ABSTRACT
Charcot’ osteoarthropathy (COA) is a rare, often misdiagnosed inflammatory debilitating complication of conditions most common being diabetes that needs to be discussed further to prevent associated morbidity. The natural history of the disease sees four stages and requires prompt diagnosis and treatment to ensure the desired outcome. We describe a case series of two cases of diabetes-associated osteoarthropathy and their management. A 72-year-old male with the early COA was managed with a total contact cast for both lower limbs and an 80-year-old male with the early COA with bone marrow edema in the tibia and talus, as well as, subtalar effusion, managed conservatively. The follow-up review documented clinical recovery in the form of a marked reduction in swelling of the lower limbs with the resolution of the functional status of lower limbs. It is the responsibility of every physician to ensure the goals of management which includes immediate offloading and good glycemic control.
ABSTRACT
Objective:To investigate the plantar pressure features of diabetic patients, and design the offloading structure of insole to reduce the plantar pressure and internal stress of the soft tissue. Methods:A three-dimensional finite element model of foot was established based on CT images. Hole structure was designed in the high plantar pressure area of diabetic patients. The effects of diameter, depth and interval of holes on plantar pressure was analyzed through orthogonal test and finite element analysis, to obtain the optimal scheme; and the offloading effect was analyzed with finite element analysis and experiment. Results:The peak plantar pressure was higher in diabetic patients than in healthy individuals. The holes with 5 mm diameter, 6 mm depth and 2 mm interval in metatarsal and calcaneus regions might effectively reduce the plantar pressure and internal stress of soft tissue, which was 15.6%, 45.6%, 53.5% and 10.1% less of the peak plantar pressure on toes, metatarsal, midfoot and calcaneus area, respectively, compared to walking without insoles. Conclusion:Finite element analysis is helpful to explore the internal stress of soft tissue in diabetic patients, and insole with hole structure can reduce the plantar pressure and internal stress of soft tissue.
ABSTRACT
Neuropathic ulcers pose a global burden carrying a risk of amputation of 15-46 times especially in developing countries. These ulcers are mainly managed with offloading techniques. In this study we share our experience of using an easy to use, cost effective method the Suvidha offloading dressings in terms of its acceptability and effectiveness in managing these cases. A prospective case series of 83 patients with mean age 58 years, managed with Suvidha offloading dressing in our institution from 2016 till 2019, excluding patients with ABI less than 0.4 and Wagner 4 and 5. They were reviewed after 6 months/SOS. Ulcer measured 1×1 to 4×4 cm, was present most commonly in the mid foot and least commonly in the lateral aspect of the foot. 53 cases were Wagner grade 2 and 9 cases Wagner grade 3. Forty cases were initially infected, 29 cases had a deformed foot, 5 cases needed interval wound debridement. The duration of ulcer healing was 2 weeks for 1×1 cm great toe ulcer, to 12 weeks for the 4×4 cm mid foot ulcer. All 83 patients were followed up for 6 months. 5 ulcers recurred. The patient satisfaction was measured by a 5-points Likert scale with a mean value of 17.4 out of 20. The Suvidha offloading footwear is a cost effective, easily replicable and efficient dressing requiring only the readily available dressing materials, with good healing rates, good patient satisfaction and adapted for developing countries. The results are comparable with other methods of offloading practiced worldwide.
ABSTRACT
Objective The incidence rate of pressure ulcer is high in critical patients and off-loading mattresses and reposi-tioning are known as effective interventions for the prevention of pressure ulcers .However, evidence is lacking for selection of the right type of mattresses and suitable interval of repositioning .This study was to compare the effects of two types of off-loading mattresses with two different repositioning intervals in preventing pressure ulcers in critical patients . Methods According to the design of this ran-domized controlled trial , we made a training plan concerning the participants , methods of intervention and comparison , criteria and methods of observation , and methods of recording , and trained 26 nurses from 7 hospitals .Using non-inferiority design and the method of stratified blocked randomization , we divided 1194 patients with the risk of pressure ulcer into a trial group ( n=596) and a control group ( n=598) , a viscoelastic sponge mattress with every-four-hours repositioning used for the former and an automatic aeration mat-tress with every-two-hours repositioning for the latter , both for 7 successive days .We examined the patients every day , recorded the in-cidence and stages of pressure ulcer , and compared the data obtained between the two groups of patients . Results The total inci-dence rate of pressure ulcer was 1.09%(13/1194), significantly lower in the trial than in the control group (0.34%[2/596] vs 1.84%[11/598], P=0.012). Conclusion A viscoelastic sponge mattress with every-four-hours repositioning is superior to an automatic aeration mattress with every-two-hours repositioning and therefore is preferred to the latter in preventing the incidence of pressure ulcer in critical patients in the ICU .
ABSTRACT
Background: To compare the effectiveness of Total contact casts (TCCs), Removable cast walkers (RCWs) and half-shoes to heal diabetic foot lesions. Methods: This proposed study was carried out as a prospective, randomized clinical trial in 100 patients diagnosed diabetic foot with superficial non-infected, non-ischemic diabetic plantar foot ulcers. Out of 100 pts, 10 pts did not use any prosthesis and in 90 pts, one of the three offloading modalities was used: Total contact cast (TCC), Removable cast walker (RCW) and half shoes (HS). Outcomes were assessed at wound healing or at 12 weeks, whichever came first. Primary outcome measures included duration of healing of diabetic wounds and also regarding the percent of wounds healed completely after 12 weeks. Results: The proportions of healing for patients treated with TCC, RCW, and HS were 85.7, 68.7, and 56.2%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities. There was also a significant difference in survival distribution (time to healing) between patients treated with a TCC and both an RCW and half-shoe. The mean number of days to complete wound healing is 30 days for TCC, 52 days for RCW and 60 days for HS. Conclusion: The TCC seems to heal a higher proportion of wounds in a shorter amount of time than two other widely used off-loading modalities, the RCW and the half-shoe.
ABSTRACT
In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.