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Plantar ulcer

Wen-Xia Li, Ying Cao, Meng-Chen Zou, Ying Huang, Ping Hu, Xiang-Rong Luo, Ya Jiang, Yao-Ming Xue, Fang Gao
OBJECTIVE: To investigate foot biomechanics characteristic of patients with type 2 diabetes mellitus. METHODS: This study was conducted among 303 patients with type 2 diabetes. The whole foot was divided into 10 regions, namely the first toe (T1); the second to fifth toes (T2-5); the first, second, third, fourth, and fifth metatarsals (M1, M2, M3, M4, and M5, respectively); midfoot (MF), and the heel medial (HM). Foot arch index, foot angle and maximum peak pressure (MPP) of the 10 regions were measured using a Footscan gait system...
October 20, 2016: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Anita Raspovic, Kate Waller, Wan Mun Wong
AIM: Felt padding is used to offload diabetes-related foot ulceration although limited quality data exists to support its use. This study aimed to quantify pressure offloading from neuropathic plantar foot ulcers in a clinical setting, when felt padding is first applied and after wear. METHODS: This study used a within-subjects, repeated measures design. Data was collected in a high-risk foot service. Peak plantar pressures, contact area and contact time were measured in 15 diabetes subjects with 16 non-complicated plantar neuropathic foot ulcers, with: no felt padding, newly applied felt padding and felt padding after one week of wear...
September 28, 2016: Diabetes Research and Clinical Practice
Ernst A Chantelau
BACKGROUND: In diabetic persons with painless neuropathic foot ulceration, foot skin was found to be insensate to noxious pinprick stimulation (stimulation area less than 0.05 mm(2)), while compression of deep subcutaneous foot tissues by Algometer II(®) (stimulation area 1 cm(2)) could evoke a deep dull aching. To elucidate this discrepancy, the Algometer II stimulation technique was critically reviewed by varying probe sizes and anatomical sites in the same study population 3 years later...
2016: Diabetic Foot & Ankle
Mansi Patel, HyunJi Boo, Suganthi Kandasamy, Dhagash Patel, Anthony Iorio
INTRODUCTION AND OBJECTIVES: Melanoma is one of the most common primary malignant tumors arising in the lower extremity. It is crucial to diagnose melanoma as quickly and as efficiently as possible for a better prognosis. The use of dermoscopy is helpful in diagnosing such conditions. Dermoscopy is a non-invasive, in-vivo technique primarily used in the examination of pigmented skin lesions. This procedure allows the visualization of subsurface skin structures in the epidermis, dermoepidermal junction, and upper dermis - structures not visible to the naked eye...
September 2016: Journal of the American Podiatric Medical Association
Nikita R Bhatt, Gaurav A Kakked, Kinnari Vyas, Rajiv Merchant
INTRODUCTION: Seventy percent of all cases of leprosy in the world occur in India. 8,462 new cases of disability were reported in India between 2010-11. Reconstructive Surgery Camps (RSC) provide free of cost plastic surgical expertise to patients of leprosy with deformity. AIM: The aim of this article was to report the outcomes of a RSC in a tertiary level university hospital in India. We also described the types of deformities in the patient group and the cost of conducting such a camp...
July 2016: Journal of Clinical and Diagnostic Research: JCDR
Malindu E Fernando, Robert G Crowther, Peter A Lazzarini, Kunwarjit S Sangla, Scott Wearing, Petra Buttner, Jonathan Golledge
BACKGROUND: Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls)...
September 15, 2016: BMC Endocrine Disorders
E López-Gavito, P Parra-Téllez, J Vázquez-Escamilla
Diabetes mellitus is a major chronic degenerative disease, which currently is taking on alarming proportions in the population of our country. Neuropathic arthropathy is one of the most interesting degenerative joint disorders and increasingly common within the orthopedic pathology. It is defined as a progressive degenerative arthropathy, chronic and affecting one or more peripheral joints, and develops as a result of the lack of sensory perception normal in the innervation of joints. As a result the joints of the feet are subjected to trauma and repetitive injury causing a neurotraumatic effect with progressive damage to the joints of the hindfoot, midfoot and forefoot...
January 2016: Acta Ortopédica Mexicana
William R Ledoux, Shruti Pai, Jane B Shofer, Yak-Nam Wang
Diabetes, and the subsequent complication of lower limb ulcers leading to potential amputation, remains an important health care problem in United States, even with declining amputation rates. It has been well documented that diabetes can alter the mechanical properties (i.e., increased stiffness) of the plantar soft tissue, although this finding is not universal. Similarly, biochemical, and histological changes have been found in the plantar soft tissue, but, as with the mechanical changes, these findings are not consistent across all studies...
October 3, 2016: Journal of Biomechanics
Sicco A Bus
BACKGROUND: An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation. METHODS: In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can heal plantar foot ulcers and prevent their recurrence. RESULTS: Noninfected, nonischemic neuropathic plantar forefoot ulcers should heal in 6 to 8 weeks with adequate offloading...
September 2016: Plastic and Reconstructive Surgery
Kamel Mohammedi, Louis Potier, Maud François, Dured Dardari, Marilyne Feron, Estelle Nobecourt-Dupuy, Manuel Dolz, Roxane Ducloux, Abdelkader Chibani, Dominique-François Eveno, Teresa Crea Avila, Ariane Sultan, Laurence Baillet-Blanco, Vincent Rigalleau, Gilberto Velho, Florence Tubach, Ronan Roussel, Jean-Claude Dupré, Dominique Malgrange, Michel Marre
BACKGROUND: Off-loading is essential for diabetic foot management, but remains understudied. The evaluation of Off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) trial aims to evaluate the efficacy of a new removable device "Orthèse Diabète" in the healing of diabetic foot. METHODS/DESIGN: ORTHODIAB is a French multi-centre randomized, open label trial, with a blinded end points evaluation by an adjudication committee according to the Prospective Randomized Open Blinded End-point...
2016: Journal of Foot and Ankle Research
Cynthia A Luu, Ethan Larson, Timothy M Rankin, Jennifer L Pappalardo, Marvin J Slepian, David G Armstrong
We report on the use of free fat grafting as a means of redistributing normal and shear stress after healing of plantar diabetic foot wounds. Although fat augmentation (lipofilling) has been described previously as an approach to supplement defects and prevent atrophy, including use as an adjunct to wound healing and to mitigate pain in the foot, we are unaware of any reports in the medical literature that have described its use in the high-risk diabetic foot in remission. An active 37-year-old man with type 2 diabetes and neuropathy presented with gangrene of his fifth ray, which was amputated...
July 2016: Plastic and Reconstructive Surgery. Global Open
Lisa Heuch, Judith Streak Gomersall
BACKGROUND: The incidence of foot ulceration related to diabetes is increasing. Many foot care professionals recommend offloading measures as part of management strategies for modulating excess pressure to prevent development of diabetic foot ulcers (DFUs). These measures may include padding, insoles/orthotic devices and footwear. There is a lack of evidence-based guidance on the effectiveness of the different offloading options for preventing primary ulceration in those with diabetes...
July 2016: JBI Database of Systematic Reviews and Implementation Reports
Uli Niemann, Myra Spiliopoulou, Thorsten Szczepanski, Fred Samland, Jens Grützner, Dominik Senk, Antao Ming, Juliane Kellersmann, Jan Malanowski, Silke Klose, Peter R Mertens
In diabetic patients, excessive peak plantar pressure has been identified as major risk factor for ulceration. Analyzing plantar pressure distributions potentially improves the identification of patients with a high risk for foot ulceration development. The goal of this study was to classify regional plantar pressure distributions. By means of a sensor-equipped insole, pressure recordings of healthy controls (n = 18) and diabetics with severe polyneuropathy (n = 25) were captured across eight foot regions. The study involved a controlled experimental protocol with multiple sessions, where a session contained several cycles of pressure exposure...
2016: PloS One
K Nagasaki, H Obara, K Tanaka, K Koyano, A Asamia, Y Kitagawa
OBJECTIVE: We retrospectively assessed the effectiveness of peripheral nerve crushing (Smithwick operation) in relieving intractable chronic pain associated with foot ulcers caused by diabetes mellitus (DM) or atherosclerosis. METHOD: From April 2009 to April 2012, patients underwent peripheral nerve crushing in the leg affected by foot ulceration. The cause of ulceration was either DM alone, atherosclerosis alone, or both DM and atherosclerosis. Because sensation in the foot is associated with five nerves: the tibial, deep peroneal, superficial peroneal, sural, and saphenous, one or more of these nerves were crushed over a length of 1...
August 2016: Journal of Wound Care
Chi-Wen Lung, Elizabeth T Hsiao-Wecksler, Stephanie Burns, Fang Lin, Yih-Kuen Jan
Diabetic foot ulcers remain one of the most serious complications of diabetes. Peak plantar pressure (PPP) and peak pressure gradient (PPG) during walking have been shown to be associated with the development of diabetic foot ulcers. To gain further insight into the mechanical etiology of diabetic foot ulcers, examination of the pressure gradient angle (PGA) has been recently proposed. The PGA quantifies directional variation or orientation of the pressure gradient during walking and provides a measure of whether pressure gradient patterns are concentrated or dispersed along the plantar surface...
2016: Frontiers in Bioengineering and Biotechnology
Kevin Deschamps, Giovanni Arnoldo Matricali, Dirk Desmet, Philip Roosen, Noel Keijsers, Frank Nobels, Herman Bruyninckx, Filip Staes
AIMS: The concept of 'classification' has, similar to many other diseases, been found to be fundamental in the field of diabetic medicine. In the current study, we aimed at determining efficacy measures of a recently published plantar pressure based classification system. METHODS: Technical efficacy of the classification system was investigated by applying a high resolution, pixel-level analysis on the normalized plantar pressure pedobarographic fields of the original experimental dataset consisting of 97 patients with diabetes and 33 persons without diabetes...
September 2016: Gait & Posture
Melodie Blakely
BACKGROUND AND PURPOSE: Published guidelines for effective management of diabetic foot ulcers (DFU) include total contact casting (TCC). The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU) in a complex patient where TCC offloading could not be utilized. CASE DESCRIPTION: The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot...
March 4, 2016: Healthcare (Basel, Switzerland)
Eran Tamir, Aharon S Finestone, Erez Avisar, Gabriel Agar
BACKGROUND: Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy...
2016: Journal of Orthopaedic Surgery and Research
José de Jesús Sandoval-Palomares, Javier Yáñez-Mendiola, Alfonso Gómez-Espinosa, José Martin López-Vela
A new, continuously-monitoring portable device that monitors the diabetic foot has shown to help in reduction of diabetic foot complications. Persons affected by diabetic foot have shown to be particularly sensitive in the plantar surface; this sensitivity coupled with certain ambient conditions may cause dry skin. This dry skin leads to the formation of fissures that may eventually result in a foot ulceration and subsequent hospitalization. This new device monitors the micro-climate temperature and humidity areas between the insole and sole of the footwear...
2016: Sensors
Kobe Van Bael, Geerhardus Van der Tempel, Isabelle Claus, Sabrina Speybrouck, Johan De Coster, Sylvie De Laere, Erik Debing, Dimitri Aerden
BACKGROUND: Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading, but treatment is not invariably successful. Achilles tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture. We assessed the feasibility and clinical outcome of a comparative minimal invasive procedure: the gastrocnemius fascia release...
August 18, 2016: Acta Chirurgica Belgica
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