Foot biomechanics in patients with diabetes mellitus: doubts regarding the relationship between neuropathy, foot motion, and deformities.

BACKGROUND: We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities. METHODS: This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed. RESULTS: No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039). CONCLUSIONS: Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors.

[Reducing skin maceration in exudative diabetic foot ulcers]. / Reducir la maceración de úlceras exudativas del pie diabético.

INTRODUCTION: highly exudate and maceration is one of the causes of delay in diabetic foot ulcers healing. The purpose of our study was to demonstrate the effectiveness in the periwound skin maceration reduction with the use of no-sting barrier film (NSBF) (3M Cavilon). MATERIAL AND METHODS: observational study which includes 40 patients with diabetes (29, 72.5% males) who suffer diabetic foot ulcers with maceration and exudate. It was evaluated the application of NSBF during 30 days and its correlation with maceration control and clinical wounds progress. RESULTS: 70% of the ulcers were showed healthy edge or lower exudates after 30 days of treatment (Day 0 n=8 vs Day 30 n=28 p<0.05). Good evolutions of clinical variables were recorded through the study. Fibrin tissues upper 60% of the ulcer area were recorded in 17 cases at day 0 versus 2 cases in day 30 (p<0.001). Granulation tissue presence turned of 13 cases with upper 50% in wound bed at day 0 versus 25 cases at the end of the study (p<0.001). DISCUSSION: the use of NSBF for the maceration management of highly exudates diabetic foot ulcers was demonstrated effective.

Reducir la maceración de úlceras exudativas del pie diabético. Utilidad de una película barrera no irritante (Cavilon®) / Reducing skin maceration in exudative diabetic foot ulcers

Introducción: el exceso de exudado y su consecuente maceración constituye una de las causas de retraso en la cicatrización en las úlceras de pie diabético. El objetivo de nuestro estudio es demostrar la efectividad en la reducción de la maceración de la piel perilesional en úlceras exudativas de pie diabético aplicando una película barrera no irritante Cavilon® 3M® (PBNI). Material y métodos: estudio observacional que incluye 40 pacientes (29; 72,5% varones) diabéticos con úlceras exudativas de pie diabético y maceración perilesional, en los que se evalúa durante 30 días la efectividad de la aplicación de una PBNI para el control de la maceración y la evolución clínica de las lesiones. Resultados: a los 30 días de tratamiento el 70% de las lesiones presentó unos bordes sanos o con exudado bajo, con una mejoría significativa con respecto a las condiciones iniciales (día 0 n=8 vs día 30 n=28 p<0,05). La evolución de las variables clínicas relacionadas con la úlcera también fue favorable a lo largo del estudio. La presencia de tejido esfacelado mayor al 60% de la superficie de la úlcera en el día cero aparecía en 17 casos frente a dos en el día 30 (p<0,001). La aparición de tejido granulación pasó de 13 casos que presentaban más del 50% de fondo granulado de la úlcera el día de inclusión a 25 el día 30 (p<0,001). Discusión: la aplicación de un PBNI en el tratamiento de la maceración de úlceras exudativas de pie diabético demostró ser efectiva(AU)

Introduction: highly exudate and maceration is one of the causes of delay in diabetic foot ulcers healing. The purpose of our study was to demonstrate the effectiveness in the periwound skin maceration reduction with the use of no-sting barrier film (NSBF) (3M'99 Cavilon'99). Material and Methods: observational study, which includes 40 patients with diabetes (29, 72,5% males) who suffer diabetic foot ulcers with maceration and exudate. It was evaluated the application of NSBF during 30 days and its correlation with maceration control and clinical wounds progress. Results:70% of the ulcers were showed healthy edge or lower exudates after 30 days of treatment (Day 0 n=8 vs Day 30 n=28 p<0,05). Good evolutions of clinical variables were recorded through the study. Fibrin tissues upper 60% of the ulcer area were recorded in 17 cases at day 0 versus 2 cases in day 30 (p<0,001). Granulation tissue presence turned of 13 cases with upper 50% in wound bed at day 0 versus 25 cases at the end of the study (p<0,001). Discussion: the use of NSBF for the maceration management of highly exudates diabetic foot ulcers was demonstrated effective(AU)

Estudio aleatorizado y comparativo de un apósito de colágeno y celulosa oxidada regenerada en el tratamiento de úlceras neuropáticas de pie diabético / Randomized comparative trial of a collagen/oxidized regenerated cellulose dressing in the treatment of neuropathic diabetic foot ulcers

Introducción. El pie diabético es una complicación de la diabetes mellitus que se manifiesta con la presencia de úlceras que a menudo anteceden a la amputación. Diferentes estudios han comprobado que el entorno de la úlcera neuropática de pie diabético contiene una elevada tasa de metaloproteinasas. El objetivo de este trabajo es evaluar la eficacia de un apósito modulador de proteasas en el tratamiento de úlceras neuropáticas de pie diabético. Material y método. Estudio controlado, aleatorizado y comparativo que incluye a 40 pacientes con úlceras de pie diabético de origen neuropático, con lesiones de una antigüedad superior a 6 semanas. Los pacientes fueron aleatorizados en 2 grupos; el grupo 1 (n = 20) recibió tratamiento con apósito modulador de proteasas y el grupo 2 (n = 20), al que se consideró grupo control, recibió tratamiento de la lesión según protocolo estandarizado. El seguimiento de los pacientes se desarrolló durante 6 semanas. Resultados. Al finalizar las 6 semanas de seguimiento cicatrizaron un total de 12 (63%) de 19 pacientes del grupo 1, de tratamiento con la matriz moduladora, frente a 3 (15%) de 19 pacientes del grupo 2 de control (p < 0,03). La media de tiempo de cicatrización fue de 23,3 ± 9,9 días en el grupo 1 y de 40,6 ± 1,15 días en el grupo 2 (p < 0,01). Conclusiones. El análisis de los resultados obtenidos contrasta la hipótesis de que la utilización de apósitos moduladores de proteasas induce una mejor regeneración tisular que un buen tratamiento local (AU)

Introduction. Diabetic foot is a complication of diabetes mellitus that manifests with the development of ulcers that frequently precede amputation. Several studies have verified that the environment of the diabetic neuropathic foot ulcer contains a high concentration of metalloproteinases. The aim of the present study was to evaluate the efficacy of a protease-modulating dressing in the treatment of neuropathic diabetic foot ulcers. Material and method. A randomized controlled trial was conducted in 40 patients with a 6-week or longer history of neuropathic diabetic foot ulcer. The patients were randomized to two groups: group 1 (n = 20) received treatment with the protease-modulating dressing while the control group (group 2; n = 20) received the treatment specified in the standardized protocol for good wound care. The patients were then followed-up for 6 weeks. Results. After 6 weeks, healing was achieved in 12 patients (63% of n = 19) in group 1 under treatment with the protease-modulating dressing versus three patients (15% of n = 19) in the control group (p < 0.03). The mean time to healing was 23.3 ± 9.9 days in group 1 and 40.6 ± 1.15 days in group 2 (p < 0.01). Conclusions. The results confirm the hypothesis that the use of protease-modulating dressings in patients with neuropathic diabetic foot ulcers leads to better tissue regeneration than good wound care (AU)

[Randomized comparative trial of a collagen/oxidized regenerated cellulose dressing in the treatment of neuropathic diabetic foot ulcers]. / Estudio aleatorizado y comparativo de un apósito de colágeno y celulosa oxidada regenerada en el tratamiento de úlceras neuropáticas de pie diabético.

INTRODUCTION: Diabetic foot is a complication of diabetes mellitus that manifests with the development of ulcers that frequently precede amputation. Several studies have verified that the environment of the diabetic neuropathic foot ulcer contains a high concentration of metalloproteinases. The aim of the present study was to evaluate the efficacy of a protease-modulating dressing in the treatment of neuropathic diabetic foot ulcers. MATERIAL AND METHOD: A randomized controlled trial was conducted in 40 patients with a 6-week or longer history of neuropathic diabetic foot ulcer. The patients were randomized to two groups: group 1 (n = 20) received treatment with the protease-modulating dressing while the control group (group 2; n = 20) received the treatment specified in the standardized protocol for good wound care. The patients were then followed-up for 6 weeks. RESULTS: After 6 weeks, healing was achieved in 12 patients (63% of n = 19) in group 1 under treatment with the protease-modulating dressing versus three patients (15% of n = 19) in the control group (p < 0.03). The mean time to healing was 23.3 +/- 9.9 days in group 1 and 40.6 +/- 1.15 days in group 2 (p < 0.01). CONCLUSIONS: The results confirm the hypothesis that the use of protease-modulating dressings in patients with neuropathic diabetic foot ulcers leads to better tissue regeneration than good wound care.