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.
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.