By Mackenzi Nelson, DPM, and John S. Steinberg, DPM
Since the discovery of diabetes, researchers have worked diligently to extend the life expectancy of those affected by diabetes. From the advent of insulin in 1921 until the present day, advances in medical management have had a very significant impact on life expectancy and glycemic control in this population.1 Helpful treatments ranging from diet and exercise to oral drug... Read More.
The non-traumatic lower extremity amputation rate among people with diabetes mellitus has increased 38 percent from 1992 to 2002.1 The number of amputations has increased from 99,552 in 2000 to 110,000 in 2002.2 To appreciate this statistic, this is more than double the number of amputations on U.S. soldiers from the Civil War through Vietnam.3
Peripheral... Read More.
By Emily A. Cook, DPM, Jeremy J. Cook, DPM, and Barry I. Rosenblum, DPM
As the role of the podiatric service becomes more integral to a multidisciplinary approach to diabetic limb salvage at an increasing number of institutions nationwide, many podiatric surgeons find themselves admitting these patients to their own service. The surgical and anesthesia teams often execute perioperative assessment and preparation, especially in non-elective... Read More.
Reducing the number of lower extremity amputations is a goal for all clinicians caring for patients with diabetes. In spite of this, the numbers of limb-threatening infections and subsequent amputations continue to rise each year. While medical and surgical interventions are frequently successful in facilitating limb salvage in patients facing amputation, failures in limb... Read More.
By Lee C. Rogers, DPM, Nicholas J. Bevilacqua, DPM, and David G. Armstrong, DPM, PhD
Charcot’s arthropathy is a devastating complication of diabetes mellitus that frequently leads to permanent disability, ulceration and amputation. It is a rapidly progressive and severe form of arthritis. Researchers have equated the acute Charcot foot to a medical emergency since therapies are available that may alter its natural history.1 Unfortunately, the pathophysiology... Read More.
According to the International Diabetes Federation (IDF), diabetes affects more than 230 million people worldwide and is expected to affect 350 million by 2025. Controlling blood glucose levels via subcutaneous injections of insulin has been a key clinical intervention for many people. While injected insulin has proven to be a reliable intervention, it is met with significant... Read More.
There are as many classification systems for wounds as there are clinicians who believe they have developed the proverbial “better mousetrap.” The various wound classification systems include the Wagner classification, the University of Texas scheme, the S(AD) SAD classification, the Red Yellow Black breakdown, which is prominent in the nursing literature, the PEDIS classification and the DEPA... Read More.
Monochromatic infrared light energy (MIRE) therapy is controversial. Do you prescribe this therapy? How can infrared light reverse sensory neuropathy or heal ulcers? Some reports indicate that just two weeks of therapy is enough to show significant improvement. Some patients rave about its benefits. Patients may say they no longer have numbness and/or pain. They may say they sleep better. It... Read More.
Over the past decade, the podiatric profession has seen an array of advances in diabetic foot ulcer healing. These advances ranged from the advent of a platelet-derived growth factor (Regranex, Johnson and Johnson) and negative pressure wound therapy (VAC therapy, KCI) to hydroscalpel debridement (Versajet, Smith and Nephew) and various prediction models (University of Texas Diabetic Foot Ulcer... Read More.
Editor’s note: Peripheral nerve decompression for patients with diabetes and lower extremity neuropathy continues to be a hotly debated topic in podiatric medicine and other specialties. The driving force of evidence based medicine has looked critically upon this procedure while many respected surgeons in a variety of fields have found great clinical successes. Dr. Mowen reviews many of the... Read More.
A dilemma of modern medicine is that reimbursement has become procedurally based. Clinicians are paid for what they do for patients, not for what they refrain from doing. Accordingly, the system, by its very nature, encourages intervention. Indeed, when one considers the combination of high patient expectations, the availability of technology, the economic pressures to generate revenue for... Read More.
Although the patient with diabetes and renal failure presents serious challenges to the limb salvage team, there is evidence and argument to support aggressive treatment and attempted limb salvage in a multidisciplinary clinical environment. An abundance of medical literature discusses the separate wound care challenges posed by diabetes and renal failure.
... Read More.