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.
Editor’s note: Peripheral nerve decompression for patients with diabetes and lower extremity neuropathy continues to be a hotly debated topic in podiatric medicine and other specialties. The driving force of evidence based medicine has looked critically upon this procedure while many respected surgeons in a variety of fields have found great clinical successes. Dr. Mowen reviews many of the... Read More.
A dilemma of modern medicine is that reimbursement has become procedurally based. Clinicians are paid for what they do for patients, not for what they refrain from doing. Accordingly, the system, by its very nature, encourages intervention. Indeed, when one considers the combination of high patient expectations, the availability of technology, the economic pressures to generate revenue for... Read More.
Although the patient with diabetes and renal failure presents serious challenges to the limb salvage team, there is evidence and argument to support aggressive treatment and attempted limb salvage in a multidisciplinary clinical environment. An abundance of medical literature discusses the separate wound care challenges posed by diabetes and renal failure.
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Do islet cells hold promise in treating diabetes? Islet cells are groupings of hormone-secreting cells in the pancreas that are responsible for several endocrine functions including the production of insulin. Pancreatic islets contain four different types of cells including: insulin-producing beta cells, glucagon-releasing alpha cells, somatostatin-producing delta cells and cells that contain... Read More.
Research is an essential part of medicine when it comes to the ongoing improvement of patient care. Although podiatry is still very early into its development of consistent research contributions, research in diabetes has an impact in what we do daily. Research on topics such as diabetic neuropathy, vascular disease, wound care, the management of diabetes and offloading... Read More.
Peripheral arterial disease (PAD) is a significant risk factor for diabetic foot amputation. It is also an important marker for atherosclerosis in other organ systems and is associated with a fourfold increase in cardiovascular death.1 Current estimates suggest a 3 to 10 percent incidence of PAD in the general population but reportedly only 25 to 33 percent of these people are symptomatic. Of... Read More.
Diabetic neuropathies are a consequence of long-term hyperglycemia and occur in patients with type 2 diabetes, usually those who are 40 years of age or older. Diabetic neuropathy may occur regardless of whether a patient has insulin-dependent or non-insulin dependent diabetes. Bear in mind that diabetic neuropathy may have a variety of clinical characteristics. Patients may have a symmetric or... Read More.