Volume 19 - Issue 3 - March 2006
Diabetes Watch »
It is well established that poorly controlled diabetes mellitus leads to vasculopathy, immunopathy and neuropathy, all of which may contribute to osteopathy. However, in order to understand the nuances of bone healing in the diabetic population, one must first have a strong grasp of the fundamentals of bone biology and biomechanics (see “A Helpful Primer On Bone Structure” below).
Bone is a dynamic medium with a multifactorial purpose including support of soft tissues, protection of soft tissues, locomotion and being a mineral reservoir. The growth, maintenance and healing of bone require
Wound Care Q&A »
Which emerging treatments show promise in treating lower-extremity wounds? Our expert panelists detail their usage of various wound care modalities, including topical antimicrobials and negative pressure wound therapy. They also take a look at what the future may bring for wound healing.
Q: What new modalities do you use in the treatment of lower extremity wounds?
A: When foot ulcers are complicated by impaired microcirculation and secondary infection, Steven Kravitz, DPM, uses the Circulator Boot™ (Circulator Boot Corp.) to help treat patients for whom revascularizati
Surgical Pearls »
Addressing the biomechanics of the first metatarsophalangeal joint (MPJ) as well as the first ray are the keys to any surgical correction of first metatarsal pathology. According to Rootian theory, the principal etiologies of hallux limitus are as follows.1
• A long first metatarsal or when the position of the first metatarsal head is relative to the second. When the first metatarsal is long, there will be jamming of the metatarsophalangeal joint during the initiation of the propulsive phase of gait. This causes a reduction in the range of dorsiflexion of the hallux and in
Non-healing skin ulcerations of the lower extremities affect millions of people in the United States and impose tremendous medical, psychosocial and financial impact. These wounds may be secondary to a myriad of etiologies including pressure, metabolic, trauma, venous, arterial etiologies and diabetic neuropathy.1
The Wound Healing Society defines chronic ulcerations as wounds that have “failed to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceeded through the repair process without establishing a sustained anatomic and functi
Diabetic peripheral neuropathy (DPN) is a “diagnosis of exclusion.” Diagnostic challenges are one thing but few practitioners relish that phrase when it comes to DPN.
For this condition, the practitioner needs to cast a very wide net of tests and keep an open mind regarding clinical suspicion in order to reach an accurate diagnostic conclusion. How likely is it that there could be another neuropathy-causing disease or medical condition resulting in these same lower extremity symptoms? Does the podiatric physician really need to consider thyroid problems, vitamin B12 deficiencies, nerve en
The goal of soft tissue coverage is to restore form and function. However, due to the anatomic complexity of the foot and ankle, soft tissue coverage in this area often falls short of Sir Harold Gillies’ adage to “… replace like with like.”1,2 Ideally, soft tissue coverage of the foot and ankle would involve primary repair free of tension and utilize neighboring sensate native tissue that is capable of withstanding the forces sustained during gait.1-3
Soft tissue wound coverage employs various forms of conservative and surgical techniques aimed at creating rapid