Volume 15 - Issue 3 - March 2002
The prevalence of diabetic ulceration is alarmingly high and increasing. Currently, it is between 4 and 10 percent, depending on a host of factors including ethnicity, geographic region and duration of disease. Wounds are clearly associated with infection and a high risk of future amputation. The economic implications are overwhelming to the health care system. As clinicians, we must be able to rapidly identify, access and manipulate the factors necessary for wound healing.
Indeed, it is vital to approach the wound healing process as a whole body process when you’re treating a patient who
Is it an infection or an inflammation? That’s just one of the questions about the paronychia that came up during a roundtable discussion among DPMs. They also addressed the debate over doing a P&A for a paronychia, whether soaking is the ideal treatment and what you should do differently when treating a diabetic who has a paronychia. Here are their comments.
Warren Joseph, DPM: Any of us who have had a paronychia know they hurt. These patients will come into your office and they are in pain. They’ve all been to their family doctor, their primary doctor if they’re HMO patients a
Wound Care Q&A »
There have been many technological advances in wound care over the past decade, ranging from research into the wound healing model to the role of growth factors and the use of living skin constructs in clinical practice. With this in mind, our expert panelists take a closer look at Apligraf and their experiences in using this product.
Q: Do you use Apligraf much in your practice? If so, when do you use it in the course of treatment?
A: Both Robert Snyder, DPM, and Sheldon Ross, DPM, use Apligraf frequently in their practices. David Armstrong, DPM, says he uses Apligraf if he does no
Research in recent years has shown distinct ethnic differences in the prevalence of diabetic complications, including amputation and more recently, foot ulceration. Although the etiology of the diabetic complications among different ethnic groups is not completely understood, preliminary data has highlighted some interesting variations in the presentation of these complications.
Projections of diabetes prevalence indicate the number of people with type 2 diabetes worldwide is set to double over a 25-year period.1 This epidemic of diabetes is due to an aging and increasingly obese population.
Diabetes Watch »
It is typically easier to heal a diabetic foot ulcer than it is to prevent recurrence. Once you’ve healed the ulcer, the next challenge is to minimize pressure at the site of the old ulceration or the site of a boney prominence. If the patient has never had an ulcer but has a high risk for ulceration, then employing pressure off devices is essential for prevention.
Obviously, the large majority of diabetic foot ulcerations are preventable. There are several keys to prevention, which include organized treatment protocols, early detection, aggressive wound care, orthotics and appropriate sho
Diagnostic Dilemmas »
It is often challenging to treat patients who have chronic ankle pain. There is an array of potential causes so it’s essential to be very thorough in arriving at your diagnosis. For example, consider the case of an active 34-year-old male who runs and plays tennis, basketball and beach volleyball. In the past six months, he says he has had acute ankle pain in certain situations and chronic pain in other situations.
More specifically, the patient says the pain is worst when he is engaged in activities involving toe raises or when he is on the ball of his foot for extended periods of time. He