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Foot, ankle, diabetic ulcers

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
A Stansal, E Tella, A Yannoutsos, I Keita, R Attal, V Gautier, D Sfeir, I Lazareth, P Priollet
OBJECTIVES: This study was conducted to determine hemodynamic and clinical tolerance under short-stretch compression therapy in elderly patients suffering from mixed-etiology leg ulcers. DESIGN: Transversal observational study conducted in 25 hospitalized patients with a moderate peripheral arterial occlusive disease defined as an ankle-brachial pressure index>0.5, an ankle pressure of>70mmHg and a toe cuff pressure (TP)>50mmHg. MATERIAL AND METHODS: Short-stretch bandages were applied daily with pressures from 20 to 30mmHg...
July 2018: Journal de médecine vasculaire
Ashwinikumar Patil, Datta More, Anant Patil, Kishor A Jadhav, Myriam E Vijil Mejia, Suresh S Patil
OBJECTIVE: To examine the clinical pattern of foot-related complications in type 2 diabetes patients. MATERIAL AND METHODS: A cross-sectional study was conducted among indoor, adult type 2 diabetes patients with risk factors for diabetic foot complications. The diabetic neuropathy symptom score (DNSS), Doppler scanning, ankle brachial pressure index (ABPI) assessment, neuropathy assessment, neuropathic disability score (NDS), biothesiometry evaluation, and bacteriological examination was performed...
April 18, 2018: Curēus
Manon Westra, Jaap J van Netten, Hendrik A Manning, Jeff G van Baal, Sicco A Bus
BACKGROUND: Non-removable knee-high devices, such as a total contact cast (TCC), are recommended for offloading diabetic plantar forefoot ulcers. However, it is insufficiently known how each of the different design characteristics of these devices contribute to offloading the diabetic foot. RESEARCH QUESTION: What is the offloading effect of the different design characteristics that make up a non-removable knee-high cast for people with diabetes and active or previous plantar forefoot ulcers? METHODS: Sixteen persons with diabetes, peripheral neuropathy and a healed or active plantar forefoot ulcer had their plantar pressures measured during walking in a non-removable knee-high device (TCC), in that device made removable (BTCC), in that device made below-ankle (cast shoe), in that cast shoe worn with a different walking sole and in a newly made cast shoe without a custom-moulded foot-device interface...
July 2018: Gait & Posture
Roshen Borkar, James Rizkalla, Youngmin Kwon, Paul Salama, Maher Rizkalla
Diabetic foot ulcers are systemic diseases that affect all blood vessels within the human body. From major blood vessels to microvasculature, hardening, thickening, and narrowing of blood vessels ultimately results to diminished blood flow to end organs. The detrimental effects of peripheral vascular disease are well recognized across medicine, particularly with regards to diabetic foot ulcers. Diabetic foot ulcers (DFU) are common across all fields of medicine, including but not limited to: orthopedics, vascular surgery, podiatry, general internal medicine, and infectious disease...
June 2018: Journal of Orthopaedics
A Searle, M J Spink, V H Chuter
BACKGROUND: Accurate measurement of ankle dorsiflexion is important in both research and clinical practice as restricted motion has been associated with many foot pathologies and increased risk of ulcer in people with diabetes. This study aimed to determine the level of association between non-weight bearing versus weight bearing ankle dorsiflexion in adults with and without diabetes, and to evaluate the reliability of the measurement tools. METHODS: One hundred and thirty-six adults with diabetes and 30 adults without diabetes underwent ankle dorsiflexion measurement non-weight bearing, using a modified Lidcombe template, and weight bearing, using a Lunge test...
June 2, 2018: BMC Musculoskeletal Disorders
Qinzhong Chen, Robert S Rosenson
Lower extremity peripheral arterial disease (LEAD) is increasing in prevalence in low with approximately 202 million people affected with LEAD worldwide. Certain subgroups of individuals (cigarette smokers, diabetics) that are particularly high risk for LEAD and major adverse limb events (MALE). Conventionally, the ankle-brachial index (ABI) is the recommended screening test for LEAD. However, the ABI has several limitations, particularly in patients with diabetes. These limitations include increased measurement variability with severity of LEAD, non-compressible calcified arteries inability to detect arterial disease distal to the ankle precludes assessment of disease in the foot where many ulcers can occur, and underestimation of the extent of microvascular occlusive disease...
June 2018: Cardiovascular Drugs and Therapy
A Sellman, P Katzman, S Andreasson, M Löndahl
AIMS: To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. METHODS: Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group)...
October 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Walaa A Khalifa
OBJECTIVES: To determine the frequency of diabetic foot ulcer recurrence and its potential risk factors. METHODS: This study included 93 patients with type 2 diabetes and followed for 2 years after primary healed foot ulceration. Demographic, diabetes related, comorbid and ulcer related variables were investigated as risk factors. Multiple logistic regression analysis was used to identify independent risk factors. RESULTS: 61.3% of patients had recurrent ulcers particularly in the forefoot (33...
June 2018: Foot
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