E. Giannin Perez, DPM, MS, and Khurram H. Khan, DPM, FACFAS
Wound healing is a challenging task for any podiatric physician, especially for our high-risk patients with diabetes. Uncontrolled diabetes has consequences for all aspects of the body but is especially detrimental to wound healing. Patients with diabetes have a 15 to 25 percent lifetime risk of developing foot ulcers and their annual treatment costs are estimated to be about $30,000.1
... Read More.
Currently, in the United States, the Centers for Disease Control and Prevention (CDC) reports there are approximately 25.8 million people with diabetes mellitus, which is 8.3 percent of the population.1 This number is estimated to grow to 44 million by the year 2034.
One of the most feared complications for the patient with diabetes is amputation. More than 60 percent of non-... Read More.
Sara L. Borkosky, DPM, AACFAS, and Thomas S. Roukis, DPM, PhD, FACFAS
Diabetes mellitus with peripheral sensory neuropathy and the associated increased risk of ulceration continue to be growing issues in today’s society.1-28 Peak ambulatory forces occur about the first ray, creating a cycle of stresses, tissue buildup and eventual breakdown.2 Conservative therapies often fail due to an inability to offload the wound properly, poor pedal hygiene and inadequate... Read More.
It is estimated that greater than 26 million Americans — over 8 percent of the total population — suffer from diabetes and the literature demonstrates that nearly 25 percent of patients with diabetes will develop a foot ulcer at some point during their lifetime.1 It has been well documented that more than half of these wounds will become infected and require hospitalization, and that nearly 20... Read More.
The past few years have produced a plethora of studies, publications and lectures on the combination of diabetes and peripheral vascular disease, and their impact upon the lower extremities. One recent study looking at over 600 patients with diabetic foot ulcers and severe peripheral arterial disease (PAD) who did not have revascularization found that one-third of patients died unhealed.1... Read More.
From 2009 to 2012, amputation rates at our facility dropped 77.3 percent as a result of the staff employing basic strategies in both prevention and wound care. This occurred despite the consistent rates of new foot ulcers that arise each year in patients with diabetes. A study by Apelqvist and colleagues in 1994 demonstrated that treatment of diabetic foot ulcers costs significantly less than... Read More.
The prevalence of diabetes, estimated at 14 percent in 2010, is projected to increase to 21 percent of adults in the United States by 2050.1 The Centers for Disease Control and Prevention (CDC) has projected that as many as one out of three U.S. adults could have diabetes by 2050 if current trends continue.1
The incidence of diabetic foot ulcers will likely parallel this trend... Read More.
The statistics are alarming. The morbidity and mortality associated with lower extremity wounds are high, and we are constantly exposed to new options to help heal our patients. The toolbox for the wound care clinician has expanded exponentially in the past decade and it seems as though we are learning more and more daily about the basic science behind wound care.
The choice... Read More.
William P. Grant, DPM, FACFAS, Lisa M. Grant, and Bryan R. Barbato, BS
It is well understood that unremitting pressure is a major etiologic factor in both the creation and persistence of diabetic foot ulcers. Sensory neuropathy in combination with autonomic and motor neuropathy readily produces foot deformities with bony prominences and skin lacking normal protective sensibility. Further complicating the problem, alteration in tendon morphology and its function... Read More.
Andrew J. Meyr, DPM, Kelly Pirozzi, DPM, and Corine Creech, DPM
Body mass index is an objective patient finding that is known to correlate with not only the development and outcome of diabetic foot ulceration but also perioperative and long-term patient morbidity and mortality.1 The Centers for Disease Control and Prevention (CDC) reported in 2010 that 35.7 percent of United States adults and almost 17 percent of youth are defined as obese based on the body... Read More.
A myriad of products exists for the treatment of acute and chronic wounds. The primary goal with any of these products is rapid wound closure. Studies have shown that a lack of reduction in wound size at four weeks of treatment should prompt the provider to engage in advanced wound care modalities to accelerate the wound toward closure.1,2
Several advanced wound care products... Read More.
There are certain protocols/algorithms that physicians follow within the hospital setting. When a patient with diabetes comes into the emergency department with an infected ulcer, a cascade of events takes place: lab tests, X-rays, wound cultures, blood cultures and consults to the appropriate specialists. Medicine, infectious disease, vascular, endocrinology and podiatry personnel usually... Read More.