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.
According to the International Diabetes Federation (IDF), diabetes affects more than 230 million people worldwide and is expected to affect 350 million by 2025. Controlling blood glucose levels via subcutaneous injections of insulin has been a key clinical intervention for many people. While injected insulin has proven to be a reliable intervention, it is met with significant... Read More.
There are as many classification systems for wounds as there are clinicians who believe they have developed the proverbial “better mousetrap.” The various wound classification systems include the Wagner classification, the University of Texas scheme, the S(AD) SAD classification, the Red Yellow Black breakdown, which is prominent in the nursing literature, the PEDIS classification and the DEPA... Read More.
Monochromatic infrared light energy (MIRE) therapy is controversial. Do you prescribe this therapy? How can infrared light reverse sensory neuropathy or heal ulcers? Some reports indicate that just two weeks of therapy is enough to show significant improvement. Some patients rave about its benefits. Patients may say they no longer have numbness and/or pain. They may say they sleep better. It... Read More.
Over the past decade, the podiatric profession has seen an array of advances in diabetic foot ulcer healing. These advances ranged from the advent of a platelet-derived growth factor (Regranex, Johnson and Johnson) and negative pressure wound therapy (VAC therapy, KCI) to hydroscalpel debridement (Versajet, Smith and Nephew) and various prediction models (University of Texas Diabetic Foot Ulcer... Read More.