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.
Any podiatrists seeking better patient outcomes should consider adding hyperbaric oxygen therapy (HBOT) to their treatment options. The practice of putting patients inside a hyperbaric chamber — either a monoplace or a multi-place chamber — and having them breathe 100 percent oxygen while under increased atmospheric pressure is gaining currency, and is well documented in the scientific literature... Read More.
Andrew H. Rice, DPM, FACFAS, and Mallory Przbylski, DPM
According to the Centers for Disease Control and Prevention (CDC), greater than 60 percent of non-traumatic lower extremity amputations occur in patients with diabetes.1 It is clear one can attribute this to diabetic foot ulcers (DFUs), soft tissue infection and osteomyelitis. Wounds that are arrested in the chronic phase of healing become susceptible to soft tissue and bone infection, and... Read More.
Diabetes mellitus is associated with a progression of microvascular and macrovascular complications.1,2 It is understandable that with the progression of these diabetes-related complications, the consumption of medications to prevent and treat them would be greater in comparison to those age-matched individuals without diabetes mellitus.3,4 Often, the use of medication by patients with diabetes... Read More.
The Affordable Care Act (ACA), which the Supreme Court recently upheld, creates a new value-based payment modifier. Starting in 2015, this payment modifier will provide differential payments to doctors based on quality and cost of care. Since the payment adjustments are to be budget neutral, some physicians will receive bonuses and others penalties under this provision. It is likely that payment... Read More.
Karen Shum, DPM, Ronald Belczyk, DPM, Lee C. Rogers, DPM, George Andros, MD, and Larissa Lee, MD
Diabetic ulcers, particularly those located in the forefoot region, pose an interesting challenge for the foot surgeon. When these ulcers occur in the neuropathic patient with adequate circulation, the pedicle flap of the great toe can serve as a useful tool for ulcer management.
Frequently, ulcerations located on the plantar aspect can be difficult to treat because of their... Read More.