The Diabetic Foot Syndrome Today: A Pandemic Uprise
The Diabetic Foot Syndrome Today: A Pandemic Uprise Department of Endocrinology, University Hospital of Skne, Malm, and Division for Clinical Sciences, University of Lund, Lund, Sweden Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp 1-18 I have read the Karger Terms and Conditions and agree. I have read the Karger Terms and Conditions and agree. Buy a Karger Article Bundle (KAB) and profit from a discount! If you would like to redeem your KAB credit, please log in . Save over 20% compared to the individual article price. Buy Cloud Access for unlimited viewing via different devices Immediate access to all parts of this book * The final prices may differ from the prices shown due to specifics of VAT rules. Diabetes mellitus is growing at epidemic proportions worldwide; currently 415 million adults are estimated to have diabetes and by 2040, this number is estimated to increase to 642 million. As a consequence, the prevalence of diabetes-related complications is bound to increase. Diabetic foot disorders are common throughout the world, resulting in major medical, social and economic consequences for the patients, and a public health problem. The risk for ulceration and amputation is much higher in individuals with diabetes compared to that of the non-diabetic population: it is estimated that every 20 s an amputation is performed on an individual with diabetes somewhere in the world. Foot ulceration is the commonest major end point among diabetic complications. More than 5% of diabetic patients have a history of foot ulceration and the cumulative lifetime incidence may be as high as 25%. Incidence and prevalence figures related to both foot ulcerations and lower extremity amputations have been reported worldwide. Continue reading >>
Neuropathy And Diabetic Foot Syndrome
Lu Cai, Academic Editor, Yuehui Wang, Academic Editor, and Zhiguo Zhang, Academic Editor Clinic for Endocrinology, Diabetology and Geriatric Medicine, Klinikum StuttgartKrankenhaus Bad Cannstatt, Prienitzweg 24, 70374 Stuttgart, Germany; [email protected] *Correspondence: [email protected] ; Tel.: +49-711-278-22601 Received 2016 Apr 27; Accepted 2016 Jun 2. Copyright 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( ). This article has been cited by other articles in PMC. Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature; in the pathophysiology of diabetic foot ulceration polyneuropathy is important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the still high rates of major amputations. Keywords: diabetic foot, neuropathy, wound healing, multidisciplinary team Diabetic foot syndrome (DFS) is a major complication of diabetes mellitus. Its occurrence is not uncommon at the stage of initial diagnosis of diabetes mellitus type 2. The management of diabetic foot ulcerations requires interdisciplinary cooperation of diverse medical fields and active exchange between medical and care/assistant professions. For patients with diabetic polyneuropathy and/or angiopathy the combination of increased plantar pressure and a systemic factor like impaired cellular wound healing leads to chronic foot lesions. For DFS prevalence rates between 4% and 15% have been recorded. Among all possibl Continue reading >>
Diabetic Foot Syndrome
A Diabetic foot is something that shows any pathology that directly results from diabetes mellitus or any chronic complication of diabetic mellitus. The presence of such characteristically diabetic pathology is known as diabetic foot syndrome. It is common mostly in people with type-1 and type-2 diabetes. The principal causes for this ailment are peripheral neuropathy, ulceration, infection and vascular compromise. These are usually associated with trauma or foot deformity that leads to the risk of lower limb amputation. It can also lead to loss of sensitivity in the foot, and so injuries go unnoticed. Most of these foot conditions happen because of nerve damage, also known as neuropathy. Diabetic patients run the risk of losing a leg, 25 times more than those without diabetes. Foot problems in diabetic patients take place by the interaction of multiple component causes.Peripheral neuropathy is one of the situations when the sensation in the feet is lost which result in injuries being unnoticed and leads to foot ulceration.Foot deformity is a condition which results in the formation of calluses on weight bearing areas.Arterial insufficiency is a condition in which blood flow to the feet become low and it slows down the process of wound healing. This increases the risk of infection. Impaired resistance to infection aggravates the risk of infection leading to amputation. Charcots joint is a rare and serious disease which is frequently related to underlying neuropathy. Diabetic foot problems are not usual in patients below 40 years of age. It increases after 40 years and is more in those aged 50 years are older. In addition, it is observed that men with diabetes have increased risk of foot amputation or ulcers than with women with diabetes. The early warning signs of diab Continue reading >>
Diabetic Foot Syndrome: Immune-inflammatory Features As Possible Cardiovascular Markers In Diabetes
Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes Antonino Tuttolomondo , Carlo Maida , and Antonio Pinto Antonino Tuttolomondo, Carlo Maida, Antonio Pinto, Dipartimento Biomedico di Medicina Interna e Specialistica, U.O.C di Medicina Interna e Cardioangiologia, Universit degli Studi di Palermo, 90127 Palermo, Italy Author contributions: Tuttolomondo A and Pinto A prepared the manuscript; Maida C contributed to the manuscript preparation and literature review. Correspondence to: Antonino Tuttolomondo, MD, PhD, Professor, Dipartimento Biomedico di Medicina Interna e Specialistica, U.O.C di Medicina Interna e Cardioangiologia, Universit degli Studi di Palermo, P.zza delle Cliniche n.2, 90127 Palermo, Italy. [email protected] Telephone: +39-091-6552128 Fax: +39-091-6552285 Received 2014 Mar 13; Revised 2014 Jun 6; Accepted 2014 Aug 27. Copyright The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. This article has been cited by other articles in PMC. Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality. Diabetic foot syndrome (DFS), as defined by the World Health Organization, is an ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection. Pathogenic events able to cause diabetic foot ulcers are multifactorial. Among the commonest causes of this pathogenic pathway its possible to consider peripheral neuropathy, foot deformity, abnormal foot pressures, abnormal joint mobility, trauma, peripheral artery disease. Several studies reported how diabetic patients show a higher mortality rate Continue reading >>
Diabetic Foot
A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long-term (or "chronic") complication of diabetes mellitus.[1] Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. Due to the peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients have a reduced ability to feel pain. This means that minor injuries may remain undiscovered for a long while. People with diabetes are also at risk of developing a diabetic foot ulcer. Research estimates that the lifetime incidence of foot ulcers within the diabetic community is around 15% and may become as high as 25%.[2] In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD) causing poor blood circulation to the extremities (diabetic angiopathy). Around half of patients with a diabetic foot ulcer have co-existing PAD.[3] Where wounds take a long time to heal, infection may set in and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.[4] Prevention[edit] Prevention of diabetic foot may include optimising metabolic control (regulating glucose levels); identification and screening of people at high risk for diabetic foot ulceration; and patient education in order to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities. Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor.[5] There is however only limited evidence that patient education has a long-term Continue reading >>
Diabetic Foot Ulcer
Sensory protection is lost ( Diabetic Neuropathy ) Charcot changes result in additional pressure points Complicating factors (related to poor healing) Acute Osteomyelitis (typically in children with hematogenous spread) with toxic or ill appearance Contrast with Chronic Osteomyelitis (typically in adults with local spread) which is slow, indolent IV. Evaluation: Inpatient Criteria for Foot Wound with Limb-Threatening Infection Ongoing Trauma persists until non-weight bearing Darko Shoe (half shoe not offloads distal foot) Other preparations with specific indications Silver products (e.g. Acticoat) may be considered for infected wounds Debridement salves (e.g. accuzyme) may be considered for Enzymatic Debridement Chronic Wound s without superinfection do not require culture Delaney and Khoury in Herbert (2017) EM:Rap 17(12): 2-3 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Diabetic Foot Ulcer." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window Mal perforant plantaire, Ulcre diabtique du pied, Ulcre du pied diabtique Ulcera di piede diabetico, Ulcera del piede diabetico lcera do p diabtica, lcera Diabtica do P lcera en pie diabtico, lcera de Pie Diabtico, lcera pdica diabtica (trastorno), lcera pdica diabtica Diabetick noha s vedem, diabetick ved Diabetic foot ulcer, diabetic foot ulcer, diabetes mellitus foot ulcer, diabetes mellitus foot ulcer (diagnosis), Diabetic foot ulcer(s), Diabetic foot ulcers, Diabetic foot ulcer (disorder), Foot Ulcer, Diabetic Derived from the NIH UMLS ( Unified Medical Language System ) FPnotebook.com is a rapid access, point-of-care medical Continue reading >>
Learning Pressure Patterns For Patients With Diabetic Foot Syndrome
Learning Pressure Patterns for Patients with Diabetic Foot Syndrome Abstract: The diabetic foot syndrome (DFS) is linked to loss of neuron functions, implying that the patients do not feel their feet and may unknowingly injure themselves or apply excessive plantar pressure. Such patients are at 17-40 times higher risk of foot amputation than non-diabetics. Sensor-equipped insoles are being developed to warn diabetics against inadverted excessive pressure. For the successful use of such technology, it is essential to understand how patients distribute plantar pressure load and to identify common pressure patterns, to be later used as basis for recognizing abnormalities. In this study, we propose a mining workflow for the discovery of pressure patterns among DFS patients. Our approach encompasses different ways of modeling pressure distribution among foot regions, and workpaths for the computation of similarity between patients and the construction of clusters of patients who apply pressure on their feet the same way. We report on our findings from a dataset of experiment participants who wore sensor-equipped insoles and were asked to apply and release pressure repeatedly over a time period of several minutes. We elaborate on the pressure patterns thus identified and juxtapose them to findings from the literature. Continue reading >>
Diabetic Ulcers: Practice Essentials, Pathophysiology, Etiology
Diabetic foot ulcers, as shown in the images below, occur as a result of various factors, such as mechanical changes in conformation of the bony architecture of the foot, peripheral neuropathy, and atherosclerotic peripheral arterial disease, all of which occur with higher frequency and intensity in the diabetic population. [ 1 , 2 ] Diabetic ulcer of the medial aspect of left first toe before and after appropriate wound care. Nonenzymatic glycation predisposes ligaments to stiffness. Neuropathy causes loss of protective sensation and loss of coordination of muscle groups in the foot and leg, both of which increase mechanical stresses during ambulation. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. [ 3 ] Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, with approximately 5% of diabetics developing foot ulcers each year and 1% requiring amputation. Physical examination of the extremity having a diabetic ulcer can be divided into examination of the ulcer and the general condition of the extremity, assessment of the possibility of vascular insufficiency, [ 4 ] and assessment for the possibility of peripheral neuropathy. The staging of diabetic foot wounds is based on the depth of soft tissue and osseous involvement. [ 5 , 6 , 7 ] A complete blood cell count should be done, along with assessment of serum glucose, glycohemoglobin, and creatinine levels. The management of diabetic foot ulcers requires offloading the wound by using appropriate therapeutic footwear, [ 8 , 9 ] daily saline or similar dressings to provide a moist wound environment, [ 10 ] debridement when necessary, antibiotic therapy if osteomyelitis or cellulitis is present, [ 11 , 12 ] optimal control of Continue reading >>
Frequently Asked Questions: Diabetic Foot Ulcers
Frequently Asked Questions: Diabetic Foot Ulcers Frequently Asked Questions: Diabetic Foot Ulcers A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication. Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable. Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, footdeformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack ofability to feel painin the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament. Vascular disease can complicate a foot ulcer, reducing the bodys ability to heal and increasing the risk for an infection. Elevations in bl Continue reading >>
Diabetic Foot Ulcers: Prevention, Diagnosis And Classification
Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. The most common risk factors for ulcer formation include diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease. A careful physical examination, buttressed by monofilament testing for neuropathy and noninvasive testing for arterial insufficiency, can identify patients at risk for foot ulcers and appropriately classify patients who already have ulcers or other diabetic foot complications. Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation. Adherence to a systematic regimen of diagnosis and classification can improve communication between family physicians and diabetes subspecialists and facilitate appropriate treatment of complications. This team approach may ultimately lead to a reduction in lower extremity amputations related to diabetes. Diabetic foot complications are the most common cause of nontraumatic lower extremity amputations in the industrialized world. The risk of lower extremity amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus.1,2 Furthermore, foot complications are the most frequent reason for hospitalization in patients with diabetes, accounting for up to 25 percent of all diabetic admissions in the United States and Great Britain.3–5 The vast majority of diabetic foot complications resulting in amputation begin w Continue reading >>
Terahertz Imaging For Early Screening Of Diabetic Foot Syndrome: A Proof Of Concept
Terahertz imaging for early screening of diabetic foot syndrome: A proof of concept Scientific Reports volume 7, Articlenumber:42124 (2017) | Download Citation Most people with diabetes suffer some deterioration of the feet. Diabetic foot syndrome causes ulceration in about 15% of cases and such deterioration leads to amputation in about 2.5% of diabetic patients, diminishing their quality of life and generating extraordinary costs for patients and public health systems. Currently, there is no objective method for the detection of diabetic foot syndrome in its early stages. We propose terahertz imaging as a method for the evaluation of such deterioration. This screening method could aid the prevention and medical treatment of this condition in the future. With a current world prevalence close to 8% and growing, one of the most important health conditions affecting people globally is Diabetes Mellitus (DM). DM is characterized by abnormal levels of blood glucose 1 , which in turn leads to long term deterioration of many organs and tissues in the body 2 . The prevalence of DM is rising alarmingly and figures in certain countries of the world have gone above 20% 3 . The so called diabetic foot, or diabetic foot syndrome, is a common consequence of DM. The feet of diabetic people present, in many cases, a combination of microvascular and neurological deterioration which results in poor irrigation and loss of sensitivity in their feet 4 . The combination of these two conditions causes dehydration of the skin, which in turn becomes more fragile, together with a compromised capacity to notice small lesions. This results in an increased risk of patients to develop severe ulcers, which in many cases require partial or total amputation of the limb; this is the most common cause Continue reading >>
Prevalence Of Diabetic Foot Syndrome Amongst Population With Type 2 Diabetes In Pakistan In Primary Care Settings
Prevalence of diabetic foot syndrome amongst population with type 2 diabetes in Pakistan in primary care settings Amanullah Khan, Nabeea Junaid ( Sanofi-Aventis Pakistan Limited. ) Objective: To determine the prevalence of diabetic foot syndrome in type 2 diabetes mellitus patients. Methods: This cross-sectional study was conducted at 25 centres across eight cities in Pakistan from August 2010 to March 2011, and comprised adult type 2 diabetics. The subjects underwent ankle brachial pressure index evaluation for diabetic foot, and neurological assessment using 10g monofilament for sensation and 128Hz tuning fork to elicit vibration. Results: Of the 230 subjects, 94(40.86%) were males and 136(59.13%) females. The overall mean age was 53.829.96 years and mean glycated haemoglobin was 8.812.04%. The prevalence of diabetic foot syndrome was 32(13.9%). Based on established diabetic foot risk classification, 37(16.08%) patients were in category-1, 6(2.60%) in category-2, 32(13.91%) in category-3 and 148(64.34%) in category-0. On ankle brachial pressure index assessment, 94(40.86%) patients had impaired values (p<0.9). Sensation was impaired in 50(21.73%) patients, vibrations could not be detected in 37(16.08%), ankle reflexes could not be elicited in 35(15.21%), and foot pulses could not palpated in 28(12.17%) patients. Conclusions: A high prevalence of diabetic foot syndrome was observed. Keywords: Diabetic foot/epidemiology, Foot ulcer, Diabetes mellitus Type 2, Amputation, Risk factors. (JPMA 67: 1818; 2017) The burden of diabetes and diabetes-related complications is increasing worldwide. Diabetic foot is a common complication of diabetes and refers to a wide spectrum of symptoms associated with a progressive loss of sensation in feet. The three main pathologies that are Continue reading >>
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Diabetic Foot Syndrome As A Possible Cardiovascular Marker In Diabetic Patients
Diabetic Foot Syndrome as a Possible Cardiovascular Marker in Diabetic Patients Dipartimento Biomedico di Medicina Interna e Specialistica, U.O.C di Medicina Interna e Cardioangiologia, Universit degli Studi di Palermo, Piazza delle Cliniche, No. 2, 90127 Palermo, Italy Received 10 December 2014; Accepted 18 March 2015 Copyright 2015 Antonino Tuttolomondo et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality; in fact, some authors showed a higher prevalence of major, previous and new-onset, cardiovascular, and cerebrovascular events in diabetic patients with foot ulcers than in those without these complications. This is consistent with the fact that in diabetes there is a complex interplay of several variables with inflammatory metabolic disorders and their effect on the cardiovascular system that could explain previous reports of high morbidity and mortality rates in diabetic patients with amputations. Involvement of inflammatory markers such as IL-6 plasma levels and resistin in diabetic subjects confirmed the pathogenetic issue of the adipovascular axis that may contribute to cardiovascular risk in patients with type 2 diabetes. In patients with diabetic foot, this adipovascular axis expression in lower plasma levels of adiponectin and higher plasma levels of IL-6 could be linked to foot ulcers pathogenesis by microvascular and inflammatory mechanisms. The purpose of this review is to focus on the immune inflammatory features of DFS and its p Continue reading >>
The Diabetic Foot Syndrome
The final prices may differ from the prices shown due to specifics of VAT rules, postage and handling. You already have online access to this title. If you would like to buy a personal digital or print copy, please click here . X + 224p.,36fig.,14in color,12tab.,hard cover,2018 Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp I-X (DOI:10.1159/000480111) Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp 1-18 (DOI:10.1159/000480040) A Complication of the Complications: The Complexity of Pathogenesis and the Role of Co-Morbidities in the Diabetic Foot Syndrome Abstract Meloni M. Izzo V. Giurato L. Uccioli L. Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp 19-32 (DOI:10.1159/000480041) Re-Evaluating the Outcomes in Diabetic Foot Management Abstract Clerici G. Iacopi E. Caminiti M.S. Casini A. Curci V. Faglia E. Piaggesi A. Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp 33-47 (DOI:10.1159/000480047) Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp 48-59 (DOI:10.1159/000480045) Diabetic Peripheral Arteriopathy: A Tale of Two Diseases Abstract Edmonds M.E. Shanahan C. Petrova N.L. Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp 60-69 (DOI:10.1159/000480046) Does Microangiopathy Contribute to the Pathogenesis of the Diabetic Foot Syndrome? Abstract Coppelli A. Abbruzzese L. Goretti C. Iacopi E. Riitano N. Piaggesi A. Piaggesi A, Apelqvist J (eds): The Diabetic Foot Syndrome. Front Diabetes. Basel, Karger, 2018, vol 26, pp 70-82 (DOI Continue reading >>
Diabetic Foot Pain And Ulcers: Causes And Treatment
Foot ulcers are a common complication of poorly controlled diabetes, forming as a result of skin tissue breaking down and exposing the layers underneath. They’re most common under your big toes and the balls of your feet, and they can affect your feet down to the bones. All people with diabetes can develop foot ulcers and foot pain, but good foot care can help prevent them. Treatment for diabetic foot ulcers and foot pain varies depending on their causes. Discuss any foot pain or discomfort with your doctor to ensure it’s not a serious problem, as infected ulcers can result in amputation if neglected. One of the first signs of a foot ulcer is drainage from your foot that might stain your socks or leak out in your shoe. Unusual swelling, irritation, redness, and odors from one or both feet are also common early symptoms of a foot ulcer. The most visible sign of a serious foot ulcer is black tissue (called eschar) surrounding the ulcer. This forms because of an absence of healthy blood flow to the area around the ulcer. Partial or complete gangrene, which refers to tissue death due to infections, can appear around the ulcer. In this case, odorous discharge, pain, and numbness can occur. Signs of foot ulcers are not always obvious. Sometimes, you won’t even show symptoms of ulcers until the ulcer has become infected. Talk to your doctor if you begin to see any skin discoloration, especially tissue that has turned black, or feel any pain around an area that appears callused or irritated. Your doctor will likely identify the seriousness of your ulcer on a scale of 0 to 3 using the following criteria: 0: no ulcer but foot at risk 1: ulcer present but no infection 2: ulcer deep, exposing joints and tendons 3: extensive ulcers or abscesses from infection Diabetic ulcers a Continue reading >>
