Approximately 3 percent of the United States population has diagnosed diabetes mellitus.1 Diabetic foot problems, however, are the leading cause of amputation.2,3 The risk of amputation is 15 times greater in patients with diabetes than in other people.2 Up to 15 percent of patients with diabetes will require amputation.1,3 Over 50,000 amputations in patients with diabetes occur... Read More.
The complications stemming from obesity have been well documented. In recent years, the popularity of the gastric bypass procedure has increased as a method of combating obesity. As the literature shows, gastric bypass has a positive effect on diabetes itself as well as diabetic neuropathy. However, the surgery is not without its risks and the entire health care team must be... Read More.
The Charcot foot and ankle is a challenging clinical entity for the qualified foot and ankle surgeon. It is a progressive disease with insidious onset. Osteoarthropathy was originally described in 1703 but it wasn’t until 1868 that it was called Charcot neuroarthropathy due to Charcot’s work in linking the disease to tabes dorsalis and neuropathy.1,2 It was Jordan who linked this destructive... Read More.
By Chad Friedman, DPM, Elizabeth Bass, DPM, and John Steinberg, DPM
Given the increasing prevalence of antimicrobial resistance, there is a growing interest in emerging wound care products that contain silver. Topical silver has a broad range of antimicrobial activity and has been used extensively to help treat high-risk burn patients. Research has confirmed that silver is effective against gram negative and positive bacteria, methicillin resistant Staph aureus (... Read More.
Researchers have studied nitric oxide (NO) extensively for the past 40 years. However, there has been an increased interest within the past 15 years. In 1998, the Nobel Prize in Physiology and Medicine was awarded to scientists who worked out the signaling mechanisms for NO in the human body.
Nitric oxide is an endogenous gas produced by cells with many diverse... Read More.
It is well established that poorly controlled diabetes mellitus leads to vasculopathy, immunopathy and neuropathy, all of which may contribute to osteopathy. However, in order to understand the nuances of bone healing in the diabetic population, one must first have a strong grasp of the fundamentals of bone biology and biomechanics (see “A Helpful Primer On Bone Structure” below).
Bone is a... Read More.
When Jean-Marie Charcot described the entity that bears his name in 1868, little did he know the controversies he would create. Charcot joint disease (or Charcot neuroarthropathy) has been one of the most misdiagnosed conditions in patients with diabetes mellitus. Patients with this entity have been misdiagnosed and consequently mistreated for osteomyelitis, cellulitis,... Read More.
By Mackenzi Nelson, DPM, and John S. Steinberg, DPM
Since the discovery of diabetes, researchers have worked diligently to extend the life expectancy of those affected by diabetes. From the advent of insulin in 1921 until the present day, advances in medical management have had a very significant impact on life expectancy and glycemic control in this population.1 Helpful treatments ranging from diet and exercise to oral drug... Read More.
The non-traumatic lower extremity amputation rate among people with diabetes mellitus has increased 38 percent from 1992 to 2002.1 The number of amputations has increased from 99,552 in 2000 to 110,000 in 2002.2 To appreciate this statistic, this is more than double the number of amputations on U.S. soldiers from the Civil War through Vietnam.3
Peripheral... Read More.
By Emily A. Cook, DPM, Jeremy J. Cook, DPM, and Barry I. Rosenblum, DPM
As the role of the podiatric service becomes more integral to a multidisciplinary approach to diabetic limb salvage at an increasing number of institutions nationwide, many podiatric surgeons find themselves admitting these patients to their own service. The surgical and anesthesia teams often execute perioperative assessment and preparation, especially in non-elective... Read More.
Reducing the number of lower extremity amputations is a goal for all clinicians caring for patients with diabetes. In spite of this, the numbers of limb-threatening infections and subsequent amputations continue to rise each year. While medical and surgical interventions are frequently successful in facilitating limb salvage in patients facing amputation, failures in limb... Read More.
By Lee C. Rogers, DPM, Nicholas J. Bevilacqua, DPM, and David G. Armstrong, DPM, PhD
Charcot’s arthropathy is a devastating complication of diabetes mellitus that frequently leads to permanent disability, ulceration and amputation. It is a rapidly progressive and severe form of arthritis. Researchers have equated the acute Charcot foot to a medical emergency since therapies are available that may alter its natural history.1 Unfortunately, the pathophysiology... Read More.