Healing diabetic neuropathic foot ulcers: are we getting better?

Margolis, David J.; Allen-Taylor, Lynne; Hoffstad, Ole; Berlin, J A

doi:10.1111/j.1464-5491.2004.01375.x

Cited by 93 publications

(81 citation statements)

References 24 publications

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“…Prophylactic surgery to correct deformities prior to ulceration has been advocated as a preventive strategy . Ulcer healing can be accelerated and recurrence prevented in feet with toe deformities by utilization of extensor tenotomy (Margolis et al, 2005). Achilles tendon lengthening reduces pressure under the metatarsal heads and promotes ulcer healing but the concomitant gait alteration increases the risk of heel ulcers prompting these authors to recommend avoiding this procedure in individuals with complete sensory loss of the heel pad (Holstein et al, 2004).…”

Section: Preventive Surgerymentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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Section: Preventive Surgerymentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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“…Recent estimates suggest that, after 20 weeks of treatment, complete wound closure is achieved in as few as 25%-50% of chronic or hard-to-heal wounds, especially venous and diabetic ulcers. [8][9][10][11][12][13][14][15][16] Other pathologies such as arterial insufficiency and peripheral neuropathy without diabetes are understudied. 17 Difficult-to-heal wounds affect tens of millions of people worldwide.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

McCallon

Weir

Lantis

2014

Journal of the American College of Clinical Wound Specialists

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Difficult-to-heal and chronic wounds affect tens of millions of people worldwide. In the U.S. alone, the direct cost for their treatment exceeds $25 billion. Yet despite advances in wound research and treatment that have markedly improved patient care, wound healing is often delayed for weeks or months. For venous and diabetic ulcers, complete wound closure is achieved in as few as 25%-50% of chronic or hard-to-heal wounds. Wound bed preparation and the consistent application of appropriate and effective debridement techniques are recommended for the optimized treatment of chronic wounds. The TIME paradigm (Tissue, Inflammation/infection, Moisture balance and Edge of wound) provides a model to remove barriers to healing and optimize the healing process. While we often think of debridement as an episodic event that occurs in specific care giver/patient interface. There is the possibility of a maintenance debridement in which the chronic application of a medication can assist in both the macroscopic and microscopic debridement of a wound. We review the various debridement therapies available to clinicians in the United States, and explore the characteristics and capabilities of clostridial collagenase ointment (CCO), a type of enzymatic debridement, that potentially allows for epithelialization while debriding. It appears that in the case of CCO it may exert this influences by removal of the necrotic plug while promoting granulation and sustaining epithelialization. It is also easily combined with other methods of debridement, is selective to necrotic tissue, and has been safely used in various populations. We review the body of evidence has indicated that this concept of maintenance debridement, especially when combined episodic debridement may add a cost an efficacious, safe and cost-effective choice for debridement of cutaneous ulcers and burn wounds and it will likely play an expanding role in all phases of wound bed preparation.

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“…52 Conversely, improved outcomes for patients with a DFU are largely attributed to wounds presenting at a stage when they were more "prognostically favorable", suggesting earlier access to care. 8,53 Time to presentation to a HRFS for patients with a DFU has been reinforced as a key performance indicator for our service 54 since local data (unpublished) showing increased ulcer severity with delayed referral.…”

Section: Delayed Referral To Multidisciplinary Servicesmentioning

confidence: 99%

“…The implementation of treatment guidelines such as those published by the International Working Group on the Diabetic Foot (IWGDF),and many other notable documents has resulted in better organized care, prevention of amputation, and improvement in patient outcomes. 7,8 While direct comparisons should be made with caution because of differences in measurement and ascertainment of diabetes incidence across countries, it is evident that there is high variation between and within countries. [9][10][11] This suggests that universal adoption of best practice and equity of access to contemporary foot care for people with diabetic foot complications are still a work in progress and may not be adequately prioritized in some regions.…”

Section: Introductionmentioning

confidence: 99%

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

Nubé¹,

Frank²,

White³

et al. 2016

CWCMR

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Diabetes-related foot ulceration is a frequent cause for hospital admission and the leading cause of nontraumatic lower limb amputation, placing a high burden on the health system, patient, and their families. Considerable advances in treatments and the establishment of specialized services and teams have improved healing rates and reduced unnecessary amputations. However, amputation rates remain high in some areas, with unacceptable variations within countries yet to be resolved. Specific risk factors including infection, ischemia, ulcer size, depth, and duration as well as probing to bone (or osteomyelitis), location of ulcer, sensory loss, deformity (and high plantar pressure), advanced age, number of ulcers present, and renal disease are associated with poor outcome and delayed healing. To assist in prediction of difficult-to-heal ulcers, more than 13 classification systems have been developed. Ulcer depth (or size), infection, and ischemia are the most common risk factors identified. High-quality treatment protocols and guidelines exist to facilitate best practice in the standard of care. Under these conditions, 66%-77% of foot ulcers will heal. The remaining proportion represents a group unlikely to heal and who will live with a non-healing wound or undergo amputation. The authors have applied their experience of managing patients in this discussion of why some ulcers are harder to heal. The article explores the effects of patient non-adherence to treatment, comorbid mental illness, a failure of research to be translated into the everyday practice of many clinicians, and the impact of delayed access to specialized treatment. These factors when combined with the main published risk factors of size, infection, ischemia and pressure are perceived as critical barriers to healing.

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Healing diabetic neuropathic foot ulcers: are we getting better?

Abstract: We have shown that individuals with a diabetic neuropathic foot ulcer seeking care are more likely to heal today than 10 years ago. The primary reason for this improvement is that individuals are seeking care when their wounds are most easily treated and these are now more likely to heal.

Cited by 93 publications

References 24 publications

Diabetic foot ulceration and amputation

Diabetic foot ulceration and amputation

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

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