Management of Diabetic Midfoot Ulcers

Wieman, T. Jeffery; Griffiths, Gareth; Polk, H. C. Jr.

doi:10.1097/00000658-199206000-00009

Cited by 38 publications

(24 citation statements)

References 12 publications

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“…Several devices are commonly used, including contact casts, crutches, wheelchairs, and special footwear (9,(11)(12)(13)(14)(15). This type of care is often the standard care arm in randomized clinical trials and was recently discussed in a consensus statement from the American Diabetes Association (8 -12,15).…”

Section: Diabetes Care 25:1835-1839 2002mentioning

confidence: 99%

Diabetic Neuropathic Foot Ulcers

et al. 2002

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OBJECTIVE -The goal of this study was to evaluate whether simple risk factors can be identified that successfully characterize who will heal and who will not heal among patients who have received standard therapy for diabetic neuropathic foot ulcers.RESEARCH DESIGN AND METHODS -For this cohort study, we evaluated Ͼ31,000 individuals with a diabetic neuropathic foot ulcer seen in the Curative Health Services System. Using multivariate logistic regression, we evaluated the association between wound size, wound duration, wound grade, and other variables and their effect on whether a patient would heal by the 20th week of care.RESULTS -We demonstrated that wound size, wound duration, and wound grade are all significantly associated with the likelihood of a wound healing by the 20th week of care. In addition, we noted that these associations were not significantly affected by the treating wound care center, whether the unit of analysis was one wound on a patient or all of their wounds, or current adjuvant therapies.CONCLUSIONS -We have shown that three easy-to-measure risk factors are associated with a wound healing. These results should help clinicians understand the likelihood that a wound will heal and help those conducting clinical investigations to design better trials. Diabetes Care 25:1835-1839, 2002L ower-extremity ulcers are a serious complication of diabetes. More than 16 million people in the U.S. have diabetes, and 15% of them can expect to develop a foot ulcer at some point in their lives (1-3). Diabetic patients admitted to the hospital with lower-extremity ulcers were hospitalized longer on average than those who were hospitalized and did not have ulcers (1,3). Whereas only 4% of the population has diabetes, 46% of those admitted to a hospital with a foot ulcer had diabetes, and half of all lower-extremity amputations in hospitalized patients occurred in diabetic patients (1,3). Those with a lower-extremity amputation have a diminished quality of life and increased health costs, often have many concomitant medical ailments, are more likely to have the contralateral limb amputated, and are more likely to die within the next 5 years than those with no amputation (4,5).There are many pathways for the development of a diabetic foot ulcer. In general, they include a combination of lowerlimb arterial insufficiency, lower-limb diabetic neuropathy, and local trauma (6). About 20% of diabetic patients with foot ulcers will primarily have inadequate arterial blood flow, ϳ50% will primarily have diabetic neuropathy, and ϳ30% will be afflicted with both conditions (1,6). Inadequate arterial blood flow is usually treated by a variety of surgical techniques that improve blood flow (7). For this study, foot ulcers on individuals with diabetes who lack protective sensation and have adequate arterial blood flow to their foot are termed diabetic neuropathic foot ulcers (DNFUs) (8 -10).The treatment of a DNFU usually consists of debridement of necrotic tissue, use of a moist wound dressing, and the use of a device that p...

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Section: Diabetes Care 25:1835-1839 2002mentioning

confidence: 99%

Diabetic Neuropathic Foot Ulcers

et al. 2002

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“…More recently, authors have advocated the idea of surgical intervention in these problem feet to protect the skin from ulceration. 1,3,9,14,18,19 Over the last 10 years we have had the opportunity to treat patients operatively for severe midfoot collapse. We present a retrospective review of the results to date.…”

Section: Introductionmentioning

confidence: 99%

Surgical Reconstruction of the Diabetic Foot: A Salvage Approach for Midfoot Collapse

1996

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Between 1985 and 1993, 18 patients representing 21 feet underwent surgical reconstruction for diabetic neuroarthropathy with collapse of the midfoot. Forty-seven percent (10/21) of these feet presented with plantar pressure ulcers. Reconstruction involved reduction and fusion of collapsed joints, using internal fixation to restore foot shape and improve weightbearing alignment. The average follow-up in these patients was 28 months (range, 6-84 months). Limb salvage was obtained in 18 of 21 feet. Average time to radiographic union was 5 months (range, 3-9 months). Improvement in shoe fit and ambulatory status was noted for 13 of the 15 patients who had successful reconstruction. Forty-seven percent of the reviewed cases were without any complication throughout their postoperative course. Seventy percent of the presenting ulcers healed without incident. There were no recurrent midfoot ulcers.

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“…Other methods that do not maximize off-loading take longer than the average of 43 days for TCC and have a considerably greater percentage of ulcers that fail to heal. [45][46][47][48][49] Thus, comparisons of healing times and the percentage of ulcers healed among the various methods help to underscore the importance of maximizing pressure off-loading through casting to promote neuropathic ulcer healing.…”

Section: Effectiveness and Expected Outcomes Of Tccmentioning

confidence: 99%

“…Total-contact casting (TCC) represents the average from several studies. 3-6,8,11-14,16,20,50 Values for dressing changes and molded insoles are from Mueller and colleagues 20 and Holstein and colleagues 48 combined; values for local ostectomy and wound debridement are from Griffiths and Wieman 46 and Wieman and colleagues 49 combined; values for becaplermin (Regranex), a platelet-derived growth factor, are from Wieman and colleagues 49. …”

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confidence: 99%