Management Of Diabetic Foot Problems Research Articles

Thermography Research in Diabetic Foot: Insights From a Scopus-Based Bibliometric Study.

Diabetic foot problems are among the most debilitating complications of diabetes mellitus. These problems incur significant economic costs and reduce quality of life. The integration of thermography technology in the screening and management of diabetic foot problems has been proven to be successful in recent years. By detecting changes in temperature, thermography helps identify early infections and assists in patient monitoring. These early successes have inspired more research and publications in this field. To date, a comprehensive bibliometric analysis of thermography-related research on diabetic foot using the Scopus database has not been conducted. This bibliometric analysis aims to fill this gap by reviewing the Scopus database from its inception until 2023 to examine the literature on thermography-related research on diabetic foot. A total of 342 articles met the selection criteria and were included in this analysis. The number of articles in this field remained low until the 2010s, when there was a sudden surge of interest that prompted numerous publications. Authors from the USA contributed the highest number of articles and had the greatest scholarly impact in this field. Despite the major contribution from the USA, there were numerous collaborations between various countries, underscoring the importance of international collaboration in advancing research and exchanging knowledge.

Predictive Factors for Lower Limb Amputation in Type 2 Diabetics.

Type 2 diabetes mellitus (T2DM) is a major public health problem.Foot-related complications are common in diabetic patients. The aim of this study is to identify predictive factors for lower limb amputation (LLA) in order to better identify this at-risk population. This was a cross-sectional study involving 134 patients who were hospitalised for the management of T2DM complicated by diabetic foot, in the department of endocrinology and diabetology.We included patients with T2DM whose diabetes was diagnosed 10 years ago or more, and who had a diabetic foot problem. Statistical differences between predictors of amputations were tested using: t-tests for numerical variables and chi-square tests for categorical variables. Significant variables were analysed by logistic regression to determine significant predictors. The mean duration of diabetes was 17±7 years. We found that 70% of patients with LLA were older than 50 years (p<10-3). The prevalence of LLA was higher (p=0.015) in patients with diabetes for more than 20 years. We noted that 58% of patients who underwent LLA were hypertensive (p<10-3). The majority of patients with LLA (58%) had abnormal micro-albuminuria (p<10-3). We found that 70% (n=12) of patients with LLA had low-density protein cholesterol levels above the target value (p<10-3). Diabetic foot grade ≥4 (4 or 5) according to Wagner's classification, was present in 24% of amputee patients. Based on a 95% confidence interval level, the independent significant predictive factors for LLA in our patients were: T2DM for more than 20 years, hypertensionand diabetic foot grade ≥4. After multivariate analysis, the significant independent predictive factorsassociated with LLA were: T2DM for more than 20 years, hypertension, and diabetic foot grade ≥4. Early management of diabetic foot problems is therefore recommended to avoid amputations.

Results of the modified Pirogoff amputation with cannulated screws for diabetic foot infection.

Syme amputation has been shown to have value in patients with diabetic foot infections, but it has inherent drawbacks. A potential alternative is the modified Pirogoff amputation. Our objective was to evaluate the outcome of modified Pirogoff amputation using internal fixation with 6.5-mm cannulated screws in the management of diabetic foot. This is a prospective study of 13 patients admitted from January 2012 to June 2015. Inclusion criteria were infection limited to the forefoot, presence of a palpable posterior tibial pulse and an ankle-brachial index of more than 0.7. Internal fixation of the calcaneum to the tibial was performed using two 6.5-mm cannulated screws under image intensifier control. In ten cases, the wounds were healed at three weeks. Osseous union was observed in ten cases; the time taken for its occurrence was 2-5 months. Removal of screws was performed in five cases. Five cases developed technical complications of screw tract infection, with two cases having distal screw migration. Good results, defined as cases not requiring a below-knee amputation for two years postoperatively, were obtained in 10 (77%) cases. At the three-year follow-up, three additional cases required proximal amputation, leaving 7 (54%) cases with good outcomes. Our prospective study showed that with careful selection of patients, good postoperative results can be obtained. There is a definite role for modified Pirogoff amputation in the management of diabetic foot problems.

Diabetes series, 6. Prevention and management of diabetic foot problems

Diabetes mellitus (DM) increases the risk of foot problems and the person with diabetes is at risk of major complications, including ulcers and amputations. A person with DM is 30 times more likely to require an amputation than a person without diabetes ( Khanolkar et al, 2008 ). Every day, 20 people with diabetes have a lower limb amputation ( Public Health England, 2016 ). Simple interventions such as smoking cessation, inspecting feet daily, seeking help if there are any concerns and wearing suitable footwear can reduce the risk of ulcers and amputations and improve quality of life. This article aims to educate the healthcare assistant on the reasons why people with diabetes develop foot ulcers and to enable the healthcare assistant to provide appropriate care and support to people with diabetes.

Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre.

This study aimed to determine the risk factors of diabetic Charcot arthropathy of the foot among diabetic patients with and without foot problems. This was a case-control study involving diabetic patients attending the Diabetic Foot Care and Wound Management Clinic at University Malaya Medical Centre, Kuala Lumpur, Malaysia, from June 2010 to June 2011. Data on sociodemographic profiles, foot factors and diabetes characteristics was collected and analysed. A total of 48 diabetic patients with Charcot arthropathy of the foot were identified. Data from these 48 patients was compared with those of 52 diabetic patients without foot problems. Up to 83.3% of patients with diabetic Charcot arthropathy presented with unilateral Charcot foot, most commonly located at the midfoot (45.8%). Patients with a history of foot problems, including foot ulcer, amputation, surgery or a combination of problems, had the highest (26-time) likelihood of developing Charcot arthropathy (odds ratio 26.4; 95% confidence interval 6.4-109.6). Other significant risk factors included age below 60 years, more than ten years' duration of diabetes mellitus and the presence of nephropathy. A history of prior diabetic foot problems is the greatest risk factor for developing diabetic Charcot arthropathy, compared with other risk factors such as diabetes characteristics and sociodemographic profiles. Preventive management of diabetic foot problems in the primary care setting and multidisciplinary care are of paramount importance, especially among chronic diabetic patients.

The diabetic foot in 2015: an overview.

In 2015, it can be said that the diabetic foot is no longer the Cinderella of diabetic complications. Thirty years ago there was little evidence-based research taking place on the diabetic foot, and there were no international meetings addressing this topic. Since then, the biennial Malvern Diabetic Foot meetings started in 1986, the American Diabetes Association founded their Foot Council in 1987, and the European Association for the Study of Diabetes established a Foot Study Group in 1998. The first International Symposium on the Diabetic Foot in The Netherlands was convened in 1991, and this was soon followed by the establishment of the International Working Group on the Diabetic Foot that has produced useful guidelines in several areas of investigation and the management of diabetic foot problems. There has been an exponential rise in publications on diabetic foot problems in high impact factor journals, and a comprehensive evidence-base now exists for many areas of treatment. Despite the extensive evidence available, it, unfortunately, remains difficult to demonstrate that most types of education are efficient in reducing the incidence of foot ulcers. However, there is evidence that education as part of a multi-disciplinary approach to diabetic foot ulceration plays a pivotal role in incidence reduction. With respect to treatment, strong evidence exists that offloading is the best modality for healing plantar neuropathic foot ulcers, and there is also evidence from two randomized controlled trials to support the use of negative-pressure wound therapy in complex post-surgical diabetic foot wounds. Hyperbaric oxygen therapy exhibits the same evidence level and strength of recommendation. International guidelines exist on the management of infection in the diabetic foot. Many randomized trials have been performed, and these have shown that the agents studied generally produced comparable results, with the exception of one study in which tigecycline was shown to be clinically inferior to ertapenem ± vancomycin. Similarly, there are numerous types of wound dressings that might be used in treatment and which have shown efficacy, but no single type (or brand) has shown superiority over others. Peripheral artery disease is another major contributory factor in the development of ulceration, and its presence is a strong predictor of non-healing and amputation. Despite the proliferation of endovascular procedures in addition to open revascularization, many patients continue to suffer from severely impaired perfusion and exhaust all treatment options. Finally, the question of the true aetiopathogenesis of Charcot neuroarthropathy remains enigmatic, although much work is currently being undertaken in this area. In this area, it is most important to remember that a clinically uninfected, warm, insensate foot in a diabetic patient should be considered as a Charcot foot until proven otherwise, and, as such, treated with offloading, preferably in a cast.

Ozone Therapy in Diabetic Foot and Chronic, Nonhealing Wounds

The objective of this study was to evaluate the role of ozone therapy (as a part of a comprehensive approach) with its different techniques in the management of diabetic foot problems and chronic nonhealing wounds. The study design included a case series study, with review of the literature. Researchers used an ozone therapy unit, a Navy Diving and Hyperbaric Medicine Institute, and Ozone Therapy Unit, at the Armed Forces Hospital, in Alexandria, Egypt. All patients with diabetic foot problems and chronic nonhealing wounds were treated with ozone therapy from August 2006 to August 2009. Full history and clinical examination to identify diagnosis, and determine therapeutic comprehensive approaches including ozone therapy treatment protocols. Observation notes on the practice of ozone techniques, progress of diseases and outcome were accurately documented. Data were reviewed against best practice described in the literature. We observed overall successful treatments in 87% (46% of them complete healing) of patients treated with ozone. We reported the general and topical effects of ozone correlated to the technique used. The present study offers the clinical evidence which supports and recommends the use of ozone in diabetic foot and chronic nonhealing wounds. Cooperation between surgeon and ozone therapist is a must for successful outcomes. Randomized controlled trials should be performed as an essential method for accurately proving the reliability, efficacy and possible side effects of ozone therapy, and to introduce ozone to the world of surgeons and clinicians.

The diabetic foot: an overview for community nurses

Diabetic foot problems are a common complication of diabetes. They can lead to much morbidity and some mortality, with foot disease the leading cause of non-traumatic lower-limb amputation in the developed world. Diabetic foot disease is a result of three main pathologies, which can occur singly or in combination: diabetic peripheral neuropathy, peripheral arterial disease and infection. The consequences of these pathologies are ulceration, Charcot foot, painful diabetic neuropathy, gangrene and amputation. This article offers a podiatrist's view of the management of diabetic foot problems, from initial assessment to the management of complex disease. Patients with a diabetic foot problem must be assessed thoroughly and referred to the local multidisciplinary team where appropriate. Recurrence of ulcers is common, so good foot health education, adequate footwear and regular podiatry (if necessary) must be an integral part of the patient's review process. Community nurses are often the first to detect a diabetic foot ulcer in housebound patients, so they need the necessary skills to manage the ulcer effectively and refer patients appropriately.

Diabetic foot – what can we learn from leprosy? Legacy of Dr Paul W. Brand

Leprosy and diabetes, though two very different conditions, may both result in severe loss of sensation in the feet, which are then a great risk of painless injury and ulceration. Seminal observations made by the late Dr Paul W. Brand, a surgeon working with leprosy patients in South India in the mid-20th century, resulted in the subsequent development of treatments to manage insensitive foot ulcers that are today entirely applicable to patients with diabetes. As a consequence of his research, the recognition of the relationship between insensitivity, repetitive pressures and skin breakdown has helped our understanding of the aetiopathogenesis of neuropathic foot lesions in diabetes: the development of the total contact cast and other casting devices to treat such lesions forms the basis of management of diabetic foot lesions with off-loading devices that are widely used in the 21st century in diabetic foot clinics around the world. Moreover, observations by Brand that the foot 'heats up before it breaks down' resulted in more recent research showing that self-skin temperature monitoring might help reduce the incidence of recurrent neuropathic foot ulcers in diabetes. In summary, Brand's understanding of 'the gift of pain' that, when lost, results in the late complications of diabetic neuropathy has guided the prevention, diagnosis and management of diabetic foot problems in the 21st century.

The diabetic foot: an overview of assessment and complications

Diabetic foot problems are a common complication of diabetes mellitus and can lead to morbidity and mortality. Foot disease is the leading cause of non-traumatic lower-limb amputation in the developed world (National Institute for Health and Clinical Excellence (NICE), 2004). Diabetic foot disease is a result of three main pathologies, which can occur singly or in combination. These are: peripheral neuropathy, peripheral arterial disease and infection. Consequences of these pathologies are ulceration, Charcot foot, painful neuropathy, gangrene and amputation (NICE, 2004). This article offers a podiatrist perspective of the management of diabetic foot problems, from initial assessment to the management of complex foot disease. Patients with a diabetic foot problem must be assessed thoroughly and referred to the local multidisciplinary team, where appropriate (NICE, 2004). Recurrence of ulcers is common, and therefore good foot health education, adequate footwear and regular podiatry, if required, must be an integral part of the patient's review process (NICE, 2004).

Evidence‐based guidelines for the management of diabetic foot problems

Management of diabetic foot problems presents a series of complex challenges for patients and for health care professionals. Appropriate guidance on best practice is essential to delivering high-quality care. The NHMRC guidelines for the management of diabetic foot problems in primary care have just been updated to address this issue. The guidelines have been developed using systematic reviews of the literature, and broad consultation of organisations representing the relevant health care professionals and patients. The development of the guidelines, the evidence considered and the recommendations developed will be reviewed.

Value of team approach combined with clinical pathway for diabetic foot problems: a clinical evaluation

Aims To evaluate the effectiveness of management of diabetic foot problems (DFP) by the National University Hospital (NUH) Multidisciplinary Diabetic Foot Team combined with a clinical pathway in terms of average length of stay (ALOS), readmission rates, hospitalisation cost per patient, major reamputation rate, and complication rate.Methods 939 patients admitted to the Department of Orthopaedic Surgery, NUH, for DFP from 2002 (before team formation) to 2007 (after team formation). It consisted of six cohorts of patients – 61 for 2002, 70 for 2003, 148 for 2004, 180 for 2005, 262 for 2006, and 218 for 2007. All patients were managed by the NUH Multidisciplinary Diabetic Foot Team combined with a clinical pathway. Statistical analyses were carried out for five parameters (ALOS, hospitalisation cost per patient, major amputation rate, readmission rate, and complication rate).ResultsFrom 2002 to 2007, the ALOS was significantly reduced from 20.36 days to 12.20 days (p=0.0005). Major amputation rate was significantly reduced from 31.15 to 11.01% (p<0.0005). There was also a significant reduction in complication rate from 19.67 to 7.34% (p=0.005). There were reductions in the hospitalisation cost per patient and readmission rate after formation of the multidisciplinary team but they were not statistically significant.Conclusion Our evaluation showed that a multidisciplinary team approach combined with the implementation of a clinical pathway in NUH was effective in reducing the ALOS, major amputation rate, and complication rate of DFP.

Saving the diabetic foot in long-term care settings

Diabetic foot complications can have serious consequences for patients. Jenny Bentley and Ali Foster discuss prevention and risk management of diabetic foot problems, which require the combined efforts of a multidisciplinary team

Guidelines for the treatment of arterial insufficiency ulcers

1. Co-chaired panel 2. University of Utah, Salt Lake City, UT 3. University of Texas, San Antonio, TX 4. Sinai Hospital/Johns Hopkins Medical Institutions, Baltimore, MD 5. GKT School of Medicine, King’s College, London, UK 6. University of Texas Health Science Center at Houston, TX 7. Sequoia Hospital, Redwood City, CA 8. Maricopa Medical Center, Phoenix, AZ 9. Tufts-New England Medical Center, Boston, MA 10. Southampton University Hospitals Trust NHS, Southampton, UK 11. Penrose–St. Francis Health Services, Colorado Springs, CO 12. Beverly Surgical Associates, Beverly, MA 13. Saint Francis Memorial Hospital, San Francisco, CA 14. Northbay Center for Wound Care, Vacaville, CA, and 15. University of California, San Francisco, CA

Step by Step, improving diabetic foot care in the developing world

AbstractThe increase in the prevalence of diabetes and its complications is alarming. The incidence of diabetic foot disease, which leads to foot amputations far too often, is unacceptably high. This is particularly true for developing countries.Worldwide, every 30 seconds a lower limb is lost as a consequence of diabetes.The International Diabetes Federation (IDF) Consultative Section and the International Working Group on the Diabetic Foot (IWGDF), together with the Diabetic Foot Society of India (DFSI) and the Muhimbili University College of Health Sciences Dar es Salaam, Tanzania (MUCHS), have initiated a foot care project called ‘Step by Step, improving diabetic foot care in the developing world’. Participating countries were India, Bangladesh, Sri Lanka and Tanzania. Teams, consisting of a doctor and a nurse or paramedic, were invited to attend a basic and an advanced course. The goal was to improve educational skills and the management of diabetic foot problems. An experienced national and international faculty was responsible for teaching and the practical sessions.This article describes the design and the execution of the project. The outcome looks very positive. It is expected that the acquired knowledge and skills of the teams will sustain and that the effect of the courses will cascade from the teams to the local community. We expect that the setup of the project can ultimately help reduce the number of lower extremity amputations. The authors feel that this project is ready to be carried out in other developing countries.This pilot study was generously supported by the World Diabetes Foundation. Copyright © 2006 John Wiley &amp; Sons.

Management of diabetic foot problems. George P. Kozak, Carl S. Hoar Jr, John L. Rowbotham, Frank C. Wheelock, Gary W. Gibbons and David Campbell. 265 × 185 mm. Pp. 250 + xvii. Illustrated. 1984. Eastbourne: W. B. Saunders. £43.50

Management of diabetic foot problems. George P. Kozak, Carl S. Hoar Jr, John L. Rowbotham, Frank C. Wheelock, Gary W. Gibbons and David Campbell. 265 × 185 mm. Pp. 250 + xvii. Illustrated. 1984. Eastbourne: W. B. Saunders. £43.50

Management of diabetic foot problems, 2nd edition

Management of diabetic foot problems, 2nd edition

Management of Diabetic Foot Problems.

Management of Diabetic Foot Problems.

Management of Diabetic Foot Problems

Management of Diabetic Foot Problems

Reviews and Notes: Management of Diabetic Foot Problems

Reviews and Notes: Management of Diabetic Foot Problems