Diabetic neuropathy is a major risk factor in patients with diabetes. However, a larger impending threat to patients with neuropathy is the risk of developing Charcot arthropathy and ultimately an ulcer that causes deformity or joint instability. In patients with diabetic neuropathy, Charcot arthropathy alone results in an increased risk of ulceration and/or amputation.1 The... Read More.
The field of advanced wound care science continues to deliver new products and concepts for use in healing problem wounds of the lower extremity. The market now includes two living cell products and numerous biologically active products that are the result of bioengineering research and development. The real advantage of these new technologies is that we can now actively... Read More.
By John E. Aruny, MD, Peter Blume, DPM, Bauer Sumpio, MD, PhD, and Benjamin Buren, DPM
Chronic critical limb ischemia has been defined as a non-healing ulceration or gangrene of the foot or toes, and/or rest pain that requires regular use of analgesics.1 These patients will require some type of intervention to resolve their condition. It can be particularly challenging to salvage the limb of a patient who has failed a bypass. The objective of revascularization is... Read More.
By Scott Neville, DPM, Peter Blume, DPM, and Jonathan Key, DPM
Although Charcot neuroarthropathy occurs in a small percentage (5 percent) of the diabetic population, the natural disease course is associated with severe morbidity including chronic ulcerations, infections and amputations.1 The medical necessity of limb preservation is well known to all podiatrists. However, the recent advent of rocker bottom reconstruction provides the... Read More.
Management of the diabetic foot is a tremendous challenge. It has been estimated that the annual healthcare costs of caring for the diabetic foot range in the billions.1 Approximately 15 percent of diabetic patients will develop a foot or leg ulceration at some point during the course of their disease and 50 percent of those patients suffer reulceration within 18 months.2... Read More.
Approximately 15 percent of all patients with diabetes can be expected to develop ulceration in their lifetime, thus putting them at risk for lower extremity amputation. Treatment for infected diabetic foot wounds accounts for one quarter of all diabetic hospital admissions in the United States and Great Britain.1-3 Patient education, proper footgear and regular foot examination can decrease the... Read More.
Ciclopirox has been well documented as a broad-spectrum antifungal agent with additional antibacterial and antiinflammatory properties.1-3 However, in recent studies reported by Linden, et al., ciclopirox has also demonstrated potent angiogenic activity, which suggests that the drug may have certain wound-healing properties.4 If this is borne out by larger studies in the future... Read More.
Many exciting antibiotics have either recently been approved, received a new FDA indication or will soon become available. Some are well known and have already been incorporated into clinical practice. Many are the first in their respective classes and have novel mechanisms of action. What place, if any, do these drugs have in the treatment of diabetic foot infections (DFIs)?... Read More.
One will not find combination therapies mentioned in evidence based medicine (EBM) journals or in research trials. In fact, one will rarely find combination therapies mentioned in many trade publications either. Purists often claim this concept presents a mixed message. How can one track performance and outcomes if he or she is using combination therapies? What component worked... Read More.
As we evolve in our treatment of foot and ankle conditions, it seems like each treatment meets with some reservation from the medical community. As podiatric physicians, our mindset is scientific in nature and we need hard facts and evidence-based results to show each treatment option is beneficial. I am with the mainstream in that thinking but I also try to rationalize a... Read More.
By Stephanie C. Wu, DPM, MS, Hong Yoon, MS, and David G. Armstrong, DPM, MSc, PhD
Skin ulceration of the lower extremity affects millions of people in the United States alone and may be secondary to a myriad of etiologies including pressure, metabolic, trauma, venous, arterial and diabetic neuropathy.1 The medical, psychosocial and financial impacts imposed by lower extremity ulcerations are tremendous. The attributable cost for the treatment of chronic lower... Read More.
In spite of efforts to control diabetes and improve limb salvage rates, the number of diabetes-related amputations continues to rise in the United States. Over 80,000 amputations are performed each year, with approximately one-half being partial foot procedures and one-half being transtibial or higher amputations.1 By evaluating and identifying patients at risk for amputation,... Read More.