New trends in the orthopaedic management of diabetic foot

Abstract

Although there are various types of therapeutic footwear currently used to treat diabetic foot ulcers (DFUs), recent literature has enforced the concept that total-contact casts are the benchmark.Besides conventional clinical tests and imaging modalities, advanced MRI techniques and high-sensitivity nuclear medicine modalities present several advantages for the investigation of diabetic foot problems.The currently accepted principles of DFU care are rigorous debridement followed by modern wound dressings to provide a moist wound environment. Recently, hyperbaric oxygen and negative pressure wound therapy have aroused increasing attention as an adjunctive treatment for patients with DFUs.For DFU, various surgical treatments are currently available, including resection arthroplasty, metatarsal osteotomies and metatarsal head resections.In the modern management of the Charcot foot, surgery in the acute phase remains controversial and under investigation. While conventional fixation techniques are frequently insufficient to keep alignment postoperatively, superconstruct techniques could provide a successful fixation.Retrograde intramedullary nailing has been a generally accepted method of achieving stability. The midfoot fusion bolt is a current treatment device that maintains the longitudinal columns of the foot. Also, Achilles tendon lengthening remains a popular method in the management of Charcot foot.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170073

Surgical correction of foot deformities as a method for prevention and treatment of diabetic foot syndrome

“…Данную работу мы соотносили с малым (пока что) отечественным опытом хирургического ортопедического лечения СДС [25,26] и с более обширным опытом иностранных коллег [27][28][29][30][31][32][33][34][35], посвященным хирургическому лечению деформаций стоп у пациентов с СДС.…”

Diabetic Foot Infection, Biofilm & New Management Strategy

“…Currently, new generation of modern wound dressing is gaining importance; these more advanced dressings can release therapeutic agents and healing enhancers such as growth factors (GFs), stem cells, peptides and other bioactive substances. Importance of extracellular matrix for wound healing has influenced researchers to generate more advanced wound dressings including collagen and other ECM proteins, also called biological dressings, such as collagen, hyaluronic acid, chitosan, elastin and fibrin [57,58]. Such dressings could reduce inflammation and wound proteases & increase GFs in the wound environment.…”

“…therapy involving the use of intralesional injection of recombinant human epidermal growth factor can prevent amputations in selected complicated DFUs, non-responsive to standard care [60]. Further clinical trials are required to evaluate the clinical efficacy and safety of such therapies, although these products are the benchmarks of biological therapies [57].…”

“…Several studies have suggested that this novel system presents potential advantages, which includes removal of infectious organism and non-viable material [9]. The main mechanism of NPWT is also to eliminate edema that removes the fluid of the lymph or the lymph in interstitial, thus improving oxygen diffusion into the cell [57]. It also eliminates collagenase and matrix metalloproteinase (MMP) enzymes that are increased in chronic wounds which hinder wound healing and is one of the most effective current strategies in reducing the risk of amputation and improving healing rates in patients with DFUs [9].…”

“…In recent years, hyperbaric oxygen therapy (HBOT) has shown increased attention as an adjuvant treatment for managing DFUs [57]. Chronic wounds are usually hypoxic, which means for adequate wound healing, it requires an increase in oxygen supply.…”