Preventing Amputation in the Patient With Diabetes

Levin, Marvin E.

doi:10.2337/diacare.18.10.1383

Cited by 134 publications

(59 citation statements)

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“…Moreover, in elderly patients, this approach could involve the risk of serious bed hypocinetic syndrome, considering the length of time generally needed to heal completely. The use of a wheelchair or crutches (19) can be equally effective, but represents once again a serious limitation to the quality of life of the patient. The methods currently recommended are therapeutic shoes or the TCC (20,21).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Caravaggi¹,

Faglia²,

Giglio³

et al. 2000

Diabetes Care

131

100

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OBJECTIVE -To evaluate and compare the rate of reduction of the surface area of neuropathic plantar ulcers in diabetic patients treated with nonremovable rigidity-differentiated fiberglass off-bearing casts or a cloth shoe with a rigid sole with unloading alkaform insoles. The secondary aim was to evaluate the side effects and degree of patient acceptance of treatment. RESEARCH DESIGN AND METHODS -Fifty diabetic patients with neuropathicplantar ulcers were consecutively enrolled and randomized to one of two treatment groups. Of the 50 patients, 24 were treated with a specialized cloth shoe with a rigid sole and an unloading alkaform insole (shoe group), and 26 patients were treated with a nonremovable off-bearing fiberglass cast (cast group). All patients in both study groups returned to the clinic for weekly control visits. Their ulcers were treated with a standard dressing. Tracings of the ulcer area using a transparent dressing were performed on the day of entry to the study and after 30 days of treatment. The presence of new ulcerations caused by the use of the pressure-relief apparatus was recorded. Patient acceptance of the treatment was measured using a visual analog scale.RESULTS -At the end of the treatment period, an 8.3% increase of the ulcer area was observed in two patients in the shoe group, whereas in the cast group, no patient presented an increase. The reduction of the ulcer area was statistically more rapid in the cast group (MannWhitney test, P = 0.0004). Furthermore, the number of ulcers completely healed at the 30-day time point was 13 (50%) in the cast group and 5 (20.8%) in the shoe group (P = 0.03). In both groups, no side effects were recorded. The average score ± SD of patient acceptance was 91.15 ± 9.9 in the shoe group and 88.33 ± 17.3 (NS) in the cast group.CONCLUSIONS -Our study has shown a significant difference in the speed of the reduction of neuropathic plantar ulcers treated with a fiberglass cast compared with a specialized cloth shoe. The use of fiberglass material with variable rigidity has also shown two important results: the elimination of side effects including ulcers caused by the cast, and high patient acceptance. These data show that the use of off-bearing casts made with fiberglass bandages of variable rigidity is the elective treatment of neuropathic plantar ulcers.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Caravaggi¹,

Faglia²,

Giglio³

et al. 2000

Diabetes Care

131

100

View full text Add to dashboard Cite

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“…Preexisting toe deformities such as hallux hammer toe, metatarsal compression, and bone protrusions make skin more susceptible to breakdown and infection in diabetic patients. Lesions in motor nerves result in toe deformities such as claw toes, crossover toes, among others (29) . Claw toes were found in 31.7% of patients, crossover toes in 23.3%, and prominence of metatarsal heads in 18.3% (30) .…”

Section: Discussionmentioning

confidence: 99%

Comportamento e conhecimento: fundamentos para prevenção do pé diabético

2009

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Objective:To describe the knowledge and behaviors of patients with diabetes towards foot care. Methods: A cross-sectional descriptive study was conducted at a university research and intervention center in the interior of the state of São Paulo. Data were collected through interviews, two specific questionnaires, and physical examination of the foot in 55 patients in 2005. Results: The participants did not recognize the dimension of the true risks regarding lack of foot care. The participant knowledge of diabetes did not translate into actions to prevent foot problems. These results suggest the need to take into consideration specific individual characteristics and the individual's interactions with the environment in designing educational interventions. Conclusions: Health care professionals need to understand that discrepancy between knowledge and behaviors of patients with diabetes is not an obstacle impossible to cross, but a challenging issue that needs to be addressed. Keywords: Diabetes mellitus; Primary prevention; Diabetic foot/prevention & control; Health behavior; Health knowledge, attitudes, practice RESUMO Objetivo: Identificar o conhecimento e comportamento de pessoas diabéticas em relação aos cuidados com os pés. Métodos: Estudo descritivo e transversal realizado em um centro de pesquisa e extensão universitária do interior paulista, em 2005. Foram entrevistados 55 pacientes diabéticos. Para a obtenção dos dados utilizamos um formulário, dois questionários e exame físico dos pés. Resultados: As pessoas diabéticas não reconhecem a dimensão do risco real com relação aos pés. O conhecimento referido nem sempre se traduz na adoção de ações de autocuidado para a prevenção de problemas relacionados aos pés. Esta realidade aponta para a necessidade de considerarmos as particularidades de cada sujeito e sua interação com o ambiente, para delineamento das intervenções educativas. Conclusões: É preciso que os profissionais de saúde compreendam que o descompasso entre conhecimento e comportamento dos diabéticos não deve ser interpretado como um obstáculo intransponível, mas como um dos desafios fundamentais que precisam ser enfrentados. Descritores: Diabetes mellitus; Prevenção primária; Pé diabético/prevenção & controle; Conduta de saúde; Conhecimentos, atitudes e prática em saúde RESUMEN Objetivo: Identificar el conocimiento y comportamiento de personas diabéticas en relación a los cuidados de los piés. Métodos: Estudio descriptivo y transversal realizado en un centro de investigación y extensión universitaria del interior paulista, en el 2005. Fueron entrevistados 55 pacientes diabéticos. Para la obtención de los datos utilizamos un formulario, dos cuestionarios y examen físico de los piés. Resultados: Las personas diabéticas no reconocen la dimensión del riesgo real en relación a los piés. El conocimiento referido no siempre se traduce en la adopción de acciones de autocuidado para la prevención de problemas relacionados a los piés. Esta realidad apunta hacia la necesidad de considerar las parti...

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“…Levin added a further stage of chronic ulceration (stage IV). 15,16 For description of OA progression, we used the KellgrenLawrence radiographic scale, which ranges from stage 0 (no radiographic findings of OA) to stage IV (signs of severe OA).…”

Section: Subjectsmentioning

confidence: 99%

Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis

Koeck

Bobrik

Faßold

et al. 2009

Journal Orthopaedic Research

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The pathogenesis of Charcot foot is based on three disputed factors: (1) loss of neurotrophic influence, (2) microtraumatic lesions, and (3) neurovascular disturbances. These etiological causes were uncovered by clinicophysiological tests. However, no results of quantitative nerve density studies of sympathetic and sensory substance P-positive (SPþ) nerve fibers are available. We studied the density of sympathetic and SPþ nerve fibers in three distinct areas of the tarsus. Fifteen patients with ankle osteoarthritis (OA) and 15 patients with diabetic Charcot foot were included. Patients with OA did not differ from those with Charcot foot in SPþ sensory nerve fiber density. However, at all three areas, the density of sympathetic nerve fibers was significantly lower in patients with Charcot foot compared to OA (p ¼ 0.006). In addition, we found that the sympathetic nerve repellent factor semaphorin 3C was highly expressed in inflamed tissue in Charcot patients. In Charcot foot of diabetic origin a severe loss of sympathetic nerve fibers was observed. These findings in chronically inflamed Charcot foot lend support to the neurovascular theory in the late chronic phase, which probably depends on the inflammatory upregulation of nerve repellent factors. ß

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Preventing Amputation in the Patient With Diabetes

Cited by 134 publications

References 0 publications

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Comportamento e conhecimento: fundamentos para prevenção do pé diabético

Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis

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