Diabetic Foot Ulcers

Michel Hermans's picture
healing rate

By Michel H.E. Hermans, MD

An interesting article in JAMA Internal Medicine (February 2015) by doctors from Massachusetts, Maryland and California (A.B. Jena, M.D. lead author) analyzed mortality and treatment differences in patients who were admitted with cardiovascular pathology during dates of national cardiology meetings and compared these with the situation when the physicians were at the hospital. They found that high-risk patients with heart failure and cardiac arrest had a lower 30-day mortality rate when a national cardiology meeting was taking place. Fewer percutaneous interventions were performed during these meetings without an effect on mortality in patients with an acute myocardial infarction. Although the authors did not state this, one might (cynically?) think that treatment may have been excessive when the (interventional) cardiologists were "at home": perhaps bad for the patient and certainly not good for the cost of health care.

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Mark Hinkes's picture
leg bones

By Dr. Mark Hinkes, DPM

Unequal limb length (ULL) is a clinical problem that is more common than most clinicians realize and is one for which most patients are rarely evaluated. Common problems associated with unequal limb length include instability in gait, falling, low back pain, sciatica, joint pain, IT Band Syndrome, chronic muscle strain, tendonitis, and failure of diabetic foot wounds to heal.

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Temple University School of Podiatric Medicine's picture

By Rizwan Tai and James McGuire DPM, PT, CPed, FAPWHc

According to Centers for Disease Control and Prevention (CDC), the number of adults between the ages of 18-79 with newly diagnosed diabetes has more than tripled in the last 30 years. Foot ulcers are a major complication of uncontrolled diabetes, and 25% of the patients will be affected with foot ulcers in their lifetime, the majority of which lead to lower extremity amputations.

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Diana Gallagher's picture

By Diana L. Gallagher MS, RN, CWOCN, CFCN

I recently had the honor of participating in a meeting of the Wound Ostomy Continence Nursing Certification Boar> (WOCNCB®). My role was to assist the Foot Care Committee with the evolution of the exam for certification in foot care nursing. All WOCNCB exams are expanding to a larger format based on the recommendations of the testing industry. The committee worked diligently to assure that item inclusion matched the test blueprint which in turn matched the job analysis that had been completed earlier this year. There is SO MUCH work that goes on behind the scenes to maintain examinations that are worthy of the WOCNCB's "Gold Standard." Participating in this meeting was truly an honor. As one of the members of the original committee for foot care nursing, I could not have been prouder of the progress that has been made in the past decade.

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Temple University School of Podiatric Medicine's picture

By Tedman L. Tan and James McGuire DPM, PT, CPed, FAPWHc

The management of diabetic foot ulcers is becoming an increasingly significant concern with the growing population of patients with diabetes in the United States. Most amputations involving the lower extremity in patients with diabetes are preceded by foot ulcers, and in turn, lower extremity amputations are associated with a high 5-year mortality rate at around 45% among individuals with diabetes.1 Therefore, diabetic foot ulcers require special attention due to the possible life-threatening complications associated with such wounds

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WoundSource Editors's picture

By the WoundSource Editors

The term diabetic foot refers generally to the increased occurrence of complications in the feet of patients with diabetes mellitus. The most common foot problems related to diabetes are peripheral neuropathy leading to ulceration, vascular disease, increased risk of infection, and deformities like Charcot arthropathy. Complications arising from diabetes are the most common non-traumatic injury to cause lower extremity amputation.

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Michel Hermans's picture

By Michel H.E. Hermans, MD

The CDC recently published encouraging data in the New England Journal of Medicine about a decline in the rate of five major complications related to diabetes mellitus: hyperglycemia, heart attack, stroke, kidney failure and amputations1. The report did not include eye-related problems (i.e. retinopathy, glaucoma, cataract). The rate of amputations went down from approx. +/- 55/10.000 adults (1990) to +/-26/10.000 adults (2010). The 2010 numbers on amputations are roughly in line with a more recent publication by the Agency for Healthcare Research and Quality (AHRQ) which reported an expected (2014) amputation rate of 3.75/person-year for type II and 3.8 for type I (figure I).

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Cheryl Carver's picture

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

Deciding on a blog topic for this month was simple. August 12th marked 18 years since my 47-year-old mother passed away due to pressure ulcer complications. A flood of memories came rushing through, realizing just how much wound care has evolved throughout the years. A feeling of "if I only knew then, what I know now" type emotions. I cannot help but have a great deal of heartfelt empathy for caregivers and their loved ones with chronic wounds. My personal experiences have led me to my sense of gratification in what I do every day.

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Aletha Tippett MD's picture

By Aletha Tippett MD

Many have never heard of diabetic foot complications Charcot foot, or at least don't know what it is. If you care for individuals with diabetes who have neuropathy, you almost certainly will see Charcot foot. My patients with Charcot have told me they have a disease of the foot "with crumbling bones." This is actually fairly accurate. Charcot is a neuropathic bone disease that causes osteoporosis-type destruction of the bones in the foot. As a result of this, the bones shift and move and break.