A Guide To Emerging Advances In Diabetic Foot Ulcer Healing

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Hyperspectral imaging, as shown above, has emerged as a new tool to aid in the diagnosis of microvascular disease and may help predict wound healing.
Here one can see an instant total contact cast (iTCC), which consists of a removable cast walker (RCW) rendered irremovable by wrapping it with cohesive bandage or fiberglass.
Dr. Rogers is the Director of the Amputation Prevention Center at Broadlawns Medical Center in Des Moines, Iowa. He completed a fellowship in diabetic limb preservation and research at the Center for Lower Extremity Ambulatory Research (CLEAR) in Chicago,
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.
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Author(s): 
By Lee C. Rogers, DPM

Additionally, tissue volumizing agents are under investigation to offload the plantar diabetic foot.16 Medical grade silicone has been injected safely deep to plantar prominences in diabetic feet.17 Wu and colleagues are investigating the use of poly-L-lactic acid (PLLA), which is an absorbable tissue volumizer. They are evaluating the pressure dispersal by F-Scan and the thickness of the plantar soft-tissue by weightbearing ultrasound.

Preventive Devices: Can They Have An Impact?
This column would be incomplete without a brief mention on the future of diabetic foot ulcer prevention.

Handheld, patient administered dermal thermometers are very promising in preventing diabetic foot ulcers. In most cases, a temperature spike can predict a diabetic foot ulcer days in advance. Coupled with proper education, the use of dermal thermometers as monitoring devices reduces the rate of diabetic foot ulcers.18 Up to this point, treatment for a “temperature spike” has consisted of rest and modification of footwear. Researchers have also proposed cooling the diabetic foot as a method of reducing preulcerative inflammation.19 Perhaps the combination of a dermal thermometer and a self-contained ice water splint will be valuable tools to reduce this complication.

Additionally, smart fabrics will play a role in the prevention and warning of diabetic foot complications. Zephyr Technologies (New Zealand) is currently testing its ShoePod Diabetic, a computerized shoe insert that takes periodic measurements of foot temperature in different zones and alerts the patient if there is a dangerous peak or temperature difference. Grants are pending for the study of a cell phone prototype that will function as a glucometer and a pedometer. This smart phone can manage data through graphing, etc. and wirelessly transmit results to the physician’s office.

In Conclusion
The aforementioned prospects represent only a few areas that affect lower extremity complications of diabetes. New treatments for painful and painless diabetic neuropathy, stem cell and growth factor therapy for wound healing, and technological advances in imaging can all be expected.

While the prevalence of diabetes is increasing and its complications are unrelenting, our understanding of this disease will improve and our armamentarium of treatments will expand. New therapies should be supported by sound science before becoming uniformly accepted. Combining a keen awareness of the new treatments with healthy skepticism and a critical appraisal of the claims can help us determine potential benefits for our patients.




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