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Foot, ankle, diabetic ulcers

Ning Wang, Bo-Hua Yang, Gang Wang, Yu Gao, Xin Cao, Xiao-Fu Zhang, Cheng-Cheng Yan, Xiao-Tong Lian, Bo-Hong Liu, Shang Ju
OBJECTIVE: To clarify and quantify risk factors among local characteristics of the foot for major amputation in diabetic foot patients. METHODS: Articles published before January 2018 on PubMed and Embase were conducted observational studies about risk factors for major amputation in patients with diabetic foot were retrieved and systematically reviewed by using Stata 12.0 statistical software. RESULTS: A total of 4668 major amputees and 65 831 controls were reported in 18 observational studies...
February 19, 2019: Journal of Cellular Biochemistry
Jiunn-Tat Lee, Li-Fu Cheng, Honda Hsu, Meng-Si Wu, Sou-Hsin Chien
BACKGROUND: In patients with diabetic foot ulcers requiring flap reconstruction, the choice of local flaps is limited by the lack of adequate tissue available. Free flaps are often bulky, presenting footwear difficulty due to poor contouring. Here, we present our experience of using the proximal lateral leg perforator flap in the reconstruction of thin diabetic foot ulcers. METHODS: This is a retrospective study of 17 patients with diabetic foot ulcers reconstructed with the proximal lateral leg perforator flap during January 2013 and December 2015...
January 28, 2019: Annals of Plastic Surgery
Hongye Li, Jiaxing You, Chao Liu, Yan Ma
Objective: To evaluate the effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer. Methods: Between June 2014 and December 2017, 17 patients with diabetic foot ulcer were treated. There were 11 males and 6 females, with a median age of 57 years (range, 46-72 years). The duration of diabetes was 2.4-32.0 years (mean, 16.0 years). According to the Wagner grading criteria, 7 cases were rated as grade 2, 8 cases as grade 3, and 2 cases as grade 4...
January 1, 2019: Chinese Journal of Reparative and Reconstructive Surgery
Murat Kahraman, Abdulhamit Misir, Turan Bilge Kizkapan, Mustafa Ozcamdalli, Erdal Uzun, Mahmut Mutlu
Epidermal growth factor is used as an adjuvant to close the wound in addition to standard care in diabetic foot ulcers. This study aimed to investigate the long-term outcomes after intralesional epidermal growth factor injections in the treatment of diabetic foot ulcers. Thirty-six feet of 34 patients (n = 34) with diabetic foot ulcers were included. Patient demographics, Wagner classifications, recurrence and amputation rates, Foot Function Index, Short Form 36, and American Academy of Orthopedic Surgeons Foot and Ankle Module scores were evaluated at the final follow-up examination...
January 3, 2019: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Yi-Jing Sheen, Tsai-Chung Li, Jiann-Liang Lin, Wen-Chen Tsai, Chuen-Der Kao, Cho-Tsan Bau, Wayne H-H Sheu
Both diabetic peripheral neuropathy and peripheral arterial disease (PAD) cause foot ulcers and often result in non-traumatic amputations in patients with type 2 diabetes. This study aimed to evaluate the association between clinical variables, PAD, and subclinical diabetic small fiber peripheral neuropathy detected by abnormal thermal thresholds of the lower extremities in patients with type 2 diabetes.We investigated 725 consecutive patients with type 2 diabetes (male/female: 372/353; mean age, 67 ± 11 years) who did not have apparent cardiovascular disease (including coronary artery disease, arrhythmia, and stroke) and who underwent the quantitative sensory test for thermal (warm and cold) thresholds of the lower limbs and ankle-brachial index (ABI)/toe-brachial index (TBI) examinations in 2015...
December 2018: Medicine (Baltimore)
Bin Wang, Wei Liu, Yongxin Huo, Zhongping Gong, Wei Wang, Ruizheng Hao, Jun Fang, Jian Zhang, Wenping Jiang
Objective: To discuss the effectiveness of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting in treatment of lower extremity arteriosclerosis obliterans (ASO) or combined with diabetic foot. Methods: Between March 2014 and June 2016, 9 patients with lower extremity ASO or combined with diabetic feet were treated with femoral-femoral artery bypass grafting and transverse tibial bone transporting. All patients were male, aged from 63 to 82 years with an average of 74...
December 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
Saneh Khunkaew, Ritin Fernandez, Jenny Sim
PURPOSE: To undertake a systematic review of the literature to investigate the HRQOL among adults living with DFUs. METHODS: A systematic search of the medical and nursing/health content databases including MEDLINE, CINAHL, and PsycINFO was conducted up to November 2018. The methodological quality of each study was assessed independently by all authors using the Joanna Briggs Institute checklist. Data analysis was conducted using the Comprehensive Meta-analysis software...
December 18, 2018: Quality of Life Research
Diana Gherman, Cristiana Iulia Dumitrescu, Andra Ciocan, Carmen Stanca Melincovici
Diabetes mellitus is the leading cause of non-traumatic amputations worldwide. Ulcer of the diabetic foot is one of the most prevalent lesions of diabetic patients and it occurs in the natural evolution of the disease as a tardive complication. Neuropathy is the main determinant of foot ulcer. A key role is played by the loss of sensitive nerves, which prove to be a protective barrier against high pressure applied otherwise on the foot. The morphopathological characteristics of neuropathic lesions in patients with diabetes show important improvement associated with the pressure relieving treatment strategies...
2018: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
A Searle MOsteo, M J Spink, V H Chuter
Background: Accurate measurement of ankle joint dorsiflexion is clinically important as a restriction has been linked to many foot and ankle pathologies, as well as increased ulcer risk and delayed ulcer healing in people with diabetes. Use of the reliable weight bearing (WB) Lunge test is limited as normal and restricted ranges for WB ankle joint dorsiflexion are not identified. Additionally the extent of WB dorsiflexion restriction that results in clinically adverse outcomes is unclear...
2018: Journal of Foot and Ankle Research
Ioanna Eleftheriadou, Anastasios Tentolouris, Pinelopi Grigoropoulou, Dimitrios Tsilingiris, Ioanna Anastasiou, Alexandros Kokkinos, Despoina Perrea, Nikolaos Katsilambros, Nikolaos Tentolouris
AIMS: To study the impact of diabetic neuropathy, both peripheral sensorimotor (DPN) and cardiac autonomic neuropathy (CAN), on transcutaneous oxygen tension (TcPO2 ) in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 163 participants were recruited; 100 with T2DM and 63 healthy individuals. Peripheral arterial disease (PAD) was defined as ankle-brachial index (ABI) values ≤0.90. Diagnosis of DPN was based on neuropathy symptom score and neuropathy disability score (NDS), while diagnosis of CAN on the battery of the cardiovascular autonomic function tests...
October 12, 2018: Journal of Diabetes and its Complications
Renan L Monteiro, Cristina D Sartor, Jane S S P Ferreira, Milla G B Dantas, Sicco A Bus, Isabel C N Sacco
BACKGROUND: Diabetic polyneuropathy (DPN) negatively affects foot and ankle function (strength and flexibility), which itself affects the daily physical activity and quality of life of patients. A physical therapy protocol aiming to strengthen the intrinsic and extrinsic foot muscles and increase flexibility may be a promising approach to improve lower-extremity function, prevent further complications, and improve autonomy for daily living activities in these patients. Thus, the inclusion of a specific foot-related exercises focused on the main musculoskeletal impairments may have additional effects to the conventional interventions in the diabetic foot...
November 14, 2018: BMC Musculoskeletal Disorders
A Searle, M J Spink, V H Chuter
BACKGROUND: An association between equinus and plantar pressure may be important for people with diabetes, as elevated plantar pressure has been linked with foot ulcer development. To determine the prevalence of equinus in community dwelling people with diabetes and to examine any association between presence of equinus and forefoot plantar pressures. METHODS: Barefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, non-weight bearing ankle range of motion and neuropathy status were assessed in 136 adults with diabetes (52...
October 5, 2018: Clinical Biomechanics
Samuel E Ford, Bruce E Cohen, W Hodges Davis, Carroll P Jones
BACKGROUND: The purpose of this study was to examine the clinical outcomes and complications of patients with midfoot Charcot managed with midfoot osteotomy, realignment arthrodesis, and stabilization using intramedullary beams. METHODS: Consecutive patients with midfoot Charcot treated at a tertiary-care foot and ankle center from January 2013 to July 2016 who underwent corrective osteotomy with internal beam fixation were identified; 25 patients were included in the final analysis...
October 4, 2018: Foot & Ankle International
Elroy Patrick Weledji, Neville Telelen Alemnju, Christophe Nouediou
Background: Peripheral arterial disease is very common in patients with diabetes, but it remains grossly under-recognized in this type of patients. Ankle brachial index (ABI) is a simple, non-invasive and reproducible method for detection and improving risk stratification. However, the sensitivity appears to be lower in diabetic patients and, false 'high' readings occur because of the arterial calcification of the vessel media which render the vessels incompressible. Materials and methods: The study evaluated the prevalence of a low ABI <0...
November 2018: Annals of Medicine and Surgery
Peter R Henning, Benjamin J Grear
PURPOSE OF REVIEW: Platelet-rich plasma has become an increasingly popular treatment option within the orthopedic community to biologically enhance and stimulate difficult-to-heal musculoskeletal tissues. This review evaluates the recent literature on platelet-rich plasma use in the treatment of foot and ankle pathologies. RECENT FINDINGS: Recent literature has demonstrated platelet-rich plasma to have a possible benefit in the treatment of Achilles pathology, chronic plantar fasciitis, osteochondral lesions of the talus, ankle osteoarthritis, and diabetic foot ulcers...
December 2018: Current Reviews in Musculoskeletal Medicine
William Tettelbach, Shawn Cazzell, Felix Sigal, Joseph M Caporusso, Patrick S Agnew, Jason Hanft, Cyaandi Dove
The aim of this study was to determine the safety and effectiveness of dehydrated human umbilical cord allograft (EpiCord) compared with alginate wound dressings for the treatment of chronic, non-healing diabetic foot ulcers (DFU). A multicentre, randomised, controlled, clinical trial was conducted at 11 centres in the United States. Individuals with a confirmed diagnosis of Type 1 or Type 2 diabetes presenting with a 1 to 15 cm2 ulcer located below the ankle that had been persisting for at least 30 days were eligible for the 14-day study run-in phase...
September 24, 2018: International Wound Journal
Marvin Heyboer, Joseph Byrne, Paula Pons, Elena Wolner, Sarah Seargent, Susan M Wojcik
Introduction: Hyperbaric oxygen (HBO2) therapy is used to promote healing in select problem wounds. Transcutaneous oxygen measurement (TCOM) can be used to predict the response of these wounds to HBO2, with in-chamber TCOM values shown to be the most predictive. We evaluated the use of in-chamber TCOM values to determine optimal treatment pressure. Methods: A retrospective review was completed of patients undergoing HBO2 therapy for a lower-extremity wound and who had in-chamber TCOM...
July 2018: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Bilal Bin Younis, Adeela Shahid, Rozina Arshad, Saima Khurshid, Muhammad Ahmad, Haroon Yousaf
BACKGROUND: Diabetic foot ulceration is a serious limb-threatening complication of diabetes. It is the common cause of hospital admissions and amputations. The objective of the study was to determine the prevalence of diabetic foot ulcers (DFU) and its association with age, gender, duration of diabetes, peripheral neuropathy (PN), peripheral arterial disease (PAD) and HbA1c. METHODS: A total of 1940 people (≥ 30 years of age) with type 2 diabetes coming to the Sakina Institute of Diabetes and Endocrine Research (specialist diabetes clinic) at Shalamar Hospital, Lahore, Pakistan, were recruited over a period of 1 year from January 2016 to January 2017...
August 6, 2018: BMC Endocrine Disorders
Fuyuan Liao, Ruopeng An, Fang Pu, Stephanie Burns, Sa Shen, Yih-Kuen Jan
The objectives of this study were to examine the effectiveness of different types of exercise on risk factors of diabetic foot ulcers, including glycated hemoglobin (HbA1c), peripheral arterial disease (PAD), and diabetic peripheral neuropathy, in people with type 2 diabetes mellitus (T2DM). PubMed, Web of Science, Cochrane Library, Scopus, and CINAHL were searched from inception to January 2018 for relevant articles. Eligible studies were randomized controlled trials (RCTs) that examined effects of exercise on the selected risk factors...
July 16, 2018: American Journal of Physical Medicine & Rehabilitation
Katie E Chatwin, Caroline A Abbott, Prabhav N Reddy, Frank L Bowling, Andrew J M Boulton, Neil D Reeves
High plantar pressure as a result of diabetic peripheral neuropathy is often reported as a major risk factor for ulceration. However, previous studies are confined to laboratories with equipment limited by cables, reducing the validity of measurements to daily life. The participant concerned in this case report was wearing an innovative plantar pressure feedback system as part of a wider study. The system allows for continuous plantar pressure monitoring and provides feedback throughout all activities of daily living...
June 2018: International Journal of Lower Extremity Wounds
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