Reversible Secondary Osteolysis in Diabetic Foot Infection

2017 ◽  
Vol 107 (6) ◽  
pp. 538-540 ◽  
Author(s):  
Partha P. Chakraborty ◽  
Ajitesh Roy ◽  
Rana Bhattacharjee ◽  
Satinath Mukhopadhyay ◽  
Subhankar Chowdhury
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Elevated Level ◽  
Bone Matrix ◽  
Surgical Interventions ◽  
Diabetic Foot Infection ◽  
Plain Radiographs ◽  
Foot Complications ◽  
Increased Blood Flow

Osteolysis, caused by active resorption of bone matrix by osteoclasts, can be primary or can develop secondary to a variety of disease processes. An elevated level of inflammatory cytokines in the local milieu and increased blood flow secondary to infection or autonomic neuropathy stimulate the osteoclasts and cause bone loss in the diabetic foot. Charcot's neuroarthropathy and osteomyelitis are well-known foot complications of diabetes, and secondary osteolysis has largely been underappreciated and, hence, underreported. Plain radiographs, an initial component in the evaluation of the diabetic foot, may not successfully differentiate secondary osteolysis from osteomyelitis. We describe a patient with phalangeal osteolysis secondary to soft-tissue infection in whom a correct and timely diagnosis helped avoid unnecessary surgical interventions.

Soft Tissue Reconstruction Pyramid in the Diabetic Foot

2010 ◽  
Vol 3 (5) ◽  
pp. 241-248 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Weight Bearing ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Best Interest ◽  
Foot Complications ◽  
Uncontrolled Diabetes ◽  
Wound Healing Response ◽  
Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

scholarly journals Antibodies to Staphylococcus aureus Bone Sialoprotein-Binding Protein Indicate Infectious Osteomyelitis

2009 ◽  
Vol 16 (6) ◽  
pp. 949-952 ◽  
Author(s):  
Lena Persson ◽  
Christian Johansson ◽  
Cecilia Rydén
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Matrix Protein ◽  
Binding Protein ◽  
Bone Matrix ◽  
Clinical Problem ◽  
Bone Sialoprotein ◽  
Diabetic Foot Infections ◽  
Bone Matrix Protein

ABSTRACT Discrimination of soft tissue infection from osteomyelitis in diabetic foot infections is a common clinical problem. Staphylococcus aureus isolates from patients with osteomyelitis express bone sialoprotein-binding protein (Bbp) that binds the bone matrix protein bone sialoprotein. The serological assay with Bbp discriminated cases of osteomyelitis from soft tissue infections in patients with diabetic foot ulcers.

Evaluation of Adherence to the Oral Antibiotic Treatment in Patients With Diabetic Foot Infection

2021 ◽  
pp. 153473462110573
Author(s):  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Yolanda García-Álvarez ◽  
Mateo López-Moral ◽  
Francisco Javier Álvaro-Afonso ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Soft Tissue ◽  
Antibiotic Treatment ◽  
Diabetic Foot ◽  
Diabetic Patients ◽  
Oral Antibiotic ◽  
Diabetic Foot Infection ◽  
Adherence Scale ◽  
Method Of Evaluation ◽  
Well Level

Introduction: The knowledge about level of adherence to oral antibiotic treatment in diabetic patients with ulcer infection could be essential as a method of evaluation/monitoring of conservative treatment. Aim: To assess the adherence to oral antibiotic treatment in outpatients with diabetic foot infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale. Methods: cross-sectional study was carried out with 46 consecutive patients who had diabetic foot infection (soft tissue or bone infection) and required antibiotic oral treatment at outpatient clinical setting. Medication adherence was tested using the Spanish version of the validated eight-item self-report MMAS-8. Results: patients with diabetic ulcer infection, had well level of adherence to antibiotic medication (7   ±   1.2 vs. 7.4   ±   1.5). Patients with lower level of adherence had lower level of satisfaction with the antibiotic medication. The profile of the patients with lower level of adherence were patients with primary level of education and patient who required more help to take the medication. Conclusion: Patients with diabetic foot infection demonstrated well level of adherence to antibiotic medication, independently of type of infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale.

scholarly journals Penetration of Piperacillin and Tazobactam into Inflamed Soft Tissue of Patients with Diabetic Foot Infection

2005 ◽  
Vol 49 (10) ◽  
pp. 4368-4371 ◽  
Author(s):  
F. J. Legat ◽  
R. Krause ◽  
P. Zenahlik ◽  
C. Hoffmann ◽  
S. Scholz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Extracellular Space ◽  
Soft Tissues ◽  
In Vivo Microdialysis ◽  
Diabetic Foot Infection

ABSTRACT We investigated the pharmacokinetics of piperacillin and tazobactam in the extracellular space fluid of inflamed soft tissues of six patients with diabetic foot infection using in vivo microdialysis and found similar penetration for piperacillin but not for tazobactam into inflamed and noninflamed soft tissue.

scholarly journals Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

2018 ◽  
Vol 56 (1) ◽  
pp. 3-8
Author(s):  
Dimitrios Velissaris ◽  
Nikolaos-Dimitrios Pantzaris ◽  
Christina Platanaki ◽  
Nikolina Antonopoulou ◽  
Charalampos Gogos
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Diabetic Foot ◽  
Assessment Tool ◽  
Tissue Infection ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Mortality And Morbidity ◽  
Diabetic Foot Infection ◽  
Patients With Diabetes

Abstract Diabetic foot ulcers (DFUs) are a very common cause of mortality and morbidity. The distinction between infected and non-infected DFU remains a very challenging task for clinicians in everyday practice. Even when infection is documented, the spectrum of diabetic foot infection is wide, ranging from cellulitis and soft tissue infection to osteomyelitis. Procalcitonin (PCT), a well-established sepsis biomarker, has been used in the diagnosis of several infections including osteomyelitis in patients with diabetes mellitus. This review gathers and presents all the relevant data, up until now, regarding the use of PCT as an assessment tool in diabetic patients with foot infection. Current evidence suggests that PCT levels could aid clinicians in distinguishing infected from non-infected DFUs as well as in the distinction between soft tissue infection and bone involvement, but further and larger studies are warranted to confirm these findings.

scholarly journals Clinicopathological study and management of diabetic foot

2017 ◽  
Vol 4 (12) ◽  
pp. 3928
Author(s):  
Chethan L. ◽  
Amith K. M.
Keyword(s):  
Diabetic Foot ◽  
Treatment Modalities ◽  
Incision And Drainage ◽  
Surgical Interventions ◽  
Wound Debridement ◽  
Knee Amputation ◽  
Foot Complications ◽  
History Of ◽  
Control Of Diabetes ◽  
Split Skin

Background: The main objectives were to study the bacteriology, pathophysiology of diabetic foot, various limb salvage procedures and outcome, different treatment modalities and newer techniques wherever applicable to prevent complications and to minimise the progression of occurred complication.Methods: 50 patients admitted with diabetic foot presenting with lesions of foot were selected for the study and were managed conservatively and surgical interventions if needed.Results: Majority of the patients in the study revealed history of trauma preceding the foot complications and the chances of injury increased in these patients because of increased incidence of ischemia, neuropathy and infection. 15 patients in this study had neuropathy, 8 patients had ischemia and all cases were culture positive. 16 cases were managed by daily dressing and wound debridement, and slough excision. 9 patients were treated with Split skin graft, 6 patients with incision and drainage (IandD) for abscess and fasciotomy, 10 cases with disarticulation, below knee amputation (BKA) was done in 4 cases and above knee amputation (AKA) in 5 cases.Conclusions: Males are almost four times more affected than females, duration of diabetes varied from 1 year to 22 years and many patients were diagnosed post admission, trivial trauma of some kind was the initiating factor in nearly half of the cases, commonest presenting lesion was Ulcer 52%, conservative treatment consisting of control of diabetes was effective. Wound debridement, slough excision followed by dressing resulted in healing in some cases. Split skin grafts, Disarticulation, below knee amputation and above knee amputations were the other modes treatment.

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.

Evaluating the Far-Infrared Radiation Bioeffects on Micro Vascular Dysfunction, Nervous System, and Plantar Pressure in Diabetes Mellitus

2019 ◽  
Vol 19 (2) ◽  
pp. 125-131
Author(s):  
Yi-Ching Cheng ◽  
Chi-Wen Lung ◽  
Yih-Kuen Jan ◽  
Fang-Chuan Kuo ◽  
Yung-Sheng Lin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Plantar Pressure ◽  
Infrared Radiation ◽  
Sensory Nerve ◽  
Far Infrared ◽  
Medical Attention ◽  
Before And After ◽  
Far Infrared Radiation

The most frequent clinical complication is diabetes. Diabetes is characterized by elevated blood glucose levels resulting in sensory nerve damage or lesions. Diabetic foot wounds are often slow to heal and require medical attention and monitoring. This study evaluates the effect of far-infrared radiation on the microcirculation and plantar pressure in the diabetic foot. Ten diabetics and 4 nondiabetics were recruited in this study. The diabetic group was examined before and after the intervention in each month for 3 consecutive months. Four nondiabetic groups were also measured before and after the intervention for 2 weeks in each month. The surface temperature and blood flow in the diabetic foot was significantly improved (temperature: 32.1 ± 2.3°C vs 33.5 ± 2.2°C, P < .05; blood flow image: 118.3 ± 58.1 PU [perfusion unit] vs 50.4 ± 4.3 PU, P < .05). The sympathetic nerve activity index LF also increased from 40.8 ± 18.6% to 61.8 ± 13.5% ( P = .07) in the second month. Plantar pressure tended to increase in the third month. This might indicate that far-infrared radiation could affect the mechanical properties of the plantar foot soft tissue. These results indicated that the effects of far-infrared radiation would improve blood circulation and change the soft tissue properties in the diabetic foot.

scholarly journals The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

2021 ◽  
Vol 9 ◽  
Author(s):  
Gayathri Victoria Balasubramanian ◽  
Nachiappan Chockalingam ◽  
Roozbeh Naemi
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Applied Pressure ◽  
Skin Perfusion ◽  
Increased Risk ◽  
Microcirculatory Function

Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.

A Scintigraphic Investigation of Magnetic Field Therapy on the Equine Third Metacarpus

1994 ◽  
Vol 07 (01) ◽  
pp. 9-13 ◽  
Author(s):  
G. R. Johnston ◽  
Linda Lauper ◽  
C. N. Kobluk
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Metabolic Activity ◽  
Local Application ◽  
Significant Response ◽  
Magnetic Field Therapy ◽  
Field Therapy ◽  
Increased Activity ◽  
Increased Blood Flow ◽  
Tissue Phase

SummaryScintigraphy was performed in the vascular, soft tissue and bone phase to demonstrate increased blood flow resulting from the local application of a permanent magnetic pad on the equine third metacarpus using a crossover trial in eight horses.The results of the vascular phase showed a highly significant (p <0.01) increase in counts associated with magnet application. An increase in counts results from increased blood flow carrying more radionuclide to the area investigated. Fifteen of the sixteen limbs tested showed an increased vascular response. The soft tissue phase had a highly significant response (p = 0.01) with thirteen of the sixteen limbs showing increased activity. The bone phase also had a highly significant response (p <0.01) with fourteen of the sixteen limbs showing increased activity.This study shows that the Equinepad® applied to the third metacarpus of the horse increases the circulation and metabolic activity of the soft tissue and bone. These effects show some variability in degree and occur in the majority of limbs tested.Scintigraphy was performed in the vascular, soft tissue and bone phase using a cross over trial to demonstrate increased blood flow and metabolic activity as a result of the local application of a permanent magnetic pad on the equine metacarpus. A highly significant increase was evident in the three phases.

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