Adjunctive Physiotherapy – A Case Report on the Management and Effective Treatment of Diabetic Neuropathic Foot Ulcer Using Adjunctive Physiotherapy

Physiotherapy must be considered and reprioritized as an adjunctive medical service for long term health and rehabilitation. Comprehensive physiotherapy has the potential to be administered in out-patient rehabilitation facilities, hospitals, and Thermal Health Centers. A review of select adjunctive physiotherapy methods will be presented along with a case report of the successful treatment, with rationally selected physiotherapeutic agents, of a Diabetic Neuropathic Foot Ulcer scheduled for surgical amputation. By highlighting this case, the author is attempting to bring attention to familiar and time-tested therapies that have fallen out of use in a primary intervention context. This case report aims to exemplify that the role for rational physiotherapeutic methods stretches beyond current mainstream applications. Historical Context. Will supply the historical and foundational work in the field of physiotherapy that contextualizes the rational basis for the applications described in the case. Therapies. Lists the physiotherapy methods highlighted in this case, reviews the mechanism of action, discusses the therapeutic application, and provides modern citation for the rationalization of the therapy. Case Report. Reviews a detailed narrative of the case in review. Covers intake, case history, progression of case, as well as clinical applications for physiotherapy as they arise in the course of case management. Conclusion. Reviews the emphasis for reconsidering the role of Physiotherapy in the primary management of acute and chronic illness.

Common late complications of longitudinal forefoot amputations in neuropathic foot treatment

Objective: To describe and quantify the complications arising in consecutive neuropathic patients undergoing partial longitudinal amputations of the foot. Method: A retrospective study was conducted with data collected from the medical records of patients monitored at the Insensitive Foot Clinic of the Foot and Ankle Group of our institution who underwent partial amputation of foot rays from 2000 to 2016. Results: A total of 28 patients met the inclusion criteria, with a total of 31 amputated/partially amputated feet. Of these, 18 (58.1%) feet were amputated/partially amputated due to diabetes, seven (22.6%) due to leprosy, two (6.5%) due to alcoholic neuropathy, two (6.5%) secondary to traumatic peripheral nerve injury, and two (6.5%) due to other causes. Fifth ray amputation was the most frequent type (n=12). The cause of amputation was the presence of an infected ulcer in 93.6% of the samples. At a mean follow-up time of 60 months, 13 (41.9%) feet required new amputations—five (38.5%) transtibial, five (38.5%) transmetatarsal, two (15.4%) of the toes, and one (7.7%) at Chopart's joint. Patients with diabetes had a 50.0% reamputation rate. Patients who initially underwent amputation of the fifth ray had a 58.3% reamputation rate. Conclusion: Partial longitudinal amputation of the foot in neuropathic patients exhibited a high reoperation rate, especially in patients with diabetes or in patients with initial amputation of the peripheral rays. Declaration of interest: The authors have no conflicts of interest.

Neuropathic foot ulcer

Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of organisms isolated from chronic osteomyelitis secondary to neuropathic foot ulcers; secondarily, to describe the clinical outcomes of 52 patients admitted to a neuropathic foot referral center. Methods: Retrospectively chart review of 52 patients with clinically infected neuropathic foot ulcers admitted to our service for treatment between 2005 and 2013. Tissue samples were collected for culture at the operating room after extensive debridement in order to determine the infectious agents and their resistance profile using the disk-diffusion technique, following CLSI criteria. Results: A total of 52 patients were analyzed (40 males and 12 females). The mean age was 58 (37-72) years. Each patient presented with an average of 2.13 microorganisms, distributed as follows: 51% Gram-positive cocci, 43% Gram-negative bacilli. Among Staphylococcus aureus isolates, the prevalence of methicillin resistance was almost 50%, and the prevalence of coagulase-negative staphylococci (CoNS) was more than 75%. Conclusion: S. aureus, E. faecalis, and CoNS were the most frequently isolated pathogens. Methicillin resistance was highly prevalent. A combination of extensive surgical debridement and prolonged antimicrobial therapy led to remission of infection in 77% of patients. Level of Evidence IV; Therapeutic Studies; Case Series.

EFFECTIVENESS OF TOTAL CONTACT CASTING IN LEPROTIC Vs DIABETIC PLANTER FOOT ULCER: A COMPARATIVE STUDY

Total Contact Casting (TCC) has been identied as 'Gold Standard' treatment approach by ofoading in neuropathic foot ulceration, a very common but notorious complication of Leprosy & Diabetes. Here we tried to compare its efcacy in diabetic & leprotic foot ulcer. AIMS & OBJECTIVES: 1. To observe the outcomes of TCC in Leprotic & Diabetic planter ulcer. 2. To compare the effectiveness of TCC in these two conditions. STUDY DESIGN: Prospective analytical study SAMPLE SIZE: n= 24 (12 diabetic & 12 Hansen's) STUDY DURATION: 12 months. STUDY PLACE: Dept of PMR; IPGMER & SSKMH, Kolkata INCLUSION CRITERA: 1. Unilateral solitary Grade 1 & 2 planter ulcerations (Wagner classication). 2. Age: 20-60 years. 3. Ambulatory patients. EXCLUSION CRITERIA: 1. Grade-3/4/5 planter ulcerations 2. Excessive leg or foot swelling. METHODS & MATERIALS:At rst, ulcers were debrided of all necrotic-tissue to create a smooth surface. Then after proper positioning, over a small amount of cotton padding, the cast was applied covering the toes up to 2 cm distal to bular head with a rocker sole for ofoading. ASSESSMENT: st rd th Assessment was done in consecutive 3 visits at the end of 1 /3 /6 week comparing the size, depth, downgrading of Wagner classication & time taken for complete ulcer healing. CONCLUSION: Overall healing in both groups was very good with TCC with no statistically signicant improvement difference