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Diabetic Ulcer


Presentation

  • The objective of the present study was to collect evidence regarding the use of PRP for the topical treatment of chronic leg ulcers.[ncbi.nlm.nih.gov]
  • In this case series we present our clinical experience and management of three patients presenting with a hot swollen foot with associated non healing ulcers.[bjd-abcd.com]
  • Results: Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions.[eurekaselect.com]
  • Majority of the cases presented with ulcer within 6–10 years of being diagnosed as a diabetic, whereas 8.2% of cases presented even after 20 years of diagnosis.[cjhr.org]
Nightmare
  • From a medicolegal perspective, heel ulcers are a nightmare for hospitals, extended care facilities and providers as the formation of a heel ulcer carries an implication of negligence, abuse or overall poor quality of care.[podiatrytoday.com]
Leg Edema
  • Ulcer: Diabetic patient with foot ulcer Refer to orthopaedic foot & ankle specialist or wound clinic Step 1: Optimize diabetes management Goal of HgA1c 8% to improve healing outcomes Step 2: Risk of peripheral vascular disease Evaluate for claudication, leg[ahpnetwork.com]
Snoring
  • Obstructive Sleep Apnoea Snoring may be a common night-time nuisance, but it can also signal a serious sleep disorder called obstructive sleep apnoea. 644 Diabetic Foot Ulcer: Symptoms and Treatment[healthhub.sg]
Bounding Pulse
  • The classic neuropathic foot has warm dry skin and bounding pulses, but many patients have a combination of neuropathy and ischaemia. The main cause of diabetic ulceration is neuropathy.[foothyperbook.com]
  • Most patients have bounding pulses in the acute phase, owing to vascular sympathetic denervation, although patients with chronic Charcot may have elements of vascular compromise.[intechopen.com]
Excoriation
  • CliniSorb should be considered if the wound is malodorous and LBF will protect the peri-wound area from excoriation by the exudate. External pressure can be reduced to the wound with appropriate footwear; bed rest or other ‘offloading’ devices.[clinimed.co.uk]
Metatarsophalangeal Arthritis
  • arthritis.4,6-8,11,12,17,50-57 Tendon lengthening can help address foot pain and deformity from these conditions.4,6,7,11,14,27,47,50-56 Patients with diabetes have a higher complication rate with foot and ankle surgery.58 Tendon lengthening via gastrocnemius-soleus[podiatrytoday.com]
Ankle Arthritis
  • Increased stress in the foot can also cause deformity and foot pain including corns, calluses, clawtoes, plantar fasciitis, posterior tibial tendinitis, arch collapse, foot and ankle arthritis, Charcot arthropathy, Achilles tendinitis, metatarsalgia,[podiatrytoday.com]
Metatarsalgia
  • Increased stress in the foot can also cause deformity and foot pain including corns, calluses, clawtoes, plantar fasciitis, posterior tibial tendinitis, arch collapse, foot and ankle arthritis, Charcot arthropathy, Achilles tendinitis, metatarsalgia,[podiatrytoday.com]
Heel Pain
  • Gastrocnemius recession for heel pain. Techniques Foot Ankle Surgery. 2011; 10(20)71-75. 52. Abbassian A, Kohls-Gatzoulis J, Solan MC. Release in the recalcitrant plantar fasciitis. Foot Ankle Int. 2012; 33(1):14-19 53. Thomas JL, Huffman L.[podiatrytoday.com]
Excitement
  • At every visit, each subject's plantar skin was excited with a weak laser light (337nm) to induce tissue fluorescence at three locations on each foot.[ncbi.nlm.nih.gov]
  • "We are excited to support Podimetrics as they scale and bring this clinically validated solution to the millions of patients who can live healthier lives free of [diabetic foot ulcers].”[mobihealthnews.com]
  • “We are excited to see a new innovation in diabetes care with the potential to improve the number of foot ulcers that heal,” said William Maisel, M.D., M.P.H., acting director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological[fda.gov]

Workup

  • Because it presents as an open, necrotic ulcer, ruling out infection is a top priority. 3 However, an initial workup to rule out infection or other conditions can delay diagnosis and treatment, 1 and treatment with broad-spectrum antibiotics poses the[mdedge.com]
  • Plain radiographs are useful in the initial workup of a diabetic foot infection. Particular attention should be paid to any radiographic abnormalities, such as cortical erosions, periosteal reactions, soft tissue gas, or radiopaque foreign bodies.[journals.sagepub.com]

Treatment

  • Healing of lesions is problematic in some cases using conventional treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Around 3-15% of all cutaneous melanomas are located on the foot and have a poorer prognosis than melanoma elsewhere.[ncbi.nlm.nih.gov]
  • Outlook (Prognosis) Without treatment, this condition can be life threatening. Severe infection is the most frequent cause of death. With treatment, the disorder tends to be chronic. Side effects of treatment may be severe or disabling.[mountsinai.org]
  • The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research.[eurekalert.org]
  • Prognosis Mortality in people with diabetes and foot ulcers is often the result of associated large vessel arteriosclerotic disease involving the coronary or renal arteries.[emedicine.medscape.com]

Etiology

  • Five of the seven randomized clinical trials studied ulcers of diabetic etiology. The results of meta-analysis showed that PRP favors the healing process (95% CI: 2.94-20.31).[ncbi.nlm.nih.gov]
  • Etiology “The majority of foot ulcers appear to result from minor trauma in the presence of sensory neuropathy.”[clinical.diabetesjournals.org]
  • Determining the underlying etiology of the ulcer and ascertaining whether the lesion is neuropathic, ischemic, or induced by adjacent foot deformity is important.[o-wm.com]

Epidemiology

  • Epidemiology and health care costs of diabetic foot problems. In: Veves A, Giurini JM, LoGerfo FW, eds. The Diabetic Foot: Medical and Surgical Management. New York, NY: Humana Press; 2002:35-58. Sen CK.[woundcareadvisor.com]
  • Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA, 301 (2009), pp. 2129-2140 [12] Asociación Latinoamericana de Diabetes. Guías ALAD de Pie Diabético. Revista de la Asociación Latinoamericana de Diabetes, 18 (2010), [13] M.A.[elsevier.es]
  • Update on some epidemiologic features of intermittent claudication: the Framingham study. J Am Geriatr Soc. 1985;33:13–8. 15. Bacharach JM, Rooke TW, Osmundson PJ, Gloviczki P.[aafp.org]
  • […] arterial) insufficiency: Impaired tissue viability, wound healing, and delivery of neutrophils Hyperglycemia and other metabolic derangements: Impaired immunological (especially neutrophil) function and wound healing and excess collagen cross-linking Epidemiology[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • . • Diabetic foot implies that the pathophysiological process of diabetes m ellitus does something to the foot that puts it at increased risk for “tissue d amage” and the resultant increase in morbidity and maybe amputation (Payne & Florkowski, 1998).[slideshare.net]
  • Peripheral artery disease: pathophysiology, diagnosis and treatment. Rev Esp Cardiol . 2007;60(9):969–982.[journals.lww.com]
  • The Diabetic Foot: Pathophysiology, evaluation and treatment. In: Levin ME, O, Neal LW, eds. The Diabetic foot. St Louis Mosby Co. Mosby Year book; 1988:7-27. Keidig NR, Root HF and Marble A.[ijsurgery.com]
  • Dokken BB (2008) The Pathophysiology of Cardiovascular Disease and Diabetes: Beyond Blood Pressure and Lipids. Diabetes Spectr 21: 160-165.[esciencecentral.org]

Prevention

  • […] treatment or management can be given to prevent wounds from occurring or getting worse.[healthhub.sg]
  • Preventing Diabetic Ulcers The good news is diabetic foot ulcers can be prevented by careful control of diabetes and proper foot care.[wexnermedical.osu.edu]
  • Remember, the first step to prevention is patient education.[consultant360.com]
  • Once an ulcer has healed, consistent preventive care will help you stop an ulcer from ever returning.[healthline.com]

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