Recurrence Rate Of Foot Ulcers Research Articles

A promising method for reducing the incidence of diabetic foot ulcers: Regulating foot temperature during walking

Diabetic foot ulcers (DFUs) pose a significant challenge in the medical field, particularly with the rising prevalence of diabetes. Consequently, there’s a growing emphasis on devising effective prevention strategies to combat the high recurrence rate of these ulcers. Daily walking, while essential for maintaining a normal lifestyle and social interaction is also the primary source of external mechanical stress applied to the foot. Preserving the integrity of foot tissues during daily walking is critical for preventing foot ulcers. An increase in foot tissue temperature, a significant environmental factor induced by walking, can diminish the foot tissue’s resistance to external mechanical stimuli by affecting tissue metabolism and biomechanical properties (tensile and compressive properties) during walking. This could be a key factor contributing to the high recurrence rate of foot ulcers, despite the advancement in clinical unloading protection technology. We propose a hypothesis that managing foot temperature and preventing a continuous temperature rise caused by walking could help protect the integrity of diabetic foot tissue. Long-term adherence to this approach could potentially reduce the incidence of DFUs. A clinical randomized controlled trial has been designed to evaluate this hypothesis from the aspects of tissue metabolism and biomechanical properties. This study aims to offer a novel method for protecting against DFUs and guide the design of foot aids.

Changes in physical function and ambulatory state after Achilles tendon lengthening for diabetic foot ulcers.

[Purpose] The recurrence rate of diabetic foot ulcers is high and is related to kinematic factors. Achilles tendon lengthening has been shown to reduce the recurrence rate of foot ulcers by increasing the range of motion in the ankle joint and decreasing the plantar load. However, there are few reports on the effects of Achilles tendon lengthening in Japanese patients, but the results are yet to be clarified. This study aims to investigate the effects of Achilles tendon lengthening on physical function and ambulatory state in patients with diabetic foot ulcers. [Participants and Methods] This study initially included 10 patients with diabetic ulcers who had undergone Achilles tendon lengthening between April 2013 and March 2020. We retrospectively evaluated the factors available from the medical records. [Results] The dorsiflexion range of motion in the ankle joint increased by 10.5 degrees on average after surgery, while the plantar load decreased by 19.1 percent, while gait speed and stride length remained unchanged. [Conclusion] Achilles tendon lengthening for diabetic foot ulcers increased the range of motion in the ankle joint and decreased the plantar load without changing the ambulatory state.

Epidemiological Characteristics of Diabetic Foot and Affecting Factors for Amputation in China

With the increased prevalence of diabetes from 0.67% in 1980 to 11.2% in 2017, the prevalence of diabetic foot has been growing in China in recent years. Diabetic foot ulcer (DFU) was one of the most serious complications of diabetes. Complicated general condition, severe infection and poor outcomes were feature characteristics of Chinese DFU patients. The annual incidence of DFU in China was as high as 8.1% in patients with diabetes, which ranked the first among the causes of chronic wounds in hospitalized patients [1-2]. And the recurrence rate of foot ulcers in healed DFU patients over 50-year-old was as high as 31.6% within one year [1].

Diabetic foot syndrome-Part 1 : Definition, pathophysiology, diagnostics and classification

In Deutschland leben ca. 8 Mio. Menschen mit Diabetes mellitus. Eine Spätfolge dieser Erkrankung ist das diabetische Fußsyndrom (DFS), dessen Prävalenz stark ansteigt. Es umfasst alle Veränderungen am Fuß als Folge der diabetischen Polyneuropathie sowie mikro- und makroangiopathischer (periphere arterielle Verschlusskrankheit, PAVK) Veränderungen. Jährlich entstehen ca. 250.000 neue diabetische Fußulzera. Diese werden oft zu chronischen Wunden. Trotz intensiver Bemühungen um Prävention, frühzeitige Diagnostik und stadiengerechte Wundbehandlung werden in Deutschland jährlich ca. 13.000 Majoramputationen bei Diabetikern durchgeführt. Bei konsequenter Therapie des DFS in interdisziplinären Zentren mit Ausschöpfung aller Möglichkeiten der Wundbehandlung, der Druckentlastung sowie einer arteriellen Revaskularisation kann die Majoramputationsrate um bis zu 80 % gesenkt werden. Durch eine geeignete Präventionsstrategie wäre die große Gefahr der Rezidivulzera geringer.

Surgical offloading procedures for diabetic foot ulcers compared to best non-surgical treatment: a study protocol for a randomized controlled trial

BackgroundDiabetic foot ulcers are frequently related to elevated pressure under a bony prominence. Conservative treatment includes offloading with orthopaedic shoes and custom made orthotics or plaster casts. While casting in plaster is usually effective in achieving primary closure of foot ulcers, recurrence rates are high. Minimally invasive surgical offloading that includes correction of foot deformities has good short and long term results. The surgery alleviates the pressure under the bony prominence, thus enabling prompt ulcer healing, negating the patient’s dependence on expensive shoes and orthotics, with a lower chance of recurrence. The purpose of this protocol is to compare offloading surgery (percutaneous flexor tenotomy, mini-invasive floating metatarsal osteotomy or Keller arthroplasty) to non-surgical treatment for patients with diabetic foot ulcers in a semi-crossover designed RCT.MethodsOne hundred patients with diabetic neuropathy related foot ulcers (tip of toe ulcers, ulcers under metatarsal heads and ulcers under the hallux interphalangeal joint) will be randomized (2:3) to a surgical offloading procedure or best available non-surgical treatment. Group 1 (surgery) will have surgery within 1 week. Group 2 (controls) will be prescribed an offloading cast applied for up to 12 weeks (based on clinical considerations). Following successful offloading treatment (ulcer closure with complete epithelization) patients will be prescribed orthopaedic shoes and custom made orthotics. If offloading by cast for at least 6 weeks fails, or the ulcer recurs, patients will be offered surgical offloading. Follow-up will take place till 2 years following randomization. Outcome criteria will be time to healing of the primary ulcer (complete epithelization), time to healing of surgical wound, recurrence of ulcer, time to recurrence and complications.DiscussionThe high recurrence rate of foot ulcers and their dire consequences justify attempts to find better solutions than the non-surgical options available at present. To promote surgery, RCT level evidence of efficacy is necessary.Trial registrationIsrael MOH_2017–08-10_000719. NIH: NCT03414216.