Clinics in podiatric medicine and surgery最新文献

Diabetes mellitus is a global health concern, with complications such as peripheral neuropathy and peripheral arterial disease (PAD) leading to diabetic foot ulcers, infections, and amputations. Chronic limb-threatening ischemia, a severe form of PAD, further impairs healing and increases amputation risk. Limb-sparing procedures like partial foot amputations aim to preserve mobility and improve outcomes. Neuropathy contributes to unnoticed injuries and poor skin integrity, while abnormal foot biomechanics from deformities increase pressure points, promoting ulcer formation. Early diagnosis, proper wound care, and revascularization are crucial in preventing complications and improving quality of life for diabetic patients.

Diabetic foot ulcers are severe complications of diabetes resulting in high health care costs and reduced quality of life. Persistent mechanical pressure, neuropathy, foot deformity, and patient comorbidities contribute to the ulcer formation and poor healing. While nonsurgical offloading techniques are common, they are associated with noncompliance, skin irritation, and limited wound assessment capability. Surgical offloading offers a direct approach in reducing and redistributing pressures to promote ulcer healing. Its success depends on proper patient selection, glycemic control, and postoperative care. When combined with multidisciplinary management, surgical offloading plays a pivotal role in promoting healing, reducing infection, and preventing infections.

This article details an evidence-based framework for decision-making and management of patients with chronic limb threatening ischemia (CLTI) and diabetes mellitus requiring vascular intervention in the context of a multidisciplinary limb salvage team. Emphasis is placed on utilization of modern clinical limb staging systems such as the Wound, Ischemia, and Foot Infection classification to stratify limb risk and follow evidence-based management strategies. For patients presenting with a first-time manifestation of CLTI who have suitable single segment great saphenous vein and are of acceptable surgical risk, strong consideration should be given to a bypass-first approach to vascular intervention.

Charcot neuroarthropathy is a condition characterized by progressive joint dislocation and bone fragmentation, which if not managed early with off-loading, often results in the destruction of the normal foot architecture, an unstable foot deformity and development of neuropathic ulceration. It is most frequently seen in patients with diabetes mellitus; however the clinician should also consider this diagnosis in patients who develop peripheral neuropathy due to chemotherapy, alcoholism, and infectious diseases such as syphilis, leprosy, and human immunodeficiency virus. This article aims to demonstrate the core principles of Charcot reconstruction using internal fixation and super construct techniques.

The National Diabetes Statistics in 2021 estimated that 38.4 million people have diabetes. The lifetime risk of developing a foot ulcer in patients with diabetes is more than 33%. About two-thirds of diabetic foot ulcers will eventually heal, but approximately 28% may result in some form of lower extremity amputation. Advanced wound care products, offloading techniques, minor surgeries, and revascularizations still leave wounds unhealed and require amputation. Research has pointed out that the dysfunction in the microcirculation may contribute to these failures. This article discusses techniques to evaluate and manage these microcirculation dysfunctions.

Charcot arthropathy is a progressive and destructive condition most commonly affecting the foot and ankle in patients with neuroarthropathy. This article provides a comprehensive overview of external fixation as a surgical modality in the treatment of Charcot deformity and explores different external fixation constructs including static circular frames, hexapod systems, and hybrid configurations. The article also outlines perioperative planning, postoperative protocols, and complication management while emphasizing the importance of patient education, glycemic control and interdisciplinary care to achieve limb salvage and functional restoration.

This article aims to guide practitioners through the evolving field of wound therapies, highlighting recent innovations with positive outcomes and potential. Therapies surveyed include silver products, negative pressure wound therapy, oxygen therapies (including hyperbaric oxygen and topical oxygen therapy), and skin substitutes. The article summarizes the benefits and risks associated with each and provides practical advice on their use for practitioners.

The prevention of diabetic foot complications requires a comprehensive approach that includes the use of appropriate footwear, custom orthotics, insoles, hosiery, and braces. Clinical evidence supports the efficacy of these interventions in reducing the risk of foot ulcers and amputations as well as providing the diabetic patient the ability to maintain mobility safely. As the global burden of diabetes continues to rise, health care providers must prioritize foot care and recommend appropriate devices as part of routine diabetic management.

Diabetic limb salvage and amputation are essential components in the management of diabetes-related pedal complications. The primary goal of limb salvage is to preserve mobility and function through techniques like revascularization, reconstruction, and debridement. However, in cases where salvage attempts repeatedly fail or pose significant health risks, amputation emerges as a viable alternative. Contrary to the perception of amputation as a failure, strategic amputations can offer faster recovery, improved functionality, and better quality of life outcomes than prolonged, unsuccessful salvage efforts. This article explores the clinical, psychological, and socioeconomic factors involved in decision-making between limb salvage and amputation.