Prevention Of Diabetic Foot Ulcers Research Articles

Smart Compression Sock for Early Detection of Diabetic Foot Ulcers

The prevention of diabetic foot ulcers remains a critical challenge. This study evaluates a smart compression sock designed to address this issue by integrating temperature, plantar pressure, and blood oxygen sensors and monitoring data recorded by these sensors. The smart sock, developed with input from a certified Pedorthist, was tested on 20 healthy adult participants aged 16 to 53. It includes four temperature sensors and pressure sensors at common ulcer sites (first and fifth metatarsal heads, calcaneus, and hallux), and a blood oxygen sensor on the hallux. The sensors are monitored, and their transduced data are collected and stored through an app installed on a personal cell phone. The mobile app interface is user-friendly, providing intuitive navigation and easy access to the sensors’ data. Using repeated measures ANOVA and post hoc tests, we analyzed the impact of various physical activities on physiological changes in the foot. The device effectively detected significant variations in blood oxygen, temperature, and pressure across six activities. Statistical analyses revealed significant differences based on activity type and sensor location. These results highlight the smart sock’s sensitivity and accuracy, suggesting its potential to prevent diabetic foot ulcers. Further clinical trials are needed to evaluate its efficacy in a larger, more diverse population.

Personalized and predictive strategies for diabetic foot ulcer prevention and therapeutic management: potential improvements through introducing Artificial Intelligence and wearable technology.

Diabetic foot ulcers represent a serious and costly complication of diabetes, with significant morbidity and mortality. The purpose of this study was to explore advancements in Artificial Intelligence, and wearable technologies for the prevention and management of diabetic foot ulcers. Key findings indicate that Artificial Intelligence-driven predictive analytics can identify early signs of diabetic foot ulcers, enabling timely interventions. Wearable technologies, such as continuous glucose monitors, smart insoles, and temperature sensors, provide real-time monitoring and early warnings. These technologies promise to revolutionize diabetic foot ulcer prevention by offering personalized care plans and fostering a participatory healthcare model. However, the review also highlights challenges such as patient adherence, socioeconomic barriers, and the need for further research to validate these technologies' effectiveness. The integration of artificial intelligence and wearable technologies holds the potential to significantly improve diabetic foot ulcer outcomes, reduce healthcare costs, and provide a more proactive and personalized approach to diabetic care. Further investments in digital infrastructure, healthcare provider training, and addressing ethical considerations are essential for successful implementation.

Minimally Invasive Distal Metatarsal Diaphyseal Osteotomy (MIS-DMDO) for the Prevention and Treatment of Chronic Plantar Diabetic Foot Ulcers.

Diabetic foot is one of the major complications of diabetes, affecting 15% of patients with diabetes. This study aims to evaluate and compare the clinical and radiographic outcomes of patients with diabetes affected by forefoot plantar preulcerative or ulcerative lesions who have undergone minimally invasive distal metatarsal diaphyseal osteotomy (MIS-DMDO) to assess its efficacy in the prevention and treatment of chronic plantar diabetic foot ulcers (CPDFUs). The study included 60 patients, 38 with preulcers and 22 with ulcers, with at least 2 years of clinical and radiologic follow-up. Clinical outcomes were assessed using the European Foot and Ankle Society (EFAS) score, the Foot Function Index (FFI), and the Manchester-Oxford Foot Questionnaire (MOXFQ). The radiographic evaluation was performed according to the Maestro criteria. Both groups improved in clinical and radiologic outcomes when comparing baseline measurements to those at the final follow-up. There were no statistical differences between preulcer and ulcer groups in terms of both clinical and radiologic outcomes, with the only exception being FFI, which was lower in the preulcerative group. In multivariate analysis, gender and glycated hemoglobin (HbA1c) were predictors of better outcomes. Specifically, FFI and MOXFQ (P < .05) exhibited larger improvements in females, while Maestro 1 and 2 were better in patients with lower HbA1c (P < .05). All patients were considered healed at the final follow-up. Carefully performed minimally invasive distal metatarsal diaphyseal osteotomy can be an effective approach to the care of impending or chronically present plantar diabetic foot ulcers.

Analytical HPLC Method for Determination of Miconazole Nitrate and Eugenol in Formulated Emulgel

A diabetic foot ulcer (DFU) is the prime cause of poor quality of life among diabetic patients. DFU leads to physical disability and an enormous economic burden on diabetic patients. The development and prognosis of DFU are preventable in most patients by modifying the risk factors for DFU. Programs intervened by clinical pharmacists can enhance rational drugs use and improve the early identification and prevention of DFU. This study intended to prove the beneficial outcome in identifying the risk factors and the provision of patient-tailored referral advice regarding DFU among diabetic patients. This cross-sectional study assessed the neuropathy through Michigan Neuropathy Screening Instrument (MNSI), Monofilament and Vibration test using Tuning Fork and Handheld Doppler for assessing the lower limb vascular disease as per NICE guideline among 137 diabetic patients. 64% of patients were found to have symptoms of neuropathy through the neuropathy assessment test whereas 36% did not have the symptoms. Foot sensory using monofilament test was found to be normal in 49.64% of DFU patients, reduced in 43.80%, and absent in 6.57% of DFU patients. The Ankle Brachial Index (ABI) was found to be normal in 48% of patients, mild in 34% of patients, moderate in 12% of patients, and incompressible in 6% of patients. Clinical Pharmacist intervened risk assessment through Hand-held Doppler, MNSI instrument, and Vibration test helped in screening the DFU patients for Neuropathy, and implementation of effective per patient-tailored education was found to be beneficial in the early identification of DFU and referral to specialty hospitals

Exploration of predictive risk factors for diabetic foot in patients with diabetes in Beijing: analysis of 5-year follow-up data of patients with diabetes mellitus in a single center in Beijing.

Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c≥ 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions.

Nursing Interventions for the Prevention and Management of Diabetic Foot Ulcers among Patients at Rajshahi Medical College Hospital

Nursing Interventions for the Prevention and Management of Diabetic Foot Ulcers among Patients at Rajshahi Medical College Hospital

Plantar pressure measurement in diabetic foot disease: A scoping review.

Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence. Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis - Scoping Review protocol. Peer-reviewed, English-language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field. A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review. Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real-world settings, and with improved technology.

IJCM_121A: Assessment of risk of foot ulcer in patients with diabetes according to the risk classification consensus of International Working Group on Diabetic Foot (IWGDF) in Ernakulam District, Kerala; a community based cross sectional study

Background: The International Diabetes Federation states that India accounts for 1 in 7 of all adults living with diabetes worldwide. Diabetic foot disease is among the most serious complications of diabetes mellitus as it is a source of major suffering and financial burden for the patient, healthcare professionals and the society in general. The leading cause of lower-limb amputations is diabetes and 40%–85% of these are preventable Objective: Assessment of diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) consensus. Methodology: A community based cross-sectional study was done in Ernakulam district involving 600 individuals with diabetes mellitus. The study gathered information on sociodemographic factors, anthropometric details and a detailed foot examination was performed with a IWGDF checklist. The collected data were entered into MS Excel, and the analysis was carried out using SPSS 21.0. Results: Mean age of patients in the study was 61.48 yrs±10.24 years.371 patients (61.83%) were females and 229(38.17%) were males.108 patients (18%) had disturbed sense of vibration (128 Hz). 90 patients (15%) had decreased sensitivity to 10-gram monofilaments. Peripheral arterial disease was present in 47 patients (7.83). 20 patients (3.33%) had history of previous ulcer. 11(1.83%) patients had lower extremity amputation. Patients were classified into four risk groups according to IWGDF criteria. Four hundred and fifty-five patients (75.83%) were in group 0, fifty-five patients (9.1%) in group 1, sixty-six patients (11%) in group 2 and twenty-four patients (4%) in group 3 of IWGDF criteria Conclusion: Routine foot examination in patients with diabetes as per IWGDF guidelines for each risk category will help in prevention of diabetic foot ulcers.

Diagnosis, Treatment, Prevention, and Rehabilitation of Diabetic Foot Ulcers and Infections: Turkish Consensus Report, 2024

Diagnosis, Treatment, Prevention, and Rehabilitation of Diabetic Foot Ulcers and Infections: Turkish Consensus Report, 2024

Complications of Percutaneous Tendo-Achilles Lengthening for Treatment and Prevention of Diabetic Foot Ulcers: A Systematic Review

Percutaneous Achilles tendon lengthening is an effective surgical procedure to treat and prevent forefoot and midfoot ulcerations in patients with diabetes. Patients with diabetes are prone to plantar ulcerations due to a combination of factors, such as peripheral neuropathy, decreased tendon elasticity, peripheral vascular disease, and hyperglycemia. Complications such as re-ulceration and transfer lesion to the heel, associated with a calcaneal gait secondary to over-lengthening, are possible with percutaneous Achilles tendon lengthening. Although percutaneous Achilles tendon lengthening is well accepted, the overall incidence of complication has not been well described. A systematic review of the reported data was performed to determine the incidence of complication for percutaneous tendo-Achilles lengthening when used for the treatment and prevention of diabetic plantar ulcerations. Nine studies involving 490 percutaneous lengthening procedures met the inclusion criteria. The overall complication rate was 27.8% (8% with transfer heel ulcerations). Given the high rate of complications associated with a percutaneous Achilles tendon lengthening, careful patient selection and consideration of these risks should be considered prior to proceeding with this procedure. Additional prospective comparative analyses with standardization of surgical technique, degrees of lengthening achieved, and post-operative weightbearing and immobilization modalities are needed to decrease incidence of complication and achieve higher healing rates.

Folic Acid and Diabetic Foot Ulcers.

Diabetic foot ulcers (DFUs) remain a major cause of morbidity. This narrative mini-review aimed to investigate the potential role of folic acid (FA) in DFUs. Individuals with DFUs exhibit lower levels of FA and lower daily intake, compared to those without DFUs. There is preliminary evidence that FA administration may contribute to improved DFUs healing. In this context, regular evaluation of dietary FA intake may prove important towards reduction or even prevention of DFUs. However, data are still limited and further research is required to enable definitive conclusions and any recommendations.

Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association.

Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country. Mounting evidence has shown that, despite these efforts, amputations associated with DFUs continue to increase. Furthermore, due to increasing patient complexity of management secondary to comorbid conditions, such as cardiovascular disease, the management of peripheral artery disease associated with DFUs has become increasingly difficult, and care delivery is often episodic and fragmented. Although structured, process-specific approaches exist at individual institutions for the management of DFUs in the cardiovascular patient population, there is insufficient awareness of these principles in the general medicine communities. Furthermore, there is growing interest in better understanding the mechanistic underpinnings of DFUs to better define personalized medicine to improve outcomes. The goals of this scientific statement are to provide salient background information on the complex pathogenesis and current management of DFUs in cardiovascular patients, to guide therapeutic and preventive strategies and future research directions, and to inform public policy makers on health disparities and other barriers to improving and advancing care in this expanding patient population.

Knowledge, Attitude, and Practice Regarding the Risk of Diabetic Feet Among Diabetic Patients in the Madinah Region, Saudi Arabia.

Introduction A patient suffering from diabetes mellitus (DM) has a high chance of developing a diabetic foot. Awareness and attitude towardthe prevention of diabetic foot ulcers are necessary for a better quality of life. Educating patients with diabetes about the methods of foot care plays an important role in preventing diabetic foot complications in individuals with DM. This study aims to determine the level of knowledge, attitude, and practices of diabetic patients about the risk of diabetic feet in Madinah, Saudi Arabia. Methodology This is an observational cross-sectional study conducted using an online questionnaire. Participants were older than 18 years of age. IBMSPSSStatistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States) was used for data analysis. The questionnaire included patient personal data, patients' knowledge regarding diabetic feet, attitude, and practice regarding the risk of diabetic feet among diabetic patients. Results A total of 1155 participants completed the questionnaire. Exactly 79.9% of people had good knowledge regarding diabetic feet and their care. The analysis revealed that age, gender, education level, and family history of DMare all significant predictors of knowledge levels among the participants. The majority of participants strongly agreed that diabetic patients should promptly seek medical assistance in case of any foot infections (90.8%) and take regular checkups (76.5%). Regarding foot care practices, people generally take good care of their feet but do not seek checkups until they experience symptoms (81.8%). Conclusion The study showed that participants had good knowledge about diabetic feet and a careful attitude towardthem. Their practices towarddiabetic feet were acceptable; however, the issue of late medical consultation after the development of symptomatology needs to be addressed.

Patients' Expectations of Evidence-Based Service at the Pharmacy Regarding Information on Self-Care of the Feet for Persons with Diabetes at Risk of Developing Foot Ulcers - A Cross-Sectional Observational Study in Sweden.

Self-care of the feet is one of the cornerstones in the prevention of diabetic foot ulcers (DFU). Often, individuals with diabetes seek help at the pharmacy, but it is still unclear whether the service meets their expectations and needs. The aims were to explore patients' expectations of support from the pharmacy regarding self-care of their feet and explore how patients with diabetes felt that they managed the self-care of their feet. The included participants (n = 17), aged 70 ± 9 years, answered surveys regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. By using software, MyFoot Diabetes, they assessed their risk of developing DFU (ranging from 1 = no risk to 4 = DFU). In addition, a healthcare professional assessed the risk grade. Sixteen patients had not received any information from the pharmacy regarding how to take care of their feet. Several suggestions for ways the pharmacy could help patients with diabetes to take care of their feet were registered. They included having the necessary skills and competence, giving advice regarding self-care, giving information regarding the products they market and have for sale and giving advice on ointments/creams. The participants gave several examples of how they self-managed their feet: by wearing shoes indoors and outdoors, wearing socks and compression stockings as often as possible, being physically active, inspecting their feet, being aware of the fact that their feet have no problems, washing, moisturising their feet, cutting their nails and finally seeking help to prevent DFU. The participants thought that they should receive competent information from the personnel at the pharmacy to improve the self-care of their feet, eg, being given information about which ointments/creams to use. NCT05692778.

Diabetic Foot Risk Factors &amp; level in Diabetes People: A Cross-Sectional Study

Objective: Determining diabetic foot risk levels and risk factors and treating foot problems is one of the main components of the prevention of diabetic foot ulcers (DFU). This study aimed to determine diabetic foot risk levels and risk factors in diabetic people.&#x0D; Materials and Methods: This descriptive cross-sectional study included 278 participants during September 2020 to March 2021. The patients' general characteristics, peripheral sensory loss (10 g-Semmes-Weinstein monofilament), foot skin temperature (palpation method) and vascular evaluation (pedal pulses) were examined.&#x0D; Results: Among 278 patients, 83 cases had DFU. Of those without DFU, 33.3% had risk level “0”, 35.4% had risk level “1”, 23.6% had risk level “2” and 7.7% had risk level “3”. In the regression analysis, male gender [OR= 0.74, 95% CI (0.014-0.338), P= 0.002], education (literate) [OR= 0.38, 95% CI (0.002-0.630), P= 0.022], foot examination by health professional [OR= 0.013, 95% CI (0.001-0.183), P= 0.001], foot deformity [OR= 0.170, 95% CI (0.042-0.679), P&lt; 0.001], foot skin temperature (cold) [OR= 0.003, 95% CI (0.000– 0.026), P&lt; 0.001], and pedal pulse [OR= 8.146, 95% CI (1.505-44.081), P&lt; 0.015] were found to have a high effect on diabetic foot development.&#x0D; Conclusion: The annual DFU rate is 29.8%. Independent risk factors of DFU were gender, education, previous history foot examination, foot skin temperature, pedal pulse and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Prevention and Treatment of Diabetic Foot Ulcer by Health Education of Specialized Nurses

Objective: To analyze the preventive effect of specialized nurse health education on diabetic foot ulcers. Methods: From January 2022 to December 2022, 90 diabetic high-risk foot patients that were admitted to the Endocrinology Department of a general hospital in Macau that met the inclusion criteria were selected as the research subjects. The research subjects were randomly divided into an intervention group and a control group, with 45 cases in each group by mechanical sampling method. The foot care knowledge of the patients one month and three months after the intervention were evaluated and analyzed. Results: The scores of foot care knowledge in the intervention group were higher than those in the control group at one month and three months after the intervention, and the difference was statistically significant (P &lt; 0.05). Conclusion: Health education by specialized nurses are essential in preventing and treating diabetic foot ulcers. Effective prevention and management of diabetic foot ulcers can be achieved through guidance on diet control, exercise, foot care, blood sugar monitoring, infection prevention, stress reduction, appropriate medication, and regular follow-up.

The awareness and determinants of diabetic foot ulcer prevention among diabetic patients: Insights from NHANES (2011–2018)

The prevention of diabetic foot ulcers (DFU) precedes treatment, in that early prevention significantly reduces the incidence of foot ulcers. The main objectives of this study were to examine the current prevalence of proactive foot ulcer examinations among diabetic patients and analyze influencing factors, in order to provide a scientific reference for the prevention of DFU in diabetic patients. The National Health and Nutrition Examination Survey (NHANES) 2011–2018 (n = 1278) data were utilized in this cross-sectional study. The dependent variable was whether patients underwent self-initiated foot ulcer inspections; risk factors that may lead to foot ulcers were included as independent variables. To explore the connection between the patient’s subjective motivation to inspect foot ulcers and risk variables, the weighted logistic regression model was further carried out. Among all risk factors, race, body mass index (BMI) and hypertension were statistically significant between whether patients were examined for foot ulcers or not. In the fully adjusted logistic regression model, only hypertension was positively correlated with diabetic patient-initiated examination for foot ulcers. This study suggests that there is still room for improvement in the knowledge and behavior of diabetic patients to be proactive in preventing DFU. Health care and community workers should conduct targeted training on diabetic foot prevention to reduce and prevent DFU by reinforcing knowledge to build positive attitudes and drive preventive behavior change.

FEET: First Nations Empowerment Through Enabling Technology: An Indigenous-led Health Pilot For Diabetic Foot Ulcer Prevention

Diabetes is a significant health challenge for Indigenous populations in Canada. Diabetic foot ulcers are common. Siksika Nation, a First Nation in Alberta, Canada provides healthcare to nearly 8,000 members through Siksika Health Services (SHS). This presentation highlights a 24-week pilot focusing on the prevention and early detection of diabetic foot ulcers and on promoting foot health within the Nation.

Intelligent plantar pressure offloading for the prevention of diabetic foot ulcers and amputations.

The high prevalence of lower extremity ulceration and amputation in people with diabetes is strongly linked to difficulties in achieving and maintaining a reduction of high plantar pressures (PPs) which remains an important risk factor. The effectiveness of current offloading footwear is opposed in part by poor patient adherence to these interventions which have an impact on everyday living activities of patients. Moreover, the offloading devices currently available utilize primarily passive techniques, whereas PP distribution is a dynamically changing process with frequent shifts of high PP areas under different areas of the foot. Thus, there is a need for pressure offloading footwear capable of regularly and autonomously adapting to PPs of people with diabetes. The aim of this article is to summarize the concepts of intelligent pressure offloading footwear under development which will regulate PPs in people with diabetes to prevent and treat diabetic foot ulcers. Our team is creating this intelligent footwear with an auto-contouring insole which will continuously read PPs and adapt its shape in the forefoot and heel regions to redistribute high PP areas. The PP-redistribution process is to be performed consistently while the footwear is being worn. To improve adherence, the footwear is designed to resemble a conventional shoe worn by patients in everyday life. Preliminary pressure offloading and user perceptions assessments in people without and with diabetes, respectively, exhibit encouraging results for the future directions of the footwear. Overall, this intelligent footwear is designed to prevent and treat diabetic foot ulcers while enhancing patient usability for the ultimate prevention of lower limb amputations.

Tingkat Pengetahuan Pasien Diabetes Melitus pada Pencegahan Luka Kaki Diabetes

Diabetes mellitus is a chronic disease characterized by elevated blood glucose levels and is the most common disease encountered by the wider community. The most common complication in patients with diabetes mellitus is diabetic foot ulcers. The level of knowledge in people with diabetes mellitus has an important role in preventing diabetic foot ulcers. This study aims to determine the relationship between the level of knowledge of diabetes mellitus patients on the prevention of diabetic foot ulcers at the Kassi-Kassi Public Health Center, Makassar City. The research design used in this study is a correlation design and uses a cross sectional approach. The determination of the sample was carried out by purposive sampling technique with a sample size of 43 people. The correlation test was performed using the Fisher Exact Test statistical test with a significance level of &lt; 0.05. The results showed that there was a significant relationship between the level of knowledge and the prevention of diabetic foot ulcers (p = 0.20 &lt; 0.05). The conclusion of this study is that there is a relationship between the level of knowledge and prevention of diabetic foot ulcers in patients with diabetes mellitus at the Kassi-Kassi Public Health Center Makassar City.