Diabetes and the Foot Information and
Resources |
Archives |
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| 13 December |
In the American Journal of Medicine, Margolis et al report on a model to predict healing of neuropathic foot ulcers. The simplest model counted 1 point each if the wound was older than 2 months, larger than 2 cm(2), or had a grade > or =3 (on a 6-point scale). The likelihood that a wound would not heal was 0.35 for a count of 0, 0.47 for a count of 1, 0.66 for a count of 2, and 0.81 for a count of 3 in the validation data set. (link)
In Archives of Physical Medicine and Rehabilitation, Horswell et al report on a staged management diabetes foot program versus standard care. Over the 12-month study period, the staged management group had a lower foot-related hospitalization rate than did the comparison group; fewer foot-related inpatient days; lower foot-related inpatient charges; fewer amputation-related hospitalizations; fewer emergency department visits; lower emergency department charges; and lower total charges. (link).
Other recent relevant pubications:
Clinical Results Related to the Use of the TissueTech Autograft System in the Treatment of Diabetic Foot Ulceration
Biomechanical Differences Among Pes Cavus, Neutrally Aligned, and Pes Planus Feet in Subjects with Diabetes |
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| 22 November |
The next issue of Diabetes Care is online. Lalita Khaodhiar et al report on an inovative technique to improve vibration and tactile perception in those with neuropathy. Localized low-level mechanical or electrical noise can significantly enhance tactile sensitivity in healthy young subjects and older adults. In the study, they examined the effect of this on vibratory and tactile sensation in patients with moderate to severe diabetic peripheral neuropathy. They found that mechanical noise stimulation improves vibration and tactile perception in diabetic patients with moderate to severe neuropathy (link).
David Armstrong et al report on safety and efficacy of first metatarsophalangeal joint arthroplasty compared with nonsurgical management of wounds at the plantar hallux interphalangeal joint in patients with diabetes. Their results suggest that resectional arthroplasty is a safe and effective procedure to treat wounds of the plantar hallux (link). |
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| 18 November |
Two interesting papers in the most recent Journal of the American Podiatric Medical Association. David Armstrong and co-workers investigated in a longitudinal study whether baseline mean skin temperature measurements are useful in predicting the most common foot-related complications of diabetes mellitus. They found that the measurements of mean skin temperatures were not an effective means of screening people for future events. The authors received the William J Stickel Silver Medal award for this paper (link). Daniel Macfarlane and Jeffrey Jensen evaluated patients' motivations and perceptions regarding diabetic footwear. They found a patient's decision to use diabetic footwear is based on the perceived value of the shoe and not on the patient's previous history of foot complications or the aesthetics of diabetic footwear (link).
ScienceDaily are reporting on research from the Massachusetts General Hospital on the regeneration of insulin-producing islets that may lead to a diabetes cure. Cells from the spleen appear to develop into insulin-producing pancreatic islet cells in adult animals (link). |
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| 14 November |
| The Morbidity and Mortality Weekly Report of 14 November is reporting on "History of Foot Ulcer Among Persons with Diabetes --- United States, 2000--2002". They concluded that approximately 12% of U.S. adults with diabetes had a history of foot ulcer, a risk factor for further ulceration or LEA (link). |
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| 25 October |
Piaggesi
et al in Diabetes Care report on their histological analysis
of plantar ulcer tissue. They concluded that the results
indicate that pressure relief with a total contact cast
is associated with changes in the histology of neuropathic
foot ulcers, indicating reduction of inflammatory and
reactive components and acceleration of reparative processes
( link
).
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| 23 October |
The
most recent issue of Journal of Foot & Ankle Surgery
has a paper on decompression of peripheral nerves for
diabetic neuropathy. The results suggest that external
neurolysis of the common peroneal, deep peroneal, and
tarsal tunnel nerves in patients with symptomatic diabetic
neuropathy and an overlying compression neuropathy as
determined by using computer-assisted neurosensory testing
appears to be an effective treatment for providing pain
relief and restoration of sensation in the foot ( link
). |
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| 5 October |
A paper in Foot
& Ankle International clearly show the importance
of preventing trauma if the amputation rate is to be reduced.
The authors found that a pivotal event analysis revealed
that only one amputation was related to footwear, six
amputations were due to non-footwear-related minor environmental
trauma, two were due to progression of vascular disease
(dry gangrene from critical ischemia), one was due to
a self-care injury while cutting the toenails, and one
was due to a decubitus ulcer. They conclude that the previously
proposed strategies to reduce the amputation rates in
individuals with diabetes have focused heavily on footwear
and education. Their study suggests that the prevention
of minor environmental trauma, including household accidents,
merits additional attention ( link).
|
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| 27 September |
The October issue
of Diabetes Care is now online. Ha Van et al compared
the efficacy, safety, and compliance of a nonremovable
fiberglass cast boot and off-loading shoes in the treatment
of diabetic plantar ulcers. The healing rate was significantly
higher with the cast boot than with the off-loading shoe
(81 vs. 70%, P = 0.017), with healing times of 68.6 ±
35.1 vs. 134.2 ± 133.0 days, respectively, and
hazard ratio 1.68 (95% CI 1.04–2.70); complete compliance
with treatment was 98 vs. 10% (P = 0.001), respectively.
Secondary osteomyelitis developed in 3 patients in the
cast boot group and 13 patients in the off-loading shoe
group (P = 0.026). They concluded that a nonremovable
fiberglass cast boot was effective in healing diabetic
plantar ulcers and in decreasing the risk of secondary
osteomyelitis. The cast boot forced compliance with off-loading,
thus promoting healing ( link).
Caravaggi et al evaluated the clinical efficacy and safety
of HYAFF 11-based autologous dermal and epidermal grafts
in the management of diabetic foot ulcers. They concluded
that autologous tissue-engineered treatment exhibited
improved healing in dorsal ulcers when compared with the
current standard dressing. They further noted that for
plantar ulcers, the off-loading cast was presumably paramount
and masked or nullified the effects of the autologous
wound treatment. This treatment, however, may be useful
in patients for whom the total off-loading cast is not
recommended and only a less effective off-loading device
can be applied ( link).
|
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| 19 September |
In a new test
of gene therapy, physicians at the University of California,
San Diego (UCSD) have applied a toothpaste-like gel to
chronic foot wounds in three patients with diabetes, in
an effort to accelerate healing ( link
). |
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| 17 September |
Wrobel et
al in JAPMA attempted to determine which clinical examination
variables predict high plantar pressures in diabetes feet.
Variables that were associated with high plantar pressures
in multivariate analysis included height, body weight
per square inch of foot surface area, Romberg's sign,
and insensitivity to monofilament. These results may be
useful in identifying diabetes patients who would benefit
from interventions designed to decrease plantar foot pressures
( link).
|
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| 13 September |
A
study in Applied Psychophysiological Biofeedback demonstrated
that a general diabetes population, including patients
with mild-to-moderate neuropathy, can increase skin perfusion
with thermal biofeedback ( link
).
A
new book, A Practical Manual of
Diabetic Footcare , by Mike Edmonds, Ali Foster and
Lee Sanders will be released soon. It can be preordered
here . |
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| 4 September |
In a recent
Foot & Ankle International, Dhalla et al, measured
the plantar pressure in diabetes subjects with total contact
casts with and without a terminal cast device. They have
shown that plantar pressure reduction with TCC can be
augmented with the addition of a terminal cast device.
In this study, forefoot pressures were reduced the most
with TCC and either the conventional cast shoe or the
rigid rocker shoe. The authors therefore recommend these
combinations for forefoot ulcers. TCC alone or combined
with any of the terminal devices proved equally effective
for midfoot plantar pressure reduction. Hindfoot ulcers
should be treated with TCC and the rubber rocker heel
or the flat rubber heel as these provided the best hindfoot
pressure reductions (link).
In JBJS, Pinzur et al concluded that results of their
retrospective review support the value of Syme ankle disarticulation
in diabetes patients with infection or gangrene. This
function-sparing amputation can be successfully performed
with a reasonable risk. Patients managed with a Syme ankle
disarticulation appeared to remain able to walk better
and to survive longer than similar patients who had a
transtibial amputation and served as historical controls.
In diabetic patients with dysvascular disease who have
adequate vascular inflow to support wound-healing (an
ultrasound Doppler ischemic index of 0.5 or a transcutaneous
partial pressure of oxygen between 20 and 30 mm Hg), the
threshold for the wound-healing parameter of serum albumin
appears to be as low as 2.5 g/dL (link).
|
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| 30 August |
| The August edition of Home Healthcare
Nurse has a article on wound care in diabetes. It has been
reproduced in full at NursingCenter.com (link). |
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| 29 August |
Lipscombe
et al in the journal, Peritoneal Dialysis International,
report on a chiropody program in Toronto that appears
to have reduced the amputation rate in those with diabetes
and on dialysis ( link
)
|
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| 28 August |
Medscape
have republished the full text of Mani et al's paper
from Wounds on Diabetic Foot Amputation: The Need for
an Objective Assessment Tool - they found that a palpable
pedal pulse delivers a 40-percent false negative predictions
in alerting professionals to the presence of arterial
disease as defined by ABI </= 0.9 ( link
)
|
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| 27 August |
The most current
issue of Diabetes Care is now online. Four publications
relate to the foot. One by Loretta Vileikyte and coworkers
from the Manchester Royal Infirmary reports on the NeuroQoL
as a reliable method to captures the key dimensions of
the diabetes patients’ experience of diabetes peripheral
neuropathy and as being a valid tool to study the impact
of neuropathy and foot ulceration on quality of life in
those with diabetes ( link).
Kalani et al report results that indicate that dalteparin
improves the outcome of chronic foot ulcers in diabetes
patients with peripheral arterial occlusive disease (link).
David Armstrong et al report on their work involving 20
subjects using removable off loading devices for diabetes
foot ulcers - they recorded the activity of these subjects
and found that the subjects appear to wear their off-loading
devices for only a minority of steps taken each day. Control
of this important aspect of care with less easily removable
devices may be needed if there is to be an increase in
the prevalence of healing ( link).
Eick et al, from Germany, report their investigation into
the sympathetic vasomotor response in those with diabetes
foot complications - the data suggests the concurrent
existence of reduced vessel elasticity due to media sclerosis
and dysfunction of the autonomic vasomotor system ( link).
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| 23 August |
WebMD have reported
on a study that shows high-pressured oxygen chambers may
speed the healing of diabetes foot ulcers ( link).
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| 20 August |
Michael J. Mueller
et al report in the most recent Journal of Bone &
Joint Surgery that following achilles tendon lengthening,
all plantar neuropathic diabetes foot ulcers healed and
had less recurrence compared to the total contact cast
group ( link). |
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