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.
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.