Diabetic foot disorders. A clinical practice guideline. For the American College of Foot and Ankle Surgeons and the American College of Foot and Ankle Orthopedics and Medicine.

Foot ulcerations, infections, and Charcot neuropathic osteoarthropathy are three serious foot complications of diabetes mellitus that can too frequently lead to gangrene and lower limb amputation. Consequently, foot disorders are one of the leading causes of hospitalization for persons with diabetes and can account for expenditures in the billions of dollars annually in the U.S. alone. Although not all foot complications can be prevented, dramatic reductions in their frequency have been obtained through the implementation of a multidisciplinary team approach to patient management. Using this concept, the authors present a Clinical Practice Guideline for diabetic foot disorders based on currently available evidence. The underlying pathophysiology and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are thoroughly reviewed. Although these guidelines cannot and should not dictate the standard of care for all affected patients, they are intended to provide evidence-based guidance for general patterns of practice. The goal of a major reduction in diabetic limb amputations is certainly possible if these concepts are embraced and incorporated into patient management protocols.

Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons.

Foot ulcerations, infections, and Charcot neuropathic osteoarthropathy are three serious foot complications of diabetes mellitus that can too frequently lead to gangrene and lower limb amputation. Consequently, foot disorders are one of the leading causes of hospitalization for persons with diabetes and can account for expenditures in the billions of dollars annually in the U.S. alone. Although not all foot complications can be prevented, dramatic reductions in their frequency have been obtained through the implementation of a multidisciplinary team approach to patient management. Using this concept, the authors present a Clinical Practice Guideline for diabetic foot disorders based on currently available evidence. The underlying pathophysiology and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are thoroughly reviewed. Although these guidelines cannot and should not dictate the standard of care for all affected patients, they are intended to provide evidence-based guidance for general patterns of practice. The goal of a major reduction in diabetic limb amputations is certainly possible if these concepts are embraced and incorporated into patient management protocols.

Grand rounds: first metatarsophalangeal joint replacement.

For approximately 30 years foot and ankle surgeons have been using a variety of techniques and devices to replace the first metatarsophalangeal joint. During this time there have been a multitude of implant designs and modifications, most attempting to anatomically and functionally replace the natural joint surfaces. The advantages and disadvantages of these many designs and various biomaterials has long been debated in scientific meetings and publications. Surgical technique, implant design, materials, and patient selection remain areas of heated debate and ongoing research. With this in mind, we asked leading foot and ankle surgeons to give their opinions on indications and utilization for joint replacement of the first metatarsophalangeal joint.

Audiometric configuration as a reflection of diabetes.

The purpose of this study was to investigate whether or not a rising, progressively improving (RPI) sensorineural hearing loss from lower toward higher frequencies might be related to or serve as an indicator or predictor of diabetes. Forty-five subjects between the ages of 21 and 79, demonstrating a RPI audiometric pattern, were considered for a 5-hour oral glucose tolerance test. Based on the National Diabetes Data Group standard, results showed that diabetes mellitus appeared in seven subjects; five subjects had impaired glucose tolerance; and nine subjects had mild but nondiagnostic glucose intolerance. Relatively normal glucose values were demonstrated by 53% of subjects. There may be some value in an RPI audiometric pattern as an indicator or early detection sign for diabetes, but further research is necessary before such conclusions can be drawn.

Complications of silicone implants in foot surgery.

Silicone rubber arthroplasty has been used in the foot with great success and with devastating failure. In an effort to understand why certain cases are successes and why certain cases are failures, a systematic investigation of several factors is necessary. A certain relationship exists among the material of which the implant is made, the design of the implant and the function it is asked to perform, and the host response to the material or implant. Simply because a material has been shown inert when placed in relatively large pieces in the body is not reason enough to support its use. The design of the implant must be such that it re-establishes function parallel to an anatomic manner. Host response to a prosthesis may be viewed in light of the tissue response to the foreign body and also with regard to its effect on bone, synovium, and articular cartilage as an organ. One must consider not only biologic compatibility but also compatibility of physical properties and physiologic function. This article has attempted to address and organize implant surgery in just this manner described. Silicone rubber arthroplasty has been a very satisfying procedure for both patient and surgeon. Complications do occur, and it is up to the surgeon to provide the analysis. The manufacturer may provide the prosthesis but the responsibility lies with the surgical community to use implantation in a proper and appropriate manner.