Intraepidermal nerve fiber density testing is gaining enthusiastic acceptance for the diagnosis as well as the staging of diabetic neuropathy. Studies have demonstrated reduced intraepidermal nerve fiber density in patients with diabetes type 1 and type 2.1 One major advantage of intraepidermal nerve fiber density testing is the ability to detect the presence of evolving... Read More.
The prevalence of individuals with diabetes continues to rise. The disease now affects nearly 24 million Americans or 7.8 percent of the population of the United States.1 Consequently, the demand for diabetic foot care continues to increase and this is exemplified by the one-year incidence of newly occurring ulcerations in patients with diabetes ranging from 1 to 2.6 percent. 2... Read More.
Podiatrists commonly encounter and treat skin and skin-structure infections (SSSIs), ranging from cellulitis to more complicated surgical site infections and infected diabetic foot ulcers. Aerobic gram-positive cocci, such as Staphylococcus aureus and streptococci, are the most common causative agents of skin infections.1
While the treatment of simple and superficial infections is relatively... Read More.
By Christopher L. Reeves, DPM,Alan A. MacGill, DPM,Amber M. Shane, DPM, and Joseph A. Conte, DPM
Clinical Editor: John S. Steinberg, DPM
Ankle fractures in patients with diabetes present a great challenge for the foot and ankle surgeon. Indeed, there is an abundance of literature documenting the difficulty of managing diabetic ankle fractures. Surgical treatment can be fraught with complications such as delayed bone and wound healing, and the development of Charcot neuroarthropathy.
When it comes to treating diabetic ankle... Read More.
Lower extremity complications associated with diabetes present a special challenge to any physician contemplating surgical management. Prophylactic foot surgery can be described as a procedure to prevent ulceration or re-ulceration in patients with diabetes without significant vascular compromise. This concept is part of a larger classification system, which stratifies the... Read More.
Given the trends indicating the increasing prevalence of diabetes in the United States, this national health concern has commanded a drastic increase in general public media attention. According to an American Diabetes Association study, the overall costs for diabetes total $98 billion, with direct medical costs of $44 billion and indirect expenses (such as disability, work loss and premature... Read More.
Diet and exercise are essential for blood sugar management and are subject of much frustration for the diabetic patient and the physician. With each visit to the physician’s office, the patient has to anticipate the stern lecture about exercising, controlling his or her diet, abstaining from sweets, and testing his or her sugars regularly or face the multitude of complications from diabetes. In... Read More.
At least 30 percent of patients with diabetes will develop cutaneous manifestations in their lifetime.1 Given that diabetes is a systemic disease, its effects on the skin may arise from many different sources (vascular, metabolic, nutritional disturbances, infectious agents and medications). Several common skin disorders may be associated with diabetes. These include necrobiosis lipoidica... Read More.
Post-surgical hypertrophic bone formation can be a frustrating problem. It has been identified at fracture, osteotomy and amputation sites. The majority of patients with hypertrophic bone formation are largely asymptomatic and practitioners often identify the condition via radiographs they get for other pathologies. However, those who are symptomatic often have a problematic non-healing wound at... Read More.
By Gordon Zernich, CP, BOCPO, Tomas Dowell, CPO, LPO, and Ronald B. Tolchin, DO, FAAPM&R
Sensory neuropathy is the most common form of diabetic neuropathy. Nerve damage results from poorly managed and chronically high levels of blood sugar. In patients who have type 1 diabetes, which usually affects those 25 years and younger, there is insulin deficiency. In regard to people with type 2 diabetes, their insulin production inadequately meets the body’s daily need to metabolize... Read More.
Lauren A. Fisher, DPM, Hillarie L. Sizemore, DPM, and Khurram H. Khan, DPM
Peripheral arterial disease (PAD) is a very common condition that affects 20 to 30 percent of patients over 50 years of age, equating to an estimated 10 million Americans. As the population ages, the incidence of PAD will likely increase dramatically.1
Intermittent claudication is a symptom among patients with PAD and one can use the presence of these symptoms as a diagnostic tool.2 True... Read More.
In the early 1980s, LoGerfo opened the window of limb salvage in critical stages of diabetic atherosclerosis by fighting the misconception of microangiopathy that had previously prevented attempts to bypass arterial lesions in diabetic foot.1 He produced evidence that revascularization of distal diabetic arterial occlusions can be successful. This evidence in turn gave a fundamental push to... Read More.