Diabetes Watch
Diabetic neuropathy results in tendon imbalance and decreased protective sensation.1,2 Tendon imbalance, especially Achilles or gastrocnemius-soleus tightness, causes or aggravates most foot problems.3-7 Achilles tendon or gastrocnemius-soleus tightness causes increased stress in the foot.8,9 This stress can cause a callus and a subsequent forefoot ulcer.8 Increased stress in the foot less... Read More.
Determining the best course of treatment for bacterial infections can be a daunting task, especially in the age of multidrug-resistant organisms.
Perhaps the most well known multidrug resistant organism is methicillin resistant Staphylococcus aureus (MRSA). A survey conducted at 97 hospitals showed the rate of MRSA in diabetic foot infections to have almost doubled between... Read More.
Any podiatric medical student could tell you that the “gold standard” for the diagnosis of osteomyelitis is bone biopsy. This is obviously an important diagnosis to reach with a high degree of confidence. From a clinical standpoint, we utilize bone biopsy results: to decide on the course and duration of antibiotic therapy; to determine the need for subsequent wound debridement; as an indication... Read More.
In lieu of the advancements in wound healing and innovations in surgical technique, limb salvage in the patient with diabetes remains a costly and complex endeavor. Some advocate immediate amputation for complex diabetic ulcers or gangrene.1 However, researchers have associated amputations in patients with diabetes with decreased life expectancy and an increased risk of contralateral amputation.2... Read More.
Pink ribbon. The juxtaposition of these two words translates into arguably the most recognized symbol anywhere, the looping image firmly embedded in our collective psyche and associated with breast cancer awareness. These words also conjure up a range of thoughts, emotions and an awareness of breast cancer that has transformed this terrible disease into a cause that extends beyond medical... Read More.
The wound care arena of the 21st century offers the practicing clinician a wide array of products and technologies to utilize in the management of diabetic foot ulcerations. Our patients are benefitting from the explosion of emerging technologies and evidence-based algorithms are helpful in guiding treatment interventions. Some technologies are innovative and a reflection of modern discoveries... Read More.
As the diabetes mellitus epidemic continues to grow, so does the number of diabetic wounds in the lower extremity. Researchers have estimated that the number of individuals with diabetes mellitus who eventually develop a lower extremity ulceration may be as high as 25 percent.1
Heel ulcers are notoriously difficult to treat because of their late clinical presentation, which... Read More.
The diabetic ulcer, particularly involving the heel, remains a challenge for the foot surgeon. When these ulcers occur in the neuropathic patient with adequate circulation, the medial plantar artery flap can serve as a useful tool for the management of these defects.
Heel ulcers are notoriously difficult to treat because of their late clinical presentation, which often involves... Read More.
Every physician, regardless of specialty, faces the non-adherent patient. When the patient has diabetes, things become even more complicated. Even though we as podiatrists are not actively managing the patient’s diabetes, his or her glycemic control directly impacts the effectiveness of our treatments.
The HbA1c does not lie but proper management of the patient’s blood sugar is... Read More.
Proper shoe gear/bracing and education on the importance of its use is essential in the long-term postoperative management of patients who have undergone a transmetatarsal amputation (TMA). Initial publications on shoe gear use after a TMA reported that patients did well with no more than the placement of lamb’s wool in the toe box of a standard shoe.1-5
However, in 1963,... Read More.
The management of diabetic foot and ankle injuries has raised significant debate and controversy over the last few years. Unfortunately, there is still no clear consensus on treatment protocols that necessitate surgical intervention. The main reason for this controversy is because there is no single correct way of treating even the most commonly encountered diabetic foot and ankle fractures and/... Read More.
At the conferring of medical degrees, physicians take the Hippocratic Oath, in which they make a covenant to practice medicine to the best of their abilities. As the oath states, “I will apply, for the benefit of the sick, all measures (that) are required.” The physician has a duty to promote the patient’s best medical interests and therefore is obliged to advise the patient to receive the... Read More.
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