Foot Ulcers Research Articles

RISK FACTORS FOR DIABETIC FOOT AND LOWER LIMB AMPUTATION

Introduction: Diabetic foot syndrome (DFS) is the major cause of hospitalization for diabetes-related complications. Protective sensation loss and impaired vision increase the susceptibility for minor feet trauma, which results in diabetic foot ulceration with or without subsequent infection. Peripheral arterial disease is a major cause of impaired ulcer, wound healing and gangrenous diabetic foot. The most important intervention to prevent diabetic foot ulceration and its consequences is early recognition of high-risk patients and their risk factors and referral to appropriate medical departments. There are various risk factors for major lower extremity amputations related to diabetic foot, which includes microvascular diseases, infections, long duration of diabetes, poor glycemic control, peripheral arterial disease, old age and associated cardiovascular comorbidities.
 Material and Methods: This study was done on the review of medical records of consecutive type 2 diabetic patients. Admitted patients were treated and managed according to the standard protocol of the hospital. History, clinical and physical examination were carried out on each patient. Ulcer characteristics like infection and depth of the ulcer, site of ulcer were assessed. Associated diabetic neuropathy and peripheral arterial disease was assessed by a clinical method. Age, sex, body mass index (BMI), smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases were recorded. The glycated haemoglobin level (HbA1c) were recorded.
 Results: A total of 128 patients with diabetic foot were included in the study of which 76(59.4%) were male and 52(40.6%) were female. Of the 76 male 6 (4.7%) had major amputation and out of 52 female 4(3.1%) had major amputation, thus total number of major amputations were 10(7.8%). Statistically significant difference was observed in HbA1C and duration of diabetes group in amputation. High HbA1C and more duration of diabetes was associated with the higher number of amputation. The rate of amputation was much higher among patients hypertension, smoking, cardiac diseases and stroke. Conclusion: Poor glycemic controls and duration of diabetes are the important independent risk factors for diabetes-related major lower extremity amputations.
 Keywords: DFS, BMI, smkoing, DM

Preogress in diagnosis and treatment of diabetic foot osteomyelitis

Diabetic foot ulcer is a major complication of diabetes which is the most expensive and the most difficult to deal with and leads to a high rate of non-traumatic amputation. Diabetic foot osteomyelitis results from aggravation of diabetic foot ulcer. Unfortunately, the current therapeutic outcomes of diabetic foot osteomyelitis are still unsatisfactory because of its difficult diagnosis and special treatment protocols which are entirely different from those for conventional soft tissue infections. This paper summarizes the latest advances achieved in diagnosis and treatment of diabetic foot osteomyelitis. Key words: Diabetic foot; Osteomyelitis; Diagnosis; Surgical procedures, operative

The impact of inflammatory factors and related cell growth factors of human umbilical cord mesenchymal stem cells for model rats with diabetic foot ulcer

Objective To study effect of inflammatory factors and related cell growth factors of human umbilical cord mesenchymal stem cells (HUCMSCs) for model rats with diabetic foot ulcer (DFU), and analyzed the possible action mechanism of HUCMSCs therapy DFU. Methods 50 specific pathogen free (SPF)-level male rats were fed with high-fat beverage for 4 weeks. The DFU models were established by means of intraperitoneal injection of 1% streptozotocin (40 mg/kg) and steam fumigation. 30 successful model rats were divided into model group, high-dose HUCMSCs group (high-dose group: femoral artery injection with HUCMSCs 2.0×106/0.2 ml) and low-dose HUCMSCs group (low-dose group: femoral artery injection with HUCMSCs 1.0×106/0.2 ml), 10 rats/each group. Another 10 SPF-level male rats were selected and set as blank control group (blank group). Then wound healing rate, serum inflammatory factors, related cell growth factors, granulation tissue fibroblasts and newly born capillaries were compared between the groups. Results (1) Wound healing rate: The model group, low-dose group, high-dose group respectively were (26.31±4.32)%, (66.92±7.24)%, (74.74±8.32)%. low-dose group and high-dose group wound healing rate were significantly higher than model group (t=8.424, 11.201, P<0.01), high-dose group wound healing rate were significantly higher than low-dose group (t=3.148, P<0.05). (2) Serum inflammatory factors: model group, low-dose group and high-dose group interleukin (IL)-1, tumor necrosis factor-α (TNF-α), hs-CRP respectively were (6.12±0.25), (4.54±0.36), (4.20±0.33) ng/L; (29.45±3.12), (21.13±3.24), (18.20±2.65) ng/L; (0.61±0.08), (0.45±0.07), (0.37±0.06) ng/L. low-dose group and high-dose group IL-1, TNF-α, hs-CRP were significantly lower than model group (t=11.400, 5.849, 5.111, 14.666, 8.691, 8.222, P<0.05, P<0.01), high-dose group were significantly lower low-dose group (t=2.202, 2.214, 2.744, P<0.05); (3) Related cell growth factors: model group, low-dose group and high-dose group basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF) respectively were (46.42±6.36), (61.35±7.20), (68.24±8.12) ng/L; (546.32±30.24), (722.36±32.17), (772.45±34.26) μg/L; (2.24±0.32), (3.65±0.41), (4.26±0.55) μg/L. Low-dose group and high-dose group bFGF, EGF, VEGF were significantly higher than model group (t=4.915, 12.609, 8.573, 6.690, 15.648, 10.039, P<0.05, P<0.01). high-dose group bFGF, EGF and VEGF were significantly higher than low-dose group (t=2.031, 3.740, 2.812, P<0.05); (4) Granulation tissue fibroblasts and newly born capillaries: model group, low-dose group and high-dose group granulation tissue fibroblasts and newly born capillaries were respectively (155.24±8.45), (278.65±9.12), (305.12±10.25) cells/visual field; (4.36±0.45), (6.45±0.62), (7.24±0.60)×10/μm2. The low-dose group and high-dose group were significantly higher than model group (t=31.389, 8.627, 35.679, 12.143, P<0.01), high-dose group were significantly higher than low-dose group (t=6.101, 2.896, P<0.05). Conclusion HUMSCs help to promote the ulcerative healing of DFU rats. Key words: Diabetic foot ulcer; Human umbilical cord mesenchymal stem cells; Inflammatory factor; Growth factor

A summary of evidence for diabetic foot assessment

Objective To search, appraise and summarize the best evidence of the diabetic foot assessment and provide a reference for the standardization of the clinical diabetic foot evaluation in China. Methods On the computer, the following websites as well as databases were searched: National Guideline Clearinghouse (NGC) of the USA, Registered Nurses' Association of Ontario (RNAO) , National Institute for Health and Care Excellence (NICE) of UK, the Scottish Intercollegiate Guidelines Network (SIGN) , New England Guidelines Group (NEGG) , International Guidelines Network (IGN) , American Center for Disease Control and Prevention (ACDC) , World Council of Enterostomal therapists (WCET) , Wound Ostomy Continence Nurses Society (WOCN) , the International Working Group on Diabetic Foot (IWGDF) , American Society for Wound Healing, American Diabetes Association (ADA) , American Society for Vascular Surgery (ASVS) , Society of Endocrinology of Chinese Medical Association, Clinical evidence, PubMed, ProQuest, Web of Science, Clinical Key, CINAHL, Best Practice, CNKI, VIP, Wanfang Data, Medlive from January of 2010 to July of 2018 about all evidence-based clinical practice guidelines and systematic reviews on assessment of diabetic foot. Two researchers evaluated the quality of the articles and performed materials extraction, and extracted the evidence from the qualified articles. Results A total of 7 articles were included among which 6 were guidelines and 1 was systemic review. After analyzing them, 9 categories and 32 items of the best evidence contents about diabetic foot assessment were concluded. Conclusions This study summarizes the best evidence for assessment of diabetic foot and provide evidence basis for medical institutions to improve clinical practice of diabetic foot assessment. When applying the evidence into clinical practice, it is necessary to evaluate specific situations, consider patients' values and willingness and select targeted evidence accordingly. Key words: Diabetic foot; Foot ulcer; Assessment; Best evidence; Evidence summary

Research progress on hierarchical management of diabetes

In the past 40 years, the prevalence of diabetes in China has been increasing year by year. The prevention and treatment of diabetes were very arduous. Hierarchical management is not only a major mode of chronic disease management in China, but also a research trend in recent years. The study reviewed the status of hierarchical management of diabetes including tertiary prevention, grading diagnosis and treatment, community grading intervention, diabetic foot ulcer and cardiovascular disease risk grading and management. And summarized the grading management indicators, methods, effects, existing problems and improvement measures. In order to provide a new direction for the development of diabetes management. Key words: Diabetes mellitus; Hierarchical management; Tertiary prevention; Risk management

STUDY OF BACTERIAL PATHOGENS WITH THEIR ANTIBIOGRAM CAUSING DIABETIC FOOT ULCERS.

10Apr 2019 STUDY OF BACTERIAL PATHOGENS WITH THEIR ANTIBIOGRAM CAUSING DIABETIC FOOT ULCERS. Shanthi sree Vaddadhi , P. Ratna Kumari and R.Lakshmi Kumari. 2nd year Post Graduate, Department of Microbiology, Siddhartha Medical College,Vijayawada-520008. Professor ,Department of Microbiology, Siddhartha Medial College,Vijayawada-520008. Head of the Department ,of Microbiology, Siddhartha Medical College,Vijayawada-520008.

Effect of evidence-based nursing on rehabilitation of type 2 diabetic foot ulcers after transverse tibial bone transportation

Objective Based on the principle of evidence-based nursing, we searched, studied and summarized a nursing pathway for patients who after transverse tibial bone transportation, and explored its effect. Methods With A set of targeted nursing intervention program, 17 patients with type 2 diabetic foot patients after transverse tibial bone transportation were nursed. After 2 months, the percentage of ulcer decreased, the visual analogue scale and the temperature of foot dorsum were used to evaluate the nursing effect. Results The average temperature of foot dorsum was (28.49±1.12) ℃, the average visual analogue scale was (4.06±1.40) . And after 2 months, the average temperature of foot dorsum was (29.97± 1.26)℃, the average visual analogue scale was (1.94±1.92), and the area of ulcer in 15 cases (2 cases could not be counted due to toe amputations in treatment) decreased by 25%~100%, with an average of 59%, compared with that before intervention. Conclusions The implementation of evidence-based nursing can provide effective nursing intervention, relieve the pain of patients, and promote the rehabilitation of diabetic foot ulcers after transverse tibial bone transportation. Key words: Evidence-based nursing; Transverse tibial bone transportation; Diabetic foot; Ulcer

RELATIONSHIP OF HEAVY METAL IN DIABETES AND NON-DIABETIC FOOT ULCER PATIENTS.

01Mar 2019 RELATIONSHIP OF HEAVY METAL IN DIABETES AND NON-DIABETIC FOOT ULCER PATIENTS. Prasanta Kumar Bhattacharyya , Priyanka Biswas , Debarshi Jana , Jayanta Ranjan Mukherjee and Madhusanta De. KPC Medical College & Hospital, Kolkata. Ramakrishna Mission SevaPratishthan, Kolkata. Institute of Post-Graduate Medical Education and Research, A.J.C. Bose Road, Kolkata-700020, West Bengal, India.

Effects of graded nursing intervention on wound healing of type 2 diabetic foot

Objective To expolre the effects of grading nursing on wound healing of type-2diabetic foot ulcer of patients. Methods A total of 84 patients with type 2 diabetic foot were randomly divided into the control group and the observation group, with 42 cases in each group.The two groups received the same treatment.The control group received routine nursing intervention, including diet and sports complications knowledge education, regular monitoring of blood glucose.The observation group was divided into three groups according to risk factors: low risk group, middle risk group and high risk group.The foot pain score, healing of foot ulcers, patient compliance and self-caring ability of the two groups were compared. Results After graded nursing intervention, there were statistically significant differences in pain score, foot ulcer area and self-care ability between the two groups(P<0.05), and the observation group was significantly better than the control group.At the last follow-up, grade 0 of foot ulcer wounds in the observation group was significantly higher than that in the control group, while grade 1 was significantly lower than that in the control group(P<0.05). The compliance scores of patients in the two groups were significantly increased in such dimensions as drug, diet, exercise, blood glucose monitoring and review, and the increase rate in the observation group was significantly higher than that in the control group(P<0.05). Conclusion The graded nursing intervention for type 2 diabetic foot ulcer can improve the pain degree of foot ulcer, promote the healing of foot ulcer, improve the self-care ability of patients, and reduce the risk of the recurrence of diabetic foot. Key words: Type-2 diabetic foot; Grading nursing; Foot ulcer; Self-care ability

Can a combination of lifestyle and clinical characteristics explain the presence of foot ulcer in patients with diabetes?

AimsThe aim of this study was to identify the biomechanical, neurological and clinical parameters along with other demographics and lifestyle risk factors that could explain the presence of foot ulcer in patients with diabetes in Africa. MethodsA total of 1270 (M/F:696/574) patients; 77(M/F:53/24) with ulcerated vs 1193 (M/F: 643/550) with non-ulcerated feet; participated in this study. A set of 28 parameters were collected and compared between the participants with and without active foot ulcers. Multivariate logistic regression was utilised to develop an explanatory model for foot ulceration. ResultsFoot swelling (χ2(1,n = 1270) = 265.9,P = 0.000,Phi = 0.464) and impaired sensation to monofilament (χ2(2,n = 1270) = 114.2,P = 0.000,Cramer'sV = 0.300) showed strong association with presence of ulceration. A lower Temperature sensitivity to cold stimuli and limited ankle joint mobility were observed to be significant (P < 0.05) contributors to ulceration. The logistic regression model can justify the presence of foot ulceration with 95.3% diagnostic accuracy, 99.1% specificity and 37.3% sensitivity. ConclusionParticipants with ulcerated foot show distinct characteristics in few foot related parameters. Swollen foot, limited ankle mobility, and peripheral sensory neuropathy were significant characteristics of patients with diabetic foot ulcer. One out of three patients with ulcerated foot showed common characteristics that could be justified by the model.

Effect of Self-Management Support Program on Improving Knowledge and Practices of Patients with Diabetic Foot

Background and study aim: Diabetes is a self managed disease and the participation of the individual, health care team and his family is very essential in managing the disease and preventing its complications.The aim of study was to evaluate the effectiveness of a self-management support program on improving Knowledge and practices of patients with diabetes mellitus at Zagazig University Hospital. Subjects and Methods: A quasi experimental research design was used in this study. A purposive sample of 70 patients with diabetic foot patients were randomly assigned to either the control (n= 35) or the study (n= 35) group using matched criteria of foot ulcer history and foot problems. Three tools were used for collection of data, patient's assessment questionnaire, questionnaire about patient knowledge about diabetes mellitus and foot care and self reported practice questionnaire. Results: The study finding revealed that sixty (60.0%) of patients in the study and control groups were males with more than 40 years of age with Mean±SD (52.7±8.8 and 53.5±7.8 respectively), there was statistical significant relationship between patient knowledge and practice where more than three quarters (89.6%) of patients who had unsatisfactory knowledge had inadequate practice. Also there was positive correlation between foot care score and knowledge score and practice score. Conclusion: The self-management support program showed an improvement in patients' knowledge which reflected an improvement on their practice and diabetic foot care behaviors in post phase. It is Recommended to increase awareness and prevent the diabetic foot and its complications by apply nursing intervention programs regarding importance of foot care and to impart knowledge on foot care, use media to motivate diabetic patient for monthly diabetic clinic visiting, use media to increase awareness about the diabetic foot, continues follow up for patients who is suffering from the diabetic foot and increase distributing free handbooks that are specific for diabetes in the public places.

STUDY OF SURGICAL MANAGEMENT AND COMPLICATIONS OF DIABETIC FOOT ULCER

Introduction: Diabetes is one of the most prevalent metabolic chronic diseases due to the imbalance production of insulin. One of the studies reported that in 2010 worldwide 285 million adults had diabetes and this figure may be increase to 439 million by the year 2030. Globally Diabetic foot ulcers (DFUs) constitute major health problem in people that significantly contribute to morbidity and mortality in diabetes patients. Approximate 1.0% to 4.1% of the annual population-based incidences of a diabetic foot ulcer (DFU) were reported. Due to this the lifetime may be as high as 25%. In Asian countries diabetic foot ulcer are major problems which are different from European countries or developing countries. From many studies reported diabetic foot problems in India are infectious and neuropathic in nature as compared to developed countries. According to World Health Organization (WHO) diabetic foot is defined as lower limb of a diabetic patient characterized by infection, potential risk of pathologic consequences ulceration or destruction of deep tissues associated with neurological abnormalities, various changes in peripheral neuropathy vasculopathy and superimposed infection that are mainly responsible foot ulceration. Ulcers are one kind of abscess which is difficult to treat because of poor wound healing that result from a combination of neuropathy, ischemia and hyperglycemia. &#x0D; Aim: The main objective was to study the outcome of treatment modalities and it’s relating factors to complication in diabetic foot ulcer. Material and method: Total 60 diabetic foot ulcer patients with the age range from 20 to 70 years were included. From all the patients’ detailed past and present history were recorded. For all the patients, general, physical and local and systemic examinations were also done. Detail laboratory examination like Fasting and Post Prandial Blood sugar levels, blood count, ECG, ESR, complete urine examination for the presence of ketone bodies and sugar, x-ray as well as culture and sensitivity of the discharge from ulcer were also done. Patients were treated with various treatment methods like conservative treatment, split skin grafting and amputation.&#x0D; Result: In this study male patients were more in proportion as compared to female. This study showed that maximum with the age group 14 -50 (43.3%) years old followed by 18.3% in 31-40 years old, 16.7% in 61-70 years old. 6.7% showed the least age group as 20 -30 years old. Out of total 60 patients, 38.3% of the patients showed diabetic ulcer foot which was more whereas 15% showed diabetic gangrene foot which was least. 25% showed diabetic cellulites foot and 21.7% showed as diabetic abscess foot. &#x0D; Conclusion: Globally as diabetes mellitus cases are increasing and it became rapidly the public health problem. This may be due to burden on economy, health system and on society to manage the diabetic foot problems. Diabetic foot management guidelines must be made into our practice protocols which may preventing limb loss, and decrease mortality and increase the quality of life of the patient. Hence for this it is only possible with the help of foot care education and health care workers. Hence, foot infection is to put first and care for it like hands.&#x0D; Keywords: Diabetes, foot ulcers, infections, amputations.

The 2017 Banting Memorial Lecture The diabetic lower limb - a forty year journey: from clinical observation to clinical science.

A series of clinical research projects conducted over the past 40 years, all of which were informed by clinical observation or discussions with people with diabetes and staff colleagues are described in this review. A study of necrobiosis lipoidica diabeticorum confirmed that this rare skin complication occurs predominantly in young women with Type 1 diabetes and other microvascular complications. Biopsies of necrobiotic lesions showed destruction of superficial nerve fibres by inflammatory tissue, which likely causes the sensory loss in lesions that is pathognomonic of the condition. The development of corneal confocal microscopy as a new non-invasive surrogate marker of peripheral neuropathy in diabetes is described next and several small studies of the use of this new technique in clinical research are reported. The influence of blood glucose instability on the genesis of neuropathic pain is then explained, with results suggesting that the stability of glycaemic control may be more important than the level of control achieved. Lastly, in neuropathy, studies of gustatory sweating are discussed, including the observation that sweating in the head and neck region is more common in people with end-stage diabetic nephropathy than in those with neuropathy. The disappearance of gustatory sweating after renal transplantation suggests a metabolic cause and for those with troublesome sweating, use of the anticholinergic, anti-muscarinic, topical cream glycopyrrolate is confirmed in a randomized control trial. In the area of diabetic foot research, distended dorsal foot veins were observed to be a clinical sign of sympathetic autonomic neuropathy: raised venous Po2 and Doppler abnormalities of blood flow are highly suggestive of arteriovenous shunting. A series of studies of the abnormalities of pressures and loads under the neuropathic diabetic foot are described: high dynamic plantar pressures are highly predictive of subsequent ulceration in the neuropathic foot. Lastly, a number of recent studies on unsteadiness and gait abnormalities when climbing and descending stairs are described. It is hoped that the art of clinical observation survives in the highly technological 21st century.

Reliability of peak foot pressure in patients with previous diabetic foot ulceration

BackgroundPrevious reliability studies on peak plantar pressure measurements in patients with previous diabetic foot ulceration (DFU) did not stratify their analyses according to whether the foot had a previous ulcer. Research questionDoes test-retest reliability of peak foot pressure measurements from the various foot regions differ between the ulcerated and non-ulcerated feet? MethodsData from 23 participants with peripheral neuropathy and healed plantar DFU were analysed in this test-retest reliability comparison study. Plantar pressure was evaluated on two sessions using Pedar®-X in-shoe system, with a mean of 7.2 days (SD = 1.6) between sessions. ResultsThe intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated for 10 foot regions. Overall, test-retest reliability was excellent (ICCs, 0.82 to 0.95) for all peak pressure variables. CV ranged between 6.3% and 18.3%, and exceeded 15% over the hallux and medial forefoot regions in the ulcer foot (18.3% and 16.4%, respectively). Hallux peak pressure CV was significantly higher over the ulcer foot than over the non-ulcer foot (5.7%, 95% CI, 1.7%–10.2%). Peak pressure CV over the forefoot also tended to be higher over the ulcer foot (medial forefoot: 6.1%, 95% CI, -0.5%–14.5%; lateral forefoot: 4.1%, 95%CI, -0.7%–11.1%). SignificancePeak plantar foot pressure may be useful to distinguish between groups of patients with peripheral neuropathy and healed plantar DFU. However, clinical decisions based on ulcer foot hallux and forefoot peak pressure measurements should be interpreted with caution.

AB174. 104. The shattered spleen—an unexpected complication of the ulcerated foot

AB174. 104. The shattered spleen—an unexpected complication of the ulcerated foot

Research progress of traditional Chinese external therapy for the patients with diabetic foot ulcer

Diabetic foot ulcer is one of the most serious complications of diabetes mellitus, which leads to a very high rate of amputation. How to deal with diabetic foot ulcer becomes a difficult issue for the clinical wound treatment. We reviewed the related literatures in recent years and summarized the experience of traditional Chinese external therapies such as debridement, fumigating and washing therapy, wet dressing therapy, hoop around therapy, thread-drawing therapy and plaster-covering therapy. Key words: Diabetic foot ulcer; Foot ulcer; Finger-toe gangrene; Traditional Chinese medicine therapy; External therapies; Review

Platelet-rich plasma in lower limb ulcers

Objective The aim of this study was to evaluate the role of platelet-rich plasma gel in patient with lower limb ulcers: diabetic and varicose ulcers. Background Diabetic foot ulcer is a major complication of diabetes mellitus. Platelet-rich plasma (PRP) is used for managing diabetic foot ulcers. PRP contains alpha- granules that release growth factors on activation such as platelet-derived growth factor (PDGF) which are important for wound healing by being angiogenic and helping stem cell differentiation and maturation. Patients and methods The study included 30 patients with chronic ulcers who were selected from vascular surgery department of Menoufia University Hospitals in the duration between February 2016 and March 2017. Patients were categorized into group I (15 patients with diabetic ulcers) and group II (15 patients with varicose ulcers). PRP gel was applied every 2 weeks for a maximum of 6 weeks. PRP was evaluated for concentration of PDGF-AB before and after activation by immunoassay. Results There was significant increase in PRP platelets count and PDGF-AB concentration after activation (P Conclusion Autologous PRP gel is an efficient and a safe source of growth factors for managing lower limb ulcers.

Effect of ultrasonic debridement for the treatment of diabetic foot ulcers: a meta-analysis

Objective To evaluate the effect of ultrasonic debridement for treating diabetic foot ulcers(DFU). Methods Randomized controlled trials, quasi-experimental studies and cohort studies of ultrasonic debridement for DFU were searched from the Cochrane Library, PubMed, EMbase, CBM, VIP and CNKI.Two authors screened, evaluated and extracted research articles, and conducted meta-analysis on studies that met the quality standards. Results A total of six studies including 624 patients were included.Of them, four studies included the outcome on the average wound healing time, and meta-analysis showed that, compared with traditional debridement, ultrasonic debridement could shorten the average healing time for wounds[weighted mean differences(WMD)=-20.78, 95%CI: -35.72-5.85, P=0.006]. Three studies included the outcome on the average wound healing rate, and meta-analysis showed that ultrasonic debridement had a higher average wound healing rate than traditional debridement(WMD=22.53, 95%CI: 19.19~25.87, P<0.001). Two studies included the outcome on the average wound healing area, and meta-analysis showed no significant difference between ultrasonic debridement and traditional debridement(WMD=-5.82, 95%CI: -18.43~6.80, P=0.370). Conclusions Ultrasonic debridement is superior to traditional debridement in treating diabetic foot ulcers. Key words: Diabetic foot; Debridement; Meta-analysis

Whole-body vibration versus Tai Chi exercise for controlling balance in lower-limb ulcers: a pilot, randomized, controlled trial

Background Foot and leg ulcers are serious complications to both patients and healthcare systems, which may contribute to impaired balance and increased risk of falling. Purpose This study was designed to determine which approach is more effective in improving balance in lower-limb ulcers cases − whole-body vibration or Tai Chi exercise. Patients and methods Thirty (12 females and 18 males) patients with foot ulcers were randomly assigned into two equal groups of 15 individuals. Both groups received their routine medical and physical therapy. In addition, group A received whole-body vibration at a frequency of 25–30 Hz and amplitude of 3–5 mm, 30 min/session, three times/week for 6 weeks, whereas group B received 6 weeks of Tai Chi exercise [In Balance (IB) program] for 15–45 min, three times/week for 6 weeks. The overall stability index was measured using a Biodex balance system at two time intervals − before treatment and 6 weeks after treatment. Results Both whole-body vibration (1.7±0.51) and Tai Chi exercise (2.53±0.48) groups showed significant improvement in stability index values 6 weeks after treatment with better improvement in the whole-body vibration group (P=0.0001). Conclusion Both Tai Chi exercise and whole-body vibration therapy have positive effects on balance in patients with foot ulcers. However, whole-body vibration therapy is more effective.

A study of effect of tarsal tunnel decompression on sensory improvement in diabetic foot: a prospective randomized control trial

Background: In India approximately, 45000 legs are amputated every year and almost 75% of these amputations are carried out in neuropathic feet which are potentially preventable. Diabetic peripheral nerves are at risk of entrapment neuropathies focally, where these nerves are contained in a closed space. The aim of the study was to find out the effect of decompression of compressed posterior tibial nerve and its branches at tarsal tunnel in restoration of sensation in diabetic foot.Methods: A total of 70 diabetic patients with ulcer foot in one limb (test limb) and with no ulcer on the other limb (control limb) were selected for study. The test limb was subjected to tarsal tunnel release. Sensory recovery was evaluated in the ulcer limb and compared with normal limb in same patient and results were evaluated statistically for significance.Results: Present study shows that following tarsal tunnel decompression surgery on test limb, 65 patients (93%) had sensory gain and 5 patients (7%) had documented no sensory gain on test limb, with statistical significance. After de-compressive surgery on the test limb, 69 patients (98.6%) were documented to have resolving of Tinel sign in the test limb with sensory improvement, suggesting adequate decompression and 1 patient (1.4%) was documented to have persistent Tinel sign suggesting possibility of inadequate decompression with no recovery of sensation, with statistical significance.Conclusions: Present study reveals that decompression of tarsal tunnel in diabetic ulcer foot patients leads to definite improvement in sensation of foot which will prevent further ulcer formation and resultant complications ending in amputations.