Objectives:The initial phase of infection of a foot ulcer in a person with diabetes is often categorized as mild. Clinicians usually treat these infections with antimicrobial therapy, often applied topically. Some experts, however, believe that mild diabetic foot ulcer infections will usually heal with local wound care alone, without antimicrobial therapy or dressings.Methods:To evaluate the potential benefit of treatment with a topical antibiotic, we performed a single-center, investigator-blinded pilot study, randomizing (1:1) adult patients with a mild diabetic foot ulcer infection to treatment with a gentamicin–collagen sponge with local care versus local care alone. Systemic antibiotic agents were prohibited.Results:We enrolled a total of 22 patients, 11 in the gentamicin–collagen sponge arm and 11 in the control arm. Overall, at end of therapy, 20 (91%) patients were categorized as achieving clinical cure of infection, and 2 (9%) as significant improvement. At the final study visit, only 12 (56%) of all patients achieved microbiological eradication of all pathogens. There was no difference in either clinical or microbiological outcomes in those who did or did not receive the gentamicin–collagen sponge, which was very well tolerated.Conclusion:The results of this pilot trial suggest that topical antibiotic therapy with gentamicin–collagen sponge, although very well tolerated, does not appear to improve outcomes in mild diabetic foot ulcer infection.

We observed an anterior displacement of weight-bearing during walking on a level gradient as well as a reduced static contact plantar surface in diabetic patients without evidence of any complications compared with the non-diabetic control group. This could be a premature sign of peripheral neuropathy, which is not evaluated on clinical examination or quantitative sensory testing used in clinics.

Will be aimed to the cause of pain and passive or active range of motion exercises will be encouraged. Physical, medical and surgical treatments have improved over the last few decades. Functional electrical stimulation in patients with shoulder pain and subluxation, applied early after onset of the stroke, has shown beneficial positive effects on subluxation, pain and mobility. Efforts should therefore be made to better understand the post-stroke shoulder pain in order to provide better outcomes of rehabilitation and thus improve quality of life for patients.

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Patients with diabetes and chronic neurological disorders are most commonly "at-risk" with foot problems. The identification of that population is therefore mandatory to prevent severe foot lesions. However, not all health care providers (HCPs) are involved in the screening process in institutions. The authors' aim was to develop and evaluate an educational program for HCP in the field of at-risk foot. All HCPs of the Loëx Hospital (Department of Rehabilitation and Geriatrics, University Hospitals of Geneva) participated in a longitudinal prospective study. Different professions of HCP (doctors, nurses, nursing aides, physiotherapists, occupational therapists, speech-language therapists, and psychologists) attended a structured educational program during a 1-year period based on a specific consultation that the authors developed. During the sessions, risk factors and therapeutic and preventive interventions are discussed with both the patient and care givers. A questionnaire was developed and used to evaluate (1) initial knowledge of HCP in the field of at-risk foot and (2) the impact of the program on the knowledge of HCP 12 months after starting the program. Twelve months after initiating the program, a significant knowledge improvement was noted in all groups of HCP except medical doctors. Nurses presented the most significant rise in knowledge score (P < .001). In conclusion, the consultation is an acceptable and effective form of long-term educational program for HCP in a hospital setting with a huge majority of patients suffering from chronic vascular and neurological conditions and loss of protective pain sensation at the lower limb.