Diabetic foot infections arising from ulcerations are the largest non-traumatic cause of lower extremity amputations. Contributing factors include peripheral neuropathy and vascular disease, rigid pedal deformities, local trauma and pressure, extensive soft tissue loss, multi-system failure, non-compliance and severe infection.

   Over the decades, there have been a number of shifts in the way clinicians approach diabetic foot infections (DFIs). Throughout the ‘60s and into the ‘70s, clinicians felt most DFIs were, like other skin and skin structure inf

   Forefoot issues related to rheumatoid arthritis (RA) are well noted with fusion of the great toe being a standard procedure in association with relocation or resection of the lesser metatarsophalangeal joints, and fusion of the proximal interphalangeal joints. Surgeons have also been successful in treating the rearfoot with fusion procedures once the arthritis is not tolerable with bracing and medication.

   As a patient grows older, it is easier to address the issues of RA in the ankle. In the thin and fairly sedentary patient, ankle replacement is a good

Promoting Wound Healing

   The newest wound dressing uses a combination of several ingredients to remove exudate and promote healing.

   In order to facilitate wound healing, Promogran Prisma^™ Matrix combines collagen, oxidized regenerated cellulose (ORC) and silver ORC+, according to the manufacturer, Johnson & Johnson Wound Management. The company says the chronic wound dressing removes the destructive elements of the wound, maintains a bacterial balance, reduces bacterial growth and utilizes silver to ensure healthy growth of tissue

   Pain management in the elderly remains one of the most challenging issues for the podiatric surgeon. As life expectancy continues to advance, more geriatric patients will undergo surgery. While these patients may undergo these procedures to help facilitate independence and a better quality of life, one must carefully weigh the risks and benefits of surgical intervention in this patient population.

   Regardless of the success of the given surgical procedure, one may still encounter significant tissue damage and the subsequent release of pain and inflammator

   Yes, these panelists say ischemia plays a significant role in chronic ulcerations and emphasize the importance of a thorough vascular workup in these patients.

By Peter A. Blume, DPM, Kenneth L. Cornell, DPM, Bauer Sumpio, MD, and
John Aruny, MD

   Clinicians must consider numerous factors when evaluating and treating ulcerations of the foot. Ulceration in the foot most frequently occurs as a result of a combination of neuropathy, ischemia and trauma. Ulcerations that become chronic in nature frequently result in a lower extremity that is at an i