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For A Patient With Type 1 Diabetes And A Heel Ulcer, Could The Addition Of Electrical Stimulation To Standard Wound Treatment Improve Wound Healing Over Standard Wound Treatment Alone?

For A Patient With Type 1 Diabetes And A Heel Ulcer, Could The Addition Of Electrical Stimulation To Standard Wound Treatment Improve Wound Healing Over Standard Wound Treatment Alone?

The purpose of Evidence in Practice is to illustrate the literature search process to obtain evidence that can guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A 68-year-old man was referred to our facility by his family doctor for treatment of a diabetic ulcer on his left heel that had been present for 6 weeks. He had been diagnosed with type 1 diabetes mellitus at 8 years of age. Five years ago, he underwent a transtibial amputation of his right leg because of an infected diabetic ulcer on his right heel. He now uses a transtibial prosthesis and a cane for ambulation. He stated that, since his amputation, he has been diligent with his foot care, which consists of daily visual inspection (for redness, inflammation, and wounds), moisturizing following showering, and callus and nail trimming. Despite his rigorous attention to his foot, he developed an ulcer on his left heel, which has been resistant to standard wound treatment (debridement, dressing changes, and off-loading). 1 He was using Lantus * (daily) and Humalog (with meals) to control his diabetes, Accupril for his hypertension, and the antibiotics Cipro and Amoxicillin. The patient reported decreased feeling in his left lower extremity and was concerned about the prospect of having another amputation. He did not appear to have an active systemic infection: when asked, he said that he had no recent nausea, fever, vomiting, or fatigue. His vital signs were all within normal ranges: body temperature of 37.1C, heart rate of 72 beats per minute, respiratory rate of 14 breaths per minute, and blood pressure of 128/78 mm Hg. The patient's body mass index was 31 kg/m2, indicating that he was overweight. Examination of th Continue reading >>

Diabetic Foot Pain

Diabetic Foot Pain

by Kenneth B. Rehm, DPM Includes photo of Dr. Kenneth B. Rehm, DPM Diabetes is one of the most common reasons people seek relief for painful feet. With diabetes, four types of foot problems may arise in the feet. Nerve Problems due to Diabetes The most common contributor to diabetic foot pain is a nerve problem called Peripheral Neuropathy. This is where the nerves are directly affected by the disease process. There are basically three types of peripheral neuropathy: sensory, motor, and autonomic neuropathy. A large percentage of pain diabetic patients complain of is due to sensory neuropathy. This can show up as "sensitive pain," where the amount of pain is not proportional to the amount of insult that is causing it. For instance, just touching the skin or putting a sheet over your feet in bed could be painful. This can be present at the same time as numbness in the feet. Sensory neuropathy symptoms can include burning, tingling or a stabbing pain. Relief is foremost on someone's mind when painful neuropathy has raised its ugly head. The first thing to do is to check your blood sugar for the past several weeks to see if there has been a trend toward high blood sugar (Editor's Note: The A1c test is traditionally employed to determine this, and should be repeated about every three months.) Persistent high blood sugar can contribute to this type of pain. Massaging your feet with a diabetic foot cream, or using a foot roller, often takes the edge off the pain. Vitamin B preparations are often recommended; and there are a variety of prescription medications that do work. Using cushioned, supportive shoes and foot support inserts is always needed to protect the feet from the pounding, rubbing and irritating pressures that contribute to neuropathic pain. Motor neuropathy can Continue reading >>

Essential Insights On Treating Diabetic Heel Ulcers

Essential Insights On Treating Diabetic Heel Ulcers

Issue Number: Volume 23 - Issue 3 - March 2010 Diabetic heel ulcers are particularly challenging to treat as a wide range of factors can affect potential healing. With this in mind, this author discusses the challenges of wound bed preparation, key considerations with offloading and the possible impact of peripheral arterial disease. Despite a better understanding and the advent of preventive measures that have been developed to address heel ulcers, the problems we encounter due to complications of diabetes make treating this specific patient population more challenging. The problem of heel ulcers will increase in conjunction with our increasing diabetic and aging population. The prevalence of heel ulcers across settings is high and continues to increase. In hospitalized patients, it ranges between 10 to 18 percent. Heel ulcers continue to be prevalent after patients are discharged.1 Researchers have shown that diabetic foot ulcers correlate with multiple co-morbidities and an increased mortality. They often serve as a barometer of a patient’s health in general and correlate with a decrease in mobility and independence. Heel ulcers are often the precursor to hospitalization, osteomyelitis, lower extremity amputation and death. Diabetic patients with foot ulcers have a higher rate of surgical intervention (97 percent versus 85 percent) and amputation (71 percent versus 63 percent) than non-diabetic patients with heel ulcers.2 Although heel ulcers are less frequent than forefoot ulcers, higher expenses and higher morbidity rates are associated with heel ulcers. Researchers have estimated that heel ulcers are one and one-half times more expensive to treat and are two to three times less likely to heal in comparison to metatarsal ulcers.2 Also keep in mind that heel ulcer Continue reading >>

Slideshow: What Your Feet Say About Your Health

Slideshow: What Your Feet Say About Your Health

Cold Feet, Many Culprits If your toes are always cold, one reason could be poor blood flow -- a circulatory problem sometimes linked to smoking, high blood pressure, or heart disease. The nerve damage of uncontrolled diabetes can also make your feet feel cold. Other possible causes include hypothyroidism and anemia. A doctor can look for any underlying problems -- or let you know that you simply have cold feet. When feet ache after a long day, you might just curse your shoes. After all, eight out of 10 women say their shoes hurt. But pain that’s not due to sky-high heels may come from a stress fracture, a small crack in a bone. One possible cause: Exercise that was too intense, particularly high-impact sports like basketball and distance running. Also, weakened bones due to osteoporosis increases the risk. Raynaud’s disease can cause toes to turn white, then bluish, and then redden again and return to their natural tone. The cause is a sudden narrowing of the arteries, called vasospasms. Stress or changes in temperature can trigger vasospasms, which usually don’t lead to other health concerns. Raynaud’s may also be related to rheumatoid arthritis, Sjögren’s disease, or thyroid problems. The most common cause of heel pain is plantar fasciitis, inflammation where this long ligament attaches to the heel bone. The pain may be sharpest when you first wake up and put pressure on the foot. Arthritis, excessive exercise, and poorly fitting shoes also can cause heel pain, as can tendonitis. Less common causes include a bone spur on the bottom of the heel, a bone infection, tumor, or fracture. Sometimes the first sign of a problem is a change in the way you walk -- a wider gait or slight foot dragging. The cause may be the slow loss of normal sensation in your feet, br Continue reading >>

Diabetic Foot Problems

Diabetic Foot Problems

What foot problems can be caused by diabetes? Diabetes mellitus can cause serious foot problems. These conditions include diabetic neuropathy (loss of normal nerve function) and peripheral vascular disease (loss of normal circulation). These two conditions can lead to: Diabetic foot ulcers: wounds that do not heal or become infected Infections: skin infections (cellulitis), bone infections (osteomyelitis) and pus collections (abscesses) Gangrene: dead tissue resulting from complete loss of circulation Charcot arthropathy: fractures and dislocations that may result in severe deformities Amputation: partial foot, whole foot or below-knee amputation What are the symptoms of a diabetic foot problem? ​Symptoms of neuropathy may include the loss of protective sensation or pain and tingling sensations. Patients may develop a blister, abrasion or wound but may not feel any pain. Decreased circulation may cause skin discoloration, skin temperature changes or pain. Depending on the specific problem that develops, patients may notice swelling, discoloration (red, blue, gray or white skin), red streaks, increased warmth or coolness, injury with no or minimal pain, a wound with or without drainage, staining on socks, tingling pain or deformity. Patients with infection may have fever, chills, shakes, redness, drainage, loss of blood sugar control or shock (unstable blood pressure, confusion and delirium). How do some of these complications develop? ​Neuropathy is associated with the metabolic abnormalities of diabetes. Vascular disease is present in many patients at the time of diagnosis of diabetes. Ulcers may be caused by external pressure or rubbing from a poorly fitting shoe, an injury from walking barefoot, or a foreign object in the shoe (rough seam, stone or tack). Infecti Continue reading >>

Is There A Relationship Between Plantar Fasciitis And Diabetes?

Is There A Relationship Between Plantar Fasciitis And Diabetes?

Question: Hi! Every morning when I wake up I have terrible foot pain. I've done some research and am pretty sure that I have plantar fasciitis. During my research I came across a source that stated that women with diabetes are at a higher risk for plantar fasciitis. Is there any truth to that? Answer: Dear Reader, The research I performed on this topic indicates that no known relationship between plantar fasciitis and diabetes has ever been established. In fact, plantar fasciitis occurs when a long fibrous plantar fascia ligament along the bottom of the foot develops tears in tissue resulting in pain and inflammation. Some of the signs and symptoms of plantar fasciitis are burning, stabbing, or aching pain in the heel of the foot. The most common cause for plantar fasciitis is an overload of physical activity or exercise. This is commonly seen in athletes who change or increase the difficulty of their exercise. Another cause of plantar fasciitis is arthritis, which makes the elderly women more prone to this condition. Also, wearing incorrect shoe sizes can cause tears in the tissue. Contributing factors include people with high arches, flat feet, and obesity. Diabetes could be a contributing factor with further heel pain and damage, but mostly among the elderly. The current treatment options for plantar fasciitis are changing physical activities, resting the foot, and applying ice. Orthotics can be helpful to promote healing and may be able to reverse it in some cases. I hope that helps! Continue reading >>

Diabetes And Foot Problems Treatment And Complications

Diabetes And Foot Problems Treatment And Complications

Diabetes and foot problems facts Two main conditions, peripheral artery disease (PAD) and peripheral neuropathy, are responsible for the increased risk of foot problems in people with diabetes. Symptoms and signs of diabetic foot problems arise due to the decreased sensation from nerve damage as well as the lack of oxygen delivery to the feet caused by vascular disease. Diabetic foot problems also include bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails. These problems are not specific to diabetes, but may occur more commonly due to the nerve and vascular damage caused by diabetes. Treatment depends on the exact type of foot problem. Surgery or even amputation may be required for some cases. Gangrene (dry gangrene) is tissue death due to absence of blood circulation. It can be life threatening if bacterial infection develops (wet gangrene). Many diabetes-related foot problems can be prevented by good control of blood sugar levels combined with appropriate care of the feet. How can diabetes cause foot problems? Both type 1 and type 2 diabetes cause damage to blood vessels and peripheral nerves that can result in problems in the legs and feet. Two main conditions, 1) peripheral artery disease (PAD), and 2) peripheral neuropathy are responsible for the increased risk of foot problems in people with diabetes. Peripheral artery disease (PAD), sometimes referred to as peripheral vascular disease (PVD), means that there is narrowing or occlusion by atherosclerotic plaques of arteries outside of the heart and brain. This is sometimes referred to as "hardening" of the arteries. Diabetes is a known risk factor for developing peripheral artery disease. In addition to pain in the calves during exercise (medically known as intermitte Continue reading >>

Skin Hydration Of The Heel With Fissure In Patients With Diabetes: A Cross-sectional Observational Study

Skin Hydration Of The Heel With Fissure In Patients With Diabetes: A Cross-sectional Observational Study

Editor who approved publication: Professor Marco Romanelli Makoto Oe,1 Kimie Takehara,2 Hiroshi Noguchi,3 Yumiko Ohashi,4 Mayu Fukuda,1 Takashi Kadowaki,5 Hiromi Sanada1,6 1Global Nursing Research Center, 2Department of Advanced Nursing Technology, 3Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, 4Department of Nursing, The University of Tokyo Hospital, 5Department of Diabetes and Metabolic Diseases, 6Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Purpose: Foot fissure should be prevented in patients with diabetes due to the likelihood of subsequent diabetic ulcer. The purpose of this study was to investigate a cutoff point for skin hydration with fissure and the factors associated with low skin hydration in patients with diabetes. Subjects and methods: Subjects were patients with diabetes who visited the diabetic foot clinic and were evaluated for skin hydration on the heel between April 2008 and March 2015. Information about fissure, skin hydration, age, sex, autonomic neuropathy, angiopathy, and tinea pedis were collected from the medical charts. Skin hydration on the heel was measured using a moisture checker. Skin hydration was compared between heels with and without fissure, and a cutoff for skin hydration with fissure was determined using receiver operating characteristic analysis. Based on the determined cutoff, factors associated with lower skin hydration were analyzed using logistic regression analysis. Results: Participants comprised 693 patients. MeanSD age was 66.810.8 years, and 57.0% of subjects were male. The frequency of fissures on the heels was 10.4%. Area under the receiver operating characteristic curve for skin hydr Continue reading >>

Silicone Sock As Treatment Of Deep Heel Fissures In People With Diabetes

Silicone Sock As Treatment Of Deep Heel Fissures In People With Diabetes

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Silicone Sock as Treatment of Deep Heel Fissures in People With Diabetes The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT02641548 Information provided by (Responsible Party): Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information This study evaluates the addition of using a sock of silicone to using a heel cream, in the treatment of heel fissures in people with diabetes, aiming at healing the fissures and preventing them from developing into ulcers. Half of the participants will use the silicone sock and a heel cream, the other half will use the cream only. Device: Sock of silicone Other: Heel cream Dry skin and heel fissures are common complications of diabetes and can develop into hard-to-heal ulcers that eventually can make amputation of the foot necessary. Patients are advised to use heel creams to heal fissures and prevent them from developing into ulcers. Clinical observations have suggested that wearing a silicone sock nighttime can heal fissures, but the additional advantage of using a silicone sock compared to use a heel cream only has not been investigated. Participants will be randomized to an intervention group (silicone sock and heel cream) or a control group (heel cream only) and the healing of fissures and development of new ulce Continue reading >>

Heel Ulcerations In The Diabetic Patient

Heel Ulcerations In The Diabetic Patient

IntroductionHeel ulcers result in a break in the dermal barrier with subsequent erosion of the underlying subcutaneous tissue. As severity increases, the defect extends to muscle and bone, representing one of the most costly, in terms of dollars as well as disability, complications in the elderly. This complication escalates the length of hospital stay and cost of care. The heel is the second leading site for development of pressure ulcers after the sacrum.1Hospital-acquired heel pressure ulcers represent a significant morbidity and often result in limb loss. Diabetic foot ulceration, including heel ulceration, is a major complication of diabetes mellitus, with a lifetime incidence of three percent a year and 15 percent in a lifetime. During the last five years, the incidence of hospital-acquired heel ulcers has increased from 19 percent to 30 percent.2,3The lack of perfusion decreases tissue resistance, leads to rapid tissue death, and impedes wound healing. Ischemia due to vascular insufficiency impedes wound healing by reducing the supply of oxygen,4 nutrients, and the mediators of the repair process. Although peripheral arterial disease alone infrequently precipitates ulceration, it has a dominant role in delayed wound healing and gangrene.Neuropathy is a major contributing risk factor for foot ulcers and can involve both somatic and autonomic fibers. The myelinated type A sensory fibers are associated with proprioception, sensation of light touch, pressure, and vibration, and motor innervation of the muscle spindles. Neuropathy of the A fiber is ataxic gait and intrinsic weakness of the foot muscles. Neuropathy of the C sensory fibers is the loss of protective sensation; it results in the loss of pain threshold with prolonged and increased shear forces and associa Continue reading >>

Heel Pain Treatment | Foot Nerve Pain Treatment | Diabetic Foot Problems Treatment | Upper West Side

Heel Pain Treatment | Foot Nerve Pain Treatment | Diabetic Foot Problems Treatment | Upper West Side

Pain in the heel may develop as a result of plantar fasciitis, which involves a stretching of the plantar fascia ligament beyond its limit. Patients with plantar fasciitis often experience pain in the heel, arch or back of the leg, which is usually worse when getting up after sitting down for a while. Many patients with plantar fasciitis also develop bone spurs, calcium growths on the bottom of the heel where the plantar fascia pulls on the heel bone. Heel pain can also be caused by overuse, heel spurs, stress fractures or tarsal tunnel syndrome. There are several treatment options available for chronic heel pain, including rest, ice, anti-inflammatory medication and exercising. Most patients can achieve successful pain relief using these treatments within two months, although the condition may become chronic for some. Supplementary treatments such as cortisone injections, arch support and orthotic inserts may be recommended in conjunction with conservative techniques. Many patients benefit from extracorporeal shockwave therapy, a minimally invasive procedure that uses low energy shock wave therapy to stimulate the healing process. Dr. Dixon will determine which type of treatment is most effective for each patients individual condition. Nerve pain may be present in the foot as a result of damage or malfunction within the actual nerve or from pressure on the nerve as a result of another condition. Many different foot conditions, including hammertoes, bunions, corns, tumors and tarsal tunnel syndrome, may place pressure on nearby nerves and, as a result, lead to pain, numbness, tingling and weakness in the affected area. Patients may experience difficulty walking and often find their daily lives are significantly affected by this pain. In order to determine the cause of Continue reading >>

Diabetic Heel Ulcers: A Major Risk Factor For Lower Extremity Amputation

Diabetic Heel Ulcers: A Major Risk Factor For Lower Extremity Amputation

Diabetic Heel Ulcers: A Major Risk Factor for Lower Extremity Amputation Nidal A. Younes, MD, MSc; Abla M. Albsoul, PhD; and Hamzeh Awad The heel plays a vital role in weight transmission and in the dynamics of walking. When a person is standing, the weight of the body is transmitted from the femur and tibia through the heel bones (talus and calcaneus) to the ground and to the heads of the metatarsals. When a person is walking, the heel is the first part of the body to transmit the weight to the ground at the heel strike.1 The development of ulcers on this area is a serious problem, requiring lengthy hospital stays and periods of disability, and often leads to lower limb amputation. Heel ulceration, on average, costs 1.5 times more than metatarsal ulceration; limb salvage of the heel is two to three times less likely than metatarsal salvage.2 The exact incidence of diabetic heel ulcers is not known, but the incidence of pressure heel ulcers in patients with and without diabetes ranges from 19% to 32%.3,4 Heel ulcers develop from the pressure of the shoes or from shearing forces concentrated on a small area that directly overlies a bony prominence encountered during walking or standing that consequently progresses toward skin loss and ulceration (see Figure 1). The capacity of the heel pad for shock absorption declines with age, contributing to tissue breakdown and heel ulceration.5 Progression of infection to heel bones or long tissue planes around the ankle joint is a major concern that results from failure of conservative treatment and leads to lower limb amputation. The objectives of heel ulcer treatment should include early intervention to 1) control infection, 2) promote healing of the ulcer, and 3) prevent recurrence after healing. The pathogenesis of foot ulcers Continue reading >>

What Can I Do For Numb, Painful Feet And Legs?

What Can I Do For Numb, Painful Feet And Legs?

My husband was diagnosed with diabetes almost a year ago. At first he was experiencing numbness in his feet. Over the past few months, he began having pain as well, sometimes as far up his leg as his calf. What can we do to help these symptoms? I have read that vitamin E and even flaxseed oil are good for the circulation. Would those be helpful? Continue reading >>

Diabetic Neuropathy

Diabetic Neuropathy

Print Overview Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet. Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal. Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle. Symptoms There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred. The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected. Peripheral neuropathy Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include: Numbness or reduced ability to feel pain or temperature changes A tingling or burning sensation Sharp pains or cramps Increased sensitivity to touch — for some people, even the weight of a bed sheet can be agonizing Muscle weakness Loss of reflexes, especially in the ankle Loss of balance and coordination Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain Autonomic neuropathy The autonomic nervous system controls your hea Continue reading >>

Severe Chronic Heel Pain In A Diabetic Patient With Plantar Fasciitis Successfully Treated Through Transcranial Direct Current Stimulation.

Severe Chronic Heel Pain In A Diabetic Patient With Plantar Fasciitis Successfully Treated Through Transcranial Direct Current Stimulation.

Abstract BACKGROUND: Recently, transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique, was proposed as a suitable method for the treatment of several chronic pain syndromes. We describe a case of severe heel pain in a diabetic patient with plantar fasciitis successfully treated with tDCS. METHODS: The present study investigated whether tDCS treatment could reduce pain and pain-related anxiety in a 65-year-old diabetic man affected by treatment-resistant right heel pain due to plantar fasciitis. The patient underwent five tDCS treatment sessions on 5 consecutive days. Each session consisted of 20-min anodal tDCS over the left primary motor cortex leg area. RESULTS: The neurostimulation protocol induced a decrease in pain intensity and pain-related anxiety that outlasted the stimulation (1 week). Furthermore, the patient stopped the intake of opioid medication. CONCLUSIONS: Therapeutic neuromodulation with tDCS may represent an alternative option for treating severe lower-extremity pain. Continue reading >>

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