Diabetic Foot Ulcers and Their Recurrence

Armstrong, David G.; Boulton, Andrew J.M.; Bus, Sicco A.

doi:10.1056/nejmra1615439

Cited by 2,740 publications

(2,840 citation statements)

References 75 publications

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“…The primary focus of the clinic is to determine the etiology of the lower extremity wound and employ appropriate modalities to rapidly accelerate wound closure, moving patients into remission [2]. Neuropathic wounds require biomechanical analysis and proper off-loading management.…”

Section: Step Two: Development Of Wound-healing Clinicsmentioning

confidence: 99%

“…Regardless if the patient was managed as an inpatient or an outpatient, the remission clinic serves as an integral part of a limb preservation program to maximize ulcer-free, hospital-free, and activity-rich days [2,18]. Individualized patient self-care and monitoring education is a key function of the remission clinic, along with home-based monitoring program coordination, as they have shown to reduce ulcer recurrence [2,19–22]. A gradual return to activity is important in extending remission.…”

Section: Step Three: Remission Clinicmentioning

confidence: 99%

“…It has increased by nearly 400% in the last generation within the USA alone [1]. It is estimated that up to one third of people diagnosed with diabetes will develop a foot ulcer [2]. Non-healing or chronic ulcerations can lead to infection and subsequent amputation [3].…”

Section: Introductionmentioning

confidence: 99%

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Building a scalable diabetic limb preservation program: four steps to success

Khan

Shin

Woelfel

et al. 2018

Diabetic Foot & Ankle

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Over the past generation, limb preservation programs and diabetic foot services have begun to proliferate within academic health science centers as well as within health-care systems in general. We describe four key components for a successful program that, developed sequentially with temporal overlap, can allow the program to scale. The first component includes establishment of a ‘hot foot line’ for urgent emergency department/inpatient referral. The second includes development of a wound-healing clinic to address outpatient care through to remission. The third component focuses on the diabetic foot in remission to maximize ulcer-free days following healing. The fourth and final component focuses on implementation of local and widespread screening clinics to identify and triage patients into appropriate therapeutic and surveillance programs for healing, remission, and primary prevention. Along with developing each of these components, we describe discrete methods to quantify success.

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Section: Step Two: Development Of Wound-healing Clinicsmentioning

confidence: 99%

Section: Step Three: Remission Clinicmentioning

confidence: 99%

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Building a scalable diabetic limb preservation program: four steps to success

Khan

Shin

Woelfel

et al. 2018

Diabetic Foot & Ankle

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“…Diabetic foot ulcers were defined as full thickness wound on the foot (i.e. below the malleoli) of a person with diagnosed diabetes mellitus (type 1 or 2 diabetes) [1]. Smartphone was defined as an internet enabled mobile phone and was a requirement so participants would have some familiarity with mobile applications and potentially be willing to use it on their own phones.…”

Section: Study Participantsmentioning

confidence: 99%

Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)

Ploderer¹,

Brown²,

Seng³

et al. 2018

Preprint

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Background: Without effective self-care, people with diabetic foot ulcers (DFUs) are at risk of prolonged healing times, hospitalization, amputation, and reduced quality of life. Despite these consequences, adherence to DFU self-care remains low. New strategies are needed to engage people in the self-care of their DFUs. Objective: We aimed to evaluate the usability and usefulness of a new mobile application to engage people with DFUs in self-care. Methods: We developed a new mobile application, "MyFootCare", to engage patients with DFU through goal-setting, progress monitoring, and reminders in self-care. Key features included novel visual analytics that automatically extracts and monitors DFU size information from mobile phone photos of the foot. A functional prototype of MyFootCare was created and evaluated through a user-centred design process with 11 participants with DFUs. Data were collected through semi-structured interviews discussing existing self-care practices and observations of MyFootCare with participants. Data were analysed qualitatively through thematic analysis. Results: Key themes were: (1) Participants already used mobile phone photos to monitor their DFU progress, but (2) had limited experience with using smartphone applications. (3) Participants desired the objective DFU size data provided by the tracking feature of MyFootCare to monitor their DFU progress. (4) Participants were ambivalent about the MyFootCare goal setting and diary features, commenting that these features were useful but also that it was unlikely that they would use them. (5) Participants desired to share their MyFootCare data with their clinicians to demonstrate engagement in self-care and to reflect on their progress. Conclusions: MyFootCare shows promising features to engage people in DFU self-care. Most notably, ulcer size data is useful to monitor progress and engage people. However, more work is needed to improve the usability and accuracy of MyFootCare, i.e., by refining the process of taking and analysing DFU photos and removing unnecessary features. These findings open the door for further work to develop a system that is easy to use and functions in everyday life conditions, and to trial it with people with DFUs and their carers.

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“…Some 415 million people in the world have diabetes, and it is estimated that, annually, 9.1–26.1 million of them will develop a foot ulcer [1,2]. These foot ulcers and associated amputations reduce quality of life (QoL) of patients and their families and put a substantial economic burden on society [3,4].…”

Section: Introductionmentioning

confidence: 99%

Beyond dichotomous thinking: a process perspective on diabetic foot disease

Jarl

Lundqvist

2017

Diabetic Foot & Ankle

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Background: Diabetic foot (DF) disease causes severe suffering around the world, and appropriate self-care activities are needed to prevent and treat this condition. However, all too often, self-care activities are less than optimal and clinicians find themselves unable to influence them in a positive direction. Clinicians’ and researchers’ mental models of the DF tend to be dichotomous: either the patient has or does not have an active ulcer or other DF disease. This mode of thinking hides the long-term perspective of DF disease, where patients’ previous experiences and expectations for the future influence their current behavior. Thus, there is a need for a different perspective on DF disease to better understand patients’ perspectives and thereby improve self-care, leading to more effective prevention and treatment. Objective: To present a novel framework, the process perspective on the DF, which can explain inadequate self-care behaviors not easily understood with a dichotomous perspective, and how they can be changed. Results: Three fictive clinical examples are used to illustrate how the process perspective on the DF can be used to understand how patients’ previous experiences and expectations for the future influence their current behavior. In particular, this process perspective is used to understand how patients’ beliefs and behaviors are sometimes self-reinforcing, resulting in stable behavior patterns, here referred to as ‘DF cycles’. These cycles are quite common in clinical practice but are difficult to analyze using a dichotomous perspective on DF disease. The process perspective on the DF is used to analyze specific ‘vicious’ DF cycles of inadequate patient behavior and to find ways to transform them into ‘virtuous’ DF cycles, resulting in effective prevention and treatment. Conclusions: The process perspective on the DF seems suitable for understanding inadequate patient behaviors not easily understood with a dichotomous perspective on DF disease, opening up new avenues for clinical practice and research to help patients live a life with long remission phases, few relapses, and a high quality of life.

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Diabetic Foot Ulcers and Their Recurrence

Cited by 2,740 publications

References 75 publications

Building a scalable diabetic limb preservation program: four steps to success

Building a scalable diabetic limb preservation program: four steps to success

Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)

Beyond dichotomous thinking: a process perspective on diabetic foot disease

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