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.
Complications related to obesity have been a topic of concern for health officials since the 1950s. However, it has only been in the past few years that a widespread epidemic has reached alarming proportions in the United States and worldwide, leading to substantial health and economic costs. In the U.S., obesity is largely linked to an increase in the incidence of type II... Read More.
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.