Is the duration of diabetic foot ulcers an independent risk factor for developing diabetic foot osteomyelitis?

OBJECTIVE: This study aimed to determine whether the prolonged duration of diabetic foot ulcers was associated with an increased incidence of diabetic foot osteomyelitis. STUDY DESIGN: A retrospective cohort study METHODS: The medical records of all patients who participated in the diabetic foot clinic between January 2015 and December 2020 were reviewed. Patients with new diabetic foot ulcers were monitored for diabetic foot osteomyelitis. The collected data included the patient's profile, comorbidities and complications, the ulcer profile (area, depth, location, duration, number of ulcers, inflammation, and history of the previous ulcer), and outcome. Univariate and multivariate Poisson regression analyses were used to assess risk variables for diabetic foot osteomyelitis. RESULTS: Eight hundred and fifty-five patients were enrolled; 78 developed diabetic foot ulcers (cumulative incidence 9% over 6 years, average annual incidence 1.5%) and among these diabetic foot ulcers, 24 developed diabetic foot osteomyelitis (cumulative incidence 30% over 6 years, average annual incidence of 5%, incidence rate 0.1/person-year). Statistically significant risk factors for the development of diabetic foot osteomyelitis were ulcers that were deep to the bone (adjusted risk ratio 2.50, p = 0.04) and inflamed wounds (adjusted risk ratio 6.20, p = 0.02). The duration of diabetic foot ulcers was not associated with diabetic foot osteomyelitis (adjusted risk ratio 1.00, p = 0.98). CONCLUSION: The duration was not an associated risk factor for diabetic foot osteomyelitis, while bone-deep ulcers and inflamed ulcers were found to be significant risk factors for the development of diabetic foot osteomyelitis.

The effectiveness of Diabetic Foot Clinic in prevention and healing of diabetic foot ulcers.

OBJECTIVE: To assess the effects of the primary prevention and the healing of diabetic foot ulcers at Diabetic Foot Clinic at a university hospital in Thailand. STUDY DESIGN: Prospective descriptive study. METHODS: Diabetic patients with diabetic foot ulcers or pre-ulcerative lesions who regularly were followed at the outpatient Diabetic Foot Clinic, were recruited. The data were collected prospectively. Prevention and healing of diabetic foot ulcers were assessed and measured. RESULTS: Thirty-five diabetic patients with diabetic foot ulcers (n=21) and pre-ulcerative lesions (n=28) were recruited. Weekly wound radius reduction was 1.1±1.1 (mean±SD) mm/week. Fifty-seven percent of the ulcers achieved the surrogate 50% area reduction within 4 weeks. The percentage of healed ulcers at 12 and 16 weeks were 38.1%, and 47.6%, respectively. The percentage of improvement of the pre-ulcerative lesion was 78.6%. The most common complication was soft tissue infection (19%) which required surgical debridement (14.2%) and minor amputation (4.8%). CONCLUSION: The effectiveness of the Diabetic Foot Clinic was assessed by the reduction of the ulcer radius, ability to reach the surrogate 50% area reduction, and the improvement of the pre-ulcerative lesion. The weekly reduction of the ulcer radius was 1.1±1.1mm/week. The percentage of reaching the surrogate 50% area reduction within 4 weeks was 57%. The percentage of improvement of the pre-ulcerative lesion was 78.6%.

Preliminary study of suprascapular nerve block (SSNB) in hemiplegic shoulder pain.

OBJECTIVE: To study the effectiveness of suprascapular nerve block in hemiplegic shoulder pain for reducing pain and increasing range of motion, and compare them to treatments with therapeutic ultrasound. STUDY DESIGN: Randomized controlled trial study. SETTING: Thai Red Cross Rehabilitation Center. MATERIAL AND METHOD: Stroke patients with hemiplegic shoulder pain who met the inclusion criteria were included into the present study and allocated to the suprascapular nerve block (SSNB) and ultrasound groups by block of four-randomization technique. Patients of the SSNB group were done the nerve block twice, after pre-assessment on the first day and the next week of follow-up. For the ultrasound group, patients were treated 5 days a week. During four weeks of study, all of the patients were given the same standard program of range of motion exercise and were evaluated the VAS score of pain and range of motion every week until four weeks. RESULTS: Ten stroke patients were equally allocated to SSNB and US groups. There were significant improvements of VAS score at the 2nd and 4th week in the SSNB group with mean decreasing VAS scores of 40.6 +/- 25.4 and 51.0 +/- 20.7 respectively. For ROM outcome of the SSNB group, the increase offlexion at the 2nd and 4th week was 17.0 +/- 6.3 and 25.4 +/- 10.4 and abduction was 13.2 +/- 11.3 and 20.6 +/- 12.5, respectively. Statistically significant increase was detected at the 4th week inflexion motion (p = 0.026). SSNB produced a faster relief of pain than the ultrasound but there was no significant difference for restoration of ROM There was no complication observed during the present study. CONCLUSION: The present study suggests that suprascapular nerve block is a safe and effective treatment for hemiplegic shoulder pain. It was more rapid and effective than therapeutic ultrasound in reducing pain score but there is a similar result for improvement of ROM.