Volume 16 - Issue 3 - March 2003

Diagnostic Dilemmas »

Diagnosing Repeated Lower Extremity Ulcerations

Guest Clinical Editor: Tamara Fishman, DPM | 5357 reads | 0 comments

A patient’s medical history can provide you with critical information that is necessary to differentiate among the various types of lower extremity ulcerations. Not only are there many different etiologies of lower extremity ulcers, it’s also important to be aware of the patient’s underlying medical conditions as well, as you will see in the following case study.
A 38-year-old Caucasian female patient recounted her underlying medical conditions when she came in for evaluation and treatment of her left leg ulceration. She injured the side of her leg while walking and had the ulceration f



Editor's Perspective »

Unraveling The Controversy Over Diabetic Footwear

By Jeff Hall, Editor-in-Chief | 3258 reads | 0 comments

How helpful is therapeutic footwear for patients with diabetes? It has been one of the most hotly debated questions over the last few months, especially in the aftermath of a controversial study that was published last year in the Journal of the American Medical Association (JAMA). (See “Study Questions Necessity Of Diabetic Footwear,” News And Trends, August 2002.)
The randomized study of 400 people who had diabetes and a history of foot ulcers had three study groups. One group wore therapeutic shoes and custom inserts, another group wore therapeutic footwear and prefabricated



Forum »

Why I Chose The Road Less Traveled

By John McCord, DPM | 4529 reads | 0 comments

My patient was a 40-something, peroxide blonde, personal fitness trainer. It was her first visit and she complained, “You have to do something about my nails. I can’t have this flaw with my job.” Her nails looked nearly normal with only slight thickening and very faint yellow discoloration. She had a history of liver dysfunction. I explained that her problem wasn’t serious enough to treat and the oral medications for fungus nails were contraindicated because of her health history.
At this point, Blondie screamed at me because I had nothing to cure her nails. I sat back and made a few



Technology In Practice »

Providing Better Mobility For Diabetes Patients

By Gina DiGironimo, Production Editor | 3417 reads | 0 comments

When diabetic patients have lower extremity injuries, they may have trouble weightbearing and getting around can prove difficult. Not only do you want to promote healing, you also want to enhance patient mobility. You may recommend traditional casting braces or something tailored specifically for your diabetic patient. One such option is the Pneumatic Walker Diabetic System.
Aircast, the manufacturer of the device, offers two other walking braces, the Pneumatic Walker and the Foam Walker, which provide pneumatic and semi-pneumatic support respectively. However, the Pneumatic Walker Diabetic S



Wound Care Q&A »

A Closer Look At Plastic Surgery Techniques

Clinical Editor: Lawrence Karlock, DPM | 7537 reads | 0 comments

Plastic and reconstructive surgery techniques can be a significant adjunct for podiatric surgeons in managing diabetic foot wounds and tissue loss. With this in mind, the panelists discuss a variety of techniques (including split-thickness skin grafting and muscle flaps) and indications for chronic ulcers, the neuropathic foot and pressure-induced heel ulcerations.

Q: When do you consider reconstructive plastic surgical techniques in the management of diabetic foot ulcers?
A:
Peter Blume, DPM, says he considers plastic surgery techniques for these ulcers when offloading and conserva



Diabetes Watch »

Current Concepts In Treating Diabetic Foot Wounds

By Richard M. Stillman, MD, FACS Clinical Editor: John Steinberg, DPM | 8997 reads | 0 comments

Managing foot wounds in diabetes patients forms much of the core practice of wound care and podiatry. In the United States, the annual cost for the care of diabetic foot wounds exceeds $5 billion.1 It’s been estimated that anywhere from 2.5 to 10.7 percent of patients with diabetes develop a foot wound each year. Even for wounds that heal, the recurrence rate is approximately 55 percent over the next five years.
According to one study, the prevalence of neuropathy in the diabetic population is 33.5 percent, the prevalence of vascular disease is 12.7 percent and the prevalence of



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