By Jennifer Jansma, DPM, and John S. Steinberg, DPM
It has been estimated that neuropathy affects between 10 to 50 percent of patients with diabetes. Specifically, autonomic sensory neuropathy is associated with a number of clinical entities such as postural hypotension, cardiac arrhythmia, bladder dysfunction and gastrointestinal motility disturbance. Symptoms of gastrointestinal motility abnormalities can include nausea, vomiting, post-prandial... Read More.
We have all heard about the concept of moist wound healing. We know that the right moisture balance is critical to the healing of chronic wounds because it promotes a healthy wound environment. We have modalities such as hydrogels and hydrocolloids, as well as normal saline and gauze. The latter is becoming antiquated but nonetheless continues to support the theory of moist wound healing... Read More.
Wound healing progresses through a series of processes, which include the formation of granulation tissue, epithelialization and connective tissue remodeling. These events require continuous modification of the complex cellular support matrix. This matrix is comprised of: structural proteins (collagen and elastin); specialized “anchoring” proteins (fibronectin, laminin and fibrillin); and... Read More.
As the complexity and price of wound care materials seems to be reaching mind-numbing proportions, choosing the right product for your patients seems to be getting harder instead of easier. However, taking into account cost, effectiveness and availability, one would be hard pressed to find a product better than zinc oxide.
Although it is most commonly associated with diaper rash ointments and... Read More.
By Anthony C. Yung, DPM, and John S. Steinberg, DPM
Surgical debridement of infected bone is an unfortunate reality for those of us who frequently treat patients with diabetes. While adequate debridement is the most important step in treating osteomyelitis, many authors have commented on the adjunctive role of antibiotics in this clinical dilemma.1-3 Systemic antibiotics are routinely used preoperatively and have been advocated for six weeks or... Read More.
By Robert A. Warriner, III, MD, and Caroline E. Fife, MD
Last month, Medicare began reimbursing for hyperbaric oxygen (HBO) treatment as an adjunctive therapy for diabetic foot ulcers. After an exhaustive review of the literature, the Centers for Medicare and Medicaid (CMS) concluded that “HBO therapy is clinically effective and, thus, reasonable and necessary in the treatment of certain patients with limb-threatening diabetic wounds of the lower... Read More.
In the course of a single day, we often see frustrating patients who do not follow the seemingly simple instructions that we give to them. Treating non-compliant diabetic patients, specifically those who are dealing with issues of wound care, infections and even amputations, can be particularly challenging.
When I use the term non-compliant, I am sure that everyone immediately visualizes his or... Read More.
Serious foot infections result from a combination of factors including disease, injury, neuropathy, vascular impairment and insufficient wound healing. Diabetic patients, in particular, are at high risk of developing serious complications in lower extremities that can lead to amputation. Of the estimated 17 million people who have Type 1 and Type 2 diabetes, almost 15 percent will undergo lower... Read More.
Autonomic neuropathy may significantly affect the quality of life of patients with diabetes. Unfortunately, despite the common prevalence of this condition in this population, autonomic neuropathy is one of the least understood and recognized complications of diabetes. Not only is there a cloudy picture in regard to the pathogenesis of the condition, there are various clinical manifestations with... Read More.
Diabetes mellitus is said to be a disorder of glucose metabolism, but it can be so much more for those individuals who have the disease and the families with whom they share their lives. The sequelae of diabetes involve vascular changes in the large and small vessels, and produce disorders of the retina, the kidneys and the coronary arteries, not to mention the peripheral vascular tree. While... Read More.
There is a moment in the operating room when every surgeon must make a decision about an amputation. Should we perform the amputation as a two-stage procedure or is it wise to close the surgical site right then and there? There was a time when surgeons always left these surgical sites open due to the concern of possibly closing over some bacterial contamination that would flourish in the sutured... Read More.
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.