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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic foot is a complication of diabetes mellitus occurring in 15% of patients that is of specific surgical interest. Over the past few years, preventive measures and the use of new therapeutic resources has reduced the number of patients undergoing demolitive surgery. The authors present a concise but at the same time sufficiently detailed picture of modern knowledge of the physiopathology, clinical aspects and current therapeutic guidelines for diabetic foot. In particular, they analyse the validity of various forms of complementary treatment to surgery, including techniques to stimulate tissue repair processes, hyperbaric oxygen therapy and laser therapy, and they underline the importance of using a multidisciplinary approach to this pathology. To this end, they review all the articles on the subject reported on Medline from 1992 to June 1998, presenting and commenting on the most significant results.
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PMID:[Diabetic foot. Physiopathology, clinical aspects, and recent therapeutic approaches]. 1085 61

Foot infections account for about 20% of all hospitalizations in people with diabetes and at least 50% of all nontraumatic lower-limb amputations performed annually in the United States. As many as 25% of all diabetics are expected to develop severe foot problems at some point in their lifetimes. Diabetic foot infections are generally more severe and more difficult to treat than infections in nondiabetics. This is due to impaired microvascular circulation, neuropathy, anatomical alterations, and impaired immune capacity in diabetic patients. Most moderate-to-severe soft-tissue diabetic foot infections are polymicrobial (i.e., due to gram-positive, gram-negative, aerobic, and anaerobic pathogens). Empiric antibiotic therapy should include broad-spectrum antibiotics capable of covering the most common pathogens found in diabetic infections. Other factors to consider in antibiotic selection include the severity of the infection, the presence of peripheral vascular disease, and the possibility of drug-resistant organisms in the infection. This review summarizes the clinical presentation and antimicrobial therapy of diabetic foot infections.
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PMID:Antibiotic selection for diabetic foot infections: a review. 1094 6

Biomechanical issues are now widely recognized as being important in the treatment of diabetic foot disease. The purpose of the present review is to identify advances that have occurred since the previous International Conference on the Diabetic Foot in 1995 in the understanding of foot biomechanics in relation to diabetes. Attention continues to be focused on the identification of a threshold plantar pressure that leads to tissue damage. Recent studies have suggested that peak barefoot pressure may be only 65% specific for the development of ulceration. The association between foot deformity and plantar pressure has been the subject of several quantitative studies, but new questions have been raised about the etiology of claw toes. The measurement of shear stress continues to be an elusive goal although several small studies have presented possibly feasible technical approaches. The importance of callus as a precursor to ulceration has been confirmed experimentally and quantitative measures of motor neuropathy have been presented. Although a number of new devices have been introduced as alternatives to the Total Contact Cast, few clinical studies of their efficacy are available yet. New information on the properties of insole materials has been published including data on changes with repeated cycling. Complications of prophylactic surgery have been shown to include a high rate of Charcot fractures. Two new series describing the fixation of such fractures have also been reported. Biomechanical issues have also been addressed in two sets of guidelines for treatment that have recently been published. These many studies confirm the central role of mechanical stress and its relief in the treatment of neuropathic foot problems in diabetes.
Diabetes Metab Res Rev
PMID:New developments in the biomechanics of the diabetic foot. 1105 80

In 1999 the International Consensus on the Diabetic Foot was published by a group of independent experts. The consensus process is described in this article together with the Practical Guidelines which were part of the consensus document.
Diabetes Metab Res Rev
PMID:International consensus and practical guidelines on the management and the prevention of the diabetic foot. International Working Group on the Diabetic Foot. 1105 95

Lower-extremity ulcers occur in approximately 15% of the estimated 16 million Americans with diabetes. The most important risk factors are neuropathy, ischemia, and poor glycemic control. Early identification of the patient at risk, patient education, and implementation of preventive measures are keys to curtailing morbidity and mortality. Diabetic foot care clinics allow enhanced patient accessibility to health care and improved quality of care. Novel treatment options have expanded the alternatives available to clinicians treating these difficult and prevalent wounds.
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PMID:The management of lower-extremity diabetic ulcers. 1118 37

In the last year an International Consensus on the Diabetic Foot has been developed by a group of independent experts from all over the world. The definition of the diabetic foot is based on WHO criteria as infection, ulceration and/or destruction of deep tissues associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. It is one of the most serious complications of diabetes: approximately 50% of all non-traumatic amputations are performed on patients with diabetes, it is a frequent cause of hospitalisation and disability of diabetic patients. Comprehensive prevention and therapy of diabetic foot provided by a podiatric team may reduce the number of amputations by 50% and it may decrease substantially the cost of long-lasting therapy. In all countries foot-care management should be organised at the general practitioner and podiatric nurse level and specialised foot centres with a diabetologist, a podiatric nurse, a radiologist, general, orthopaedic and vascular surgeons, an orthopaedic technician and a physiotherapist should be formed. The podiatric team has the following responsibilities--to identify patients at high risk and monitor them and to treat patients with ulcers. Treatment of diabetic foot must include non-weight bearing, long-lasting antibiotic therapy, improving circulation and topical treatment-debridement.
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PMID:[Care of patients with the diabetic foot syndrome based on an international consensus]. 1139 39

This study was carried out in the Metabolic Disease Department of the University Hospital of Brazzaville, between January 1995 and December 1999. Our purpose was to define epidemiological and clinical aspects of trophic disorders of the lower limbs, as observed among 247 diabetic patients. Diabetic foot was observed in 86.2% of adult patients with diabetes type 2, and in 13.8% of patients with diabetes type 1. The average duration of diabetes was 8 years. In 2.8% of cases, diabetes was discovered as a result of trophic disorders. Among observed lesions, infectious foot prevailed (63.9%) and mal perforant was exceptional (1.2%). The mortality rate before surgical intervention was high (22.6%).
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PMID:[Epidemiological and clinical aspects of the diabetic foot at the Central University Hospital of Brazzaville]. 1168 Dec 20

Diabetic foot ulcers are a frequent and severe complication of diabetes mellitus. A multidisciplinary approach (in-patient and out-patient care) improves prognosis and reduces the amputation rate. Risk factors are well defined and easily identified. High-risk patients (sensory loss, vascular disease, previous ulcer, foot deformities) have to be detected. In France, comprehensive foot-care programs, including education and regular foot examination, must be developed. The reduction of the economical and human burden needs the urgent formation of more multidisciplinary teams (to take care of patients properly and very early), foot care networks, and prevention programs.
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PMID:[Diabetic foot]. 1179 23

Diabetic foot disease in the form of ulceration, charcot joint fracture, and amputation affects 20% of patients with diabetes. This results in tremendous morbidity, mortality, and health care cost. The magnitude of this problem has been underrecognized by health care professionals. Impaired glucose control over a period of years affects peripheral nerve function by loss of protective sensation, muscle atrophy, foot deformity, and neuropathic fractures. Yearly foot examinations can identify risk factors. Regular nail care, callus removal, and education can prevent plantar ulceration. Protective footwear and custom orthotics improve function by reducing force and shear impact on the fragile foot and accommodate the patient's deformities. A cost-effective strategy of yearly comprehensive foot examinations, education, and appropriate interventions can improve both the quality and duration of life for those with diabetes mellitus.
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PMID:Diabetic foot: evaluation and management. 1200 20

We estimated the prevalence of foot symptoms and disease and evaluated foot care practices in a primary care based sample including 2106 people with diabetes in Trinidad. Symptoms of neuropathy were reported by 1030 (49%), previous foot ulceration by 257 (12%), and amputation by 92 (4%). Previous foot ulceration was associated with longer duration of diabetes (odds ratio 1.05, (95% CI 1.04-1.06) per year) and greater severity of neuropathy symptoms (1.17 (1.10-1.24) per unit increase in score). A history of foot ulceration gave relative odds of amputation of 16.3 (8.1-32.9). In those with previous foot ulceration, 120 (47%) went barefoot in the home, and 44 (17%) went barefoot outside the house. Overall, 1491 (71%) subjects reported they cut their toenails themselves, help was provided by a friend or relative to 584 (28%) and by a nurse or chiropodist to 13 ( < 1%). Most patients (1320, 63%) reported that they would treat a cut or blister on the foot themselves, while only 650 (31%) would attend for health care. Diabetic foot disease is common but care practices predispose to foot injury. Implementation of a strategy to improve care of the feet is needed.
Diabetes Res Clin Pract 2002 Apr
PMID:Diabetic foot disease and foot care in a Caribbean community. 1187 19


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