It is extremely beneficial to have close interaction with the patient’s primary care physician for help with diabetic control or management of other co-morbidities such as renal disease or congestive heart failure that could affect healing. It is also effective to have a dietitian both for diabetes management and increased protein intake to aid wound healing. If the patient has significant infection, infectious disease consultation may be appropriate. We work with all of these providers at our facility for comprehensive care of each patient. A multidisciplinary approach has been associated with better outcomes in treating diabetic ulceration since many health-related factors may affect wound healing.17-19
Proven Strategies To Prevent Lower Extremity Amputation
- Volume 26 - Issue 7 - July 2013
- 6223 reads
- 0 comments
1. Apelqvist J, Ragnarson-Tennvall G, Persson U, Larsson J. Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation. J Intern Med. 1994;235(5):463-471.
2. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-228.
3. Johnston MV, Pogach L, Rajan M, Mitchinson A, Krein S, Bonacker K, Reiber G. Personal and treatment factors associated with foot self-care among veterans with diabetes. JRRD. 2006;42(2):227-238.
4. Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev. 2000;16 Suppl 1:S75-S83.
5. Andersen C, Roukis T. The Diabetic Foot. Surg Clin N Am. 2007;87(5):1149-1177.
6. Lewis J, Lipp A. Pressure-relieving interventions for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2013;1.CD002302. doi: 10:1002/14651858.
7. Morona JK, Buckley ES, Jones S, Reddin EA, Merlin TL. Comparison of the clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2013;29(3):183-193.
8. Maciejewski M, Reiber G, Smith D, Wallace C, Hayes S, Boyko E. Effectiveness of diabetic therapeutic footwear in preventing reulceration. Diabetes Care. 2004;27(7):1774-1782.
9. Hastings M, Mueller,M, Pilgram T, Lott D, Commean P, Johnson J. Foot and Ankle Int. 2007;28(1):84-88.
10. Rhim B, Harkless L. Prevention: can we stop problems before they arise? Semin Vasc Surg. 2012;25(2):122-128.
11. Laborde JM. Neuropathic toe ulcers treated with toe flexor tenotomies. Foot Ankle Int. 2007;28(11):1160-1164.
12. Roukis TS, Schade VL. Minimum-incision metatarsal osteotomies. Clin Podiatr Med Surg. 2008;25(4):587-607.
13. Colen LB, Kim DJ, Grant W, Yeh JT, Hind B. Achilles tendon lengthening: friend or foe in the diabetic foot? Plast Reconstr Surg. 2013;131(1):37e-43e.
14. Schweinberger M, Roukis T. Surgical correction of soft-tissue ankle equinus contracture. Clin Podiatr Med Surg. 2008;25(4):571-585.
15. Waaijman R, Keukenkamp R, de Haart M, Polomski WP, Nollet F, Bus SA. Adherence to wearing prescription custom-made footwear in patients with diabetes at high risk for plantar foot ulceration. Diabetes Care. 2013 Feb 19. [Epub ahead of print].
16. Apelqvist J, Larsson J, Agardh CD. Long-term prognosis for diabetic patients with foot ulcers. J Intern Med. 1993;233(6):485-491.
17. Weck M, Slesaczeck T, Paetzold H, Muench D, Nanning T, Gagem G, Brechow A, Dietrich U, Holfert M, Bornstein S, Barthel A, Thomas A, Hanefeld M, Koehler C. Structured health care for subjects with diabetic foot ulcers results in a major reduction of amputation rates. Cardiovasc Diabetol. 2013;13;12(1):45 [Epub ahead of print].
18. Vuorisalo S, Venermo M, Lepaentalo M. Treatment of diabetic foot ulcers. J Cardiovasc Surg (Torino). 2009;50(3):275-91.
19. Wrobel J, Charns M, Diehr P, Robbins J, Reiber G, Bonacker K, Haas L, Pogach L. The relationship between provider coordination and diabetes-related foot outcomes. Diabetes Care. 2003;26(11):3042-3047.
For further reading, see “Preventing Amputation In Patients With Diabetes” in the March 2008 issue of Podiatry Today.