patients with diabetic foot ulcers had a severe 25-hydroxyvitamin D3 deficiency with levels below 10 ng/ml. Only 12% of the patients had 25-hydroxyvitamin D3 levels above 20 ng/ml. Secondary hyperparathyroidism was found in 27.9% of patients and 11.5% of the patients were hypocalcemic. There was a negative correlation (r=–0.241) (p<00.1) between Armstrong classification and 25-hydroxyvitamin D3 status. In conclusion, patients with diabetic foot syndrome are at high risk of 25-hydroxyvitamin D3 deficiency. Thus, any patient with diabetic foot syndrome should undergo 25-hydroxyvitamin D3 measurement and supplementation, if values are found to be decreased.

scholarly journals Risk Factors for Diabetic Foot Ulcers in Metreleptin Naïve Patients With Lipodystrophy

2021 ◽  
Author(s):  
Onur Saydam ◽  
Basak Ozgen Saydam ◽  
Suleyman Cem Adiyaman ◽  
Melda Sonmez Ince ◽  
Mehmet Ali Eren ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Partial Lipodystrophy ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract AimPatients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population.MethodsNinety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers).Results Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95%CI: 3.31 - 503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95%CI: 2.97 - 246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95%CI: 1.96 - 90.67, p = 0.008).ConclusionOur study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

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