Thomas Belken, DPM, and Neal Mozen, DPM, FACFAS, CWS
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.
John J. Stapleton, DPM, FACFAS, and Thomas Zgonis, DPM, FACFAS
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.
It is well known that diabetic foot ulcers contribute to extensive morbidity and mortality in patients with diabetes.1 Advanced biological and topical drug treatments have been introduced over the last two decades in an attempt to expedite wound closure, thereby reducing the risk of infection, amputation and other complications. These products include topical growth factors (Regranex®, Systagenix... Read More.
Sari Goldman, BS, Devin Poonai, Oendrila Kamal, BA, and Khurram H. Khan, DPM
When it comes to diagnosing and treating lower extremity issues in patients with diabetes, a thorough biomechanical evaluation is at the top of the list. More often than not, a current ulcer began as a superficial hyperkeratosis, which unfortunately developed in a patient whose ability to perceive the pain normally associated with such a lesion in a timely manner was compromised due to neuropathy... Read More.
Transmetatarsal amputation (TMA) is an effective procedure, which preserves limb length while treating forefoot pathology that necessitates amputation in patients with adequate circulation. Success rates range from 39.4 percent to 93.3 percent.1-14 The most commonly reported complications of a TMA are an equinus or equinovarus deformity of the residual foot, and recurrent ulceration.5,8,15-19... Read More.
With the recognition of limb salvage as a key to decreasing mortality and increasing the quality of life in patients with chronic non-healing ulcerations, the transmetatarsal amputation (TMA) has become a common procedure.1-4 The current epidemic of diabetes mellitus affects 7.8 percent of the population in the United States. Moreover, an additional 57 million individuals have been diagnosed with... Read More.
David A. Farnen, BS, and Stephanie C. Wu, DPM, MSc
The prevalence of diabetes is increasing rapidly and is expected to reach epidemic proportion over the next decade. Recent research estimates that the number of people diagnosed with diabetes will rise from 23.7 million to 44.1 million between 2009 and 2034.1 The Centers for Disease Control and Prevention (CDC) further predict that up to one-third of U.S. adults could have diabetes by 2050 if... Read More.
At the recent annual meeting of the American Podiatric Medical Association (APMA), Gibson and colleagues presented an elegant study confirming what is well known to all podiatric physicians. In patients with diabetes, the study authors noted that “care by podiatrists appears to prevent or delay lower extremity amputation and hospitalization.”1
Podiatric care may include the use... Read More.
Fifty million people in India have diabetes.1 This is nearly double the estimated 26 million in the United States who have the disease.2 Although 8 percent of the global diabetes population live in the U.S., America’s diabetes care spending totals more than 50 percent of total world expenditures on the disease.3 In contrast, only 10 percent of the 1.3 billion people in India have healthcare... Read More.
Recent data suggests that three visits to a podiatrist prior to development of an ulceration correlates with better overall outcomes with fewer hospitalizations and decreased associated healthcare costs for patients with diabetes.1 As the incidence of diabetes continues to rise among the general population, this study reinforces the value of the podiatric physician within the community and the... Read More.