Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities

Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly.The development of foot ulcer in a diabetic patient has been estimated to be 19%-34%through their lifetime.The pathophysiology of diabetic foot ulcer consist of neuropathy,trauma and,in many patients,additional peripheral arterial disease.In particular,diabetic neuropathy leads to foot deformity,callus formation,and insensitivity to trauma or pressure.The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification,surgical debridement,dressing to facilitate wound healing,offloading,vascular assessment(status and presence of a chance for interventional vascular correction),and infection and glycemic control.Although especially surgical procedures are sometimes inevitable,they are poor predictive factors for the prognosis of diabetic foot ulcer.Different novel treatment modalities such as nonsurgical debridement agents,oxygen therapies,and negative pressure wound therapy,topical drugs,cellular bioproducts,human growth factors,energy-based therapies,and systematic therapies have been available for patients with diabetic foot ulcer.However,it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials.This review aims at evaluating diabetic foot ulcer with regard to all aspects.We will also focus on conventional and novel adjunctive therapy in diabetic foot management.

Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers?

One of the most common and serious complications of diabetes mellitus is ulceration of the foot. Among persons with diabetes, 12%-25% will present to a healthcare institution for a foot disorder during their lifespan. Despite currently available medical and surgical treatments, these are still the most common diabetes-related cause of hospitalization and of lower extremity amputations. Thus, many adjunctive and complementary treatments have been developed in an attempt to improve outcomes. We herein review the available literature on the effectiveness of several treatments, including superficial and deep heaters, electro-therapy procedures, prophylactic methods, exercise and shoe modifications, on diabetic foot wounds. Overall, although physical therapy modalities seem to be useful in the treatment of diabetic foot wounds, further randomized clinical studies are required.

Mesenchymal stem cells-based drug delivery systems for diabetic foot ulcer:A review

The complication of diabetes,which is known as diabetic foot ulcer(DFU),is a significant concern due to its association with high rates of disability and mortality.It not only severely affects patients’quality of life,but also imposes a substantial burden on the healthcare system.In spite of efforts made in clinical practice,treating DFU remains a challenging task.While mesenchymal stem cell(MSC)therapy has been extensively studied in treating DFU,the current efficacy of DFU healing using this method is still inadequate.However,in recent years,several MSCs-based drug delivery systems have emerged,which have shown to increase the efficacy of MSC therapy,especially in treating DFU.This review summarized the application of diverse MSCs-based drug delivery systems in treating DFU and suggested potential prospects for the future research.

Treatment of diabetic foot ulcer with medicinal leech therapy and honey curcumin dressing: a case report

Background:Diabetic foot ulcers(DFUs)are common in patients with diabetes.The mortality rate of DFUs is ranked the highest after cancer.With advancements in modern medicine,leech therapy,a traditional treatment method for chronic wounds in Iranian medicine,has proven effective in relieving venous congestion.Herein,we aimed to observe the curative effects of leech therapy in combination with honey and curcumin dressing in a 77-year-old patient with a diabetic foot ulcer(UFC).Methods:Two medium-sized medicinal leeches were placed surrounding a grade 2 wound,based on Wagner’s classification system,located on the right first toe.The patient reported a visual analogue scale(VAS)score of 8.After leech therapy,the wound was covered with honey and curcumin,followed by oral administration of ciprofloxacin for 10 days.Results:Pain increased immediately after leech therapy(VAS:9-10)but decreased significantly(VAS:6)2 days after the therapy.At the end of the 2nd day,pain completely disappeared.After 3 weeks,there was no wound on the toe.After 12 weeks,there were no traces of the wound.Conclusion:Leech therapy in combination with honey and curcumin dressing is effective against disease progression in patients with DFUs.

Effectiveness of topical oxygen therapy in wound healing for patients with diabetic foot ulcer

Objectives:Non-healing wounds have been one of the major challenges in health care because of increased morbidity,especially for those who have diabetes mellitus.Numerous regimens are being innovated to produce an evidence-based practice that would minimize complications and promote healing.Topical oxygen therapy is an innovation in wound care that has been considered influential in the wound healing process.This intervention aims to increase the oxygen concentration in the affected limb to promote wound healing.Methods:This research applied an experimental design that targeted a total of 60 adult patients aged 45–64 years with diabetic foot ulcers.A randomized systematic sampling technique was used to allow equal chances and prevent bias.In total,30 patients in the control group received usual care for diabetic foot ulcers,and the remaining 30 patients in the experimental group received topical oxygen therapy together with standard care for diabetic foot ulcers.Subjects were assessed using the Wagner-Meggitt Wound Classification System.Results:The result proved that there was a significant difference in the wound grade of patients in the experimental group after the application of the usual wound care plus the topical oxygen therapy using Friedman's test.The control and experimental groups were compared using Mann–Whitney statistical analyses,and the results showed that there was a significant difference between the control and experimental groups after the application of topical oxygen therapy.Conclusions:Topical oxygen therapy was demonstrated to be effective to aid in the wound healing process of patients with diabetic foot ulcers.Fur ther research was recommended to improve the application of topical oxygen therapy to patients with chronic wounds and promote the wound healing process.

Effect of Carbon Dioxide Therapy on Diabetic Foot Ulcer

Ulceration of diabetic foot represents one of the most concerning complications associated with uncontrolled blood sugar in diabetes mellitus. The aim of this study is to evaluate the condition of twenty-two diabetic patients with different degrees of ulceration in their feet after daily secessions of carbon dioxide therapy. Blood flow to the affected foot was measured by Doppler;also the size, color, degree of ulceration and sensation of the ulcerative area were all evaluated. Results showed improvement of blood flow to the affected foot as well as improvement in the sensation and color of the ulcerative area. It was concluded that carbon dioxide therapy of diabetic foot was promising and needed thorough investigation to be brought widely into application.

Diabetic foot disease:From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

The burden of diabetic foot disease(DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy(DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.

Diabetic foot ulcers:Classification,risk factors and management

Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection,amputation,and death,and is affecting increasing numbers of patients with diabetes mellitus.The pathogenesis of foot ulcers is complex,and different factors play major roles in different stages.The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate,which means that management and nursing plans need to be considered carefully.The importance of establishment of measures for prevention and management of DFU has been emphasized.Therefore,a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management.In the first part of this review,we list several commonly used classification systems and describe their application conditions,scope,strengths,and limitations;in the second part,we briefly introduce the common risk factors for DFU,such as neuropathy,peripheral artery disease,foot deformities,diabetes complications,and obesity.Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management;in the last part,we emphasize the importance of preventive education,characterize several of the most frequently used management approaches,including glycemic control,exercise,offloading,and infection control,and call for taking into account and weighing the quality of life during the formulation of treatment plans.Multidisciplinary intervention and management of diabetic foot ulcers(DFUs)based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs,and improve their prognosis.

Diabetic foot ulcer:A comprehensive review of pathophysiology and management modalities

Diabetic foot ulcer (DFU) is a debilitating and severe manifestation ofuncontrolled and prolonged diabetes that presents as ulceration, usually locatedon the plantar aspect of the foot. Approximately 15% of individuals with diabeteswill eventually develop DFU, and 14%-24% of them will require amputation ofthe ulcerated foot due to bone infection or other ulcer-related complications. Thepathologic mechanisms underlying DFU are comprise a triad: Neuropathy,vascular insufficiency, and secondary infection due to trauma of the foot.Standard local and invasive care along with novel approaches like stem celltherapy pave the way to reduce morbidity, decrease amputations, and preventmortality from DFU. In this manuscript, we review the current literature withfocus on the pathophysiology, preventive options, and definitive management ofDFU.

Prevalence and interrelationships of foot ulcer, risk-factors and antibiotic resistance in foot ulcers in diabetic populations: A systematic review and meta-analysis

BACKGROUND Diabetic foot ulceration(DFU)is the prime health concern globally.It accounts for the major burden related to disease mortality and morbidity and economic cost.The timely and early recognition of the DFU can help present its occurrence and improve clinical outcomes.AIM To evaluate interrelationships between foot ulcers,risk factors,and antibiotic resistance among diabetic patients having ulcers in their foot.METHODS The databases such as PubMed,ERIC,Medline,and Google Scholar were extensively used for the extraction of studies.The selected studies were published within the time-period of 2014-2018.Ten studies were selected,which were found to be completely relevant to the current study.RESULTS The prevalence of diabetic foot ulcers among the population was evaluated,and the associated risk factors with its prevalence.Moreover,few studies also reported on the bacteria that are found to be most prevailing among diabetic patients.A narrative discussion was drawn through this analysis,which was used to highlight the specific area of research through selected studies,extraction of the significant information that matched with the topic of research,and analysis of problem through the findings of the selected articles.The results helped in assessing significant knowledge regarding the risk factors of diabetic foot ulcers and the role of antimicrobial resistant in its treatment.CONCLUSION The gram-negative bacteria were found to be the most common reason for diabetic foot ulcers.The study only included 10 studies that are not sufficient to produce generalized results,and no information was reported on the tests required to analyze antimicrobial susceptibility that can guide clinicians to propose better and sound treatment plans.It is evident that most study results depicted that the most common risk factors were found to be hypertension and neuropathy.

Prevalence and Risk Factor of Diabetic Foot Ulcers in a Regional Hospital, Eastern Indonesia

Indonesia is one of the top ten diabetes mellittus (DM) countries. However as the main complication of DM, there was lack of studies related to diabetic foot ulcer (DFU). Thus, the aim of this study was to survey the prevalence of DFU risk factors and DFU among type 2 diabetes mellitus (T2DM) patients. An epidemiological study was conducted at an outpatient endocrine clinic in a regional hospital, eastern Indonesia. All T2DM participants attending research setting that were ≥ 18 years were included. Demographic and foot care behavior were assessed using minimum data sheet (MDS). Meanwhile, presence of risk factors was evaluated by using 5.07/10 g Semmes-Weinsten Monofilament (SWM) for neuropathy and presence of angiopathy was evaluated with Ankle Brachial Index (ABI) by using a hand held Doppler (Bidop ES-100V3, Hadeco-Kawasaki, Japan) both dorsal and posterior tibialis foot. At the end of study, 249 T2DM participants were enrolled. The prevalence of DFU risk factors was 55.4% (95% CI: 53.7% - 57.0%), and prevalence of DFU was 12% (95% CI: 10.3% - 13.6%). Based on a logistic regression, predictors for DFU risk factors included age (OR: 1.04;95% CI: 1.005 - 1.074) and daily foot inspection (OR: 0.36;95% CI: 0.186 - 0.703). Meanwhile, the predictors for presence of DFU were insulin (OR: 9.37;95% CI: 2.240 - 39.182), shoes (OR: 0.05;95% CI: 0.007 - 0.294), spiritual belief that DM was a disease (OR: 0.04;95% CI: 0.004 - 0.326) and belief that DM was a temptation from God (OR: 0.13;95% CI: 0.027 - 0.598). In conclusion, we recommend to educate high risk patients to understand positive foot care behavior as essentially preventive strategies to prevent presence risk and DFU.

Twenty-eight Cases of Diabetic Foot Ulcer and Gangrene Treated with the Chinese Herbal Medicine Combined with Injection of Ahylsantinfarctase

Since 1995, the Chinese herbal medicine for supplementing qi and activating blood circulation combined with injection of ahylsantinfarctase into the femoral artery has been used in 28 cases of diabetes complicated with gangrene and ulcer of the foot, with quite good therapeutic effects as reported in the following.……

Osteomyelitis in diabetic foot:A comprehensive overview

Foot infection is a well recognized risk factor for major amputation in diabetic patients. The osteomyelitis is one of the most common expression of diabetic foot infection, being present approximately in present in 10%-15% of moderate and in 50% of severe infectious process. An early and accurate diagnosis is required to ensure a targeted treatment and reduce the risk of major amputation. The aim of this review is to report a complete overview about the management of diabetic foot osteomyelitis. Epidemiology, clinical aspects, diagnosis and treatment are widely described according to scientific reccomendations and our experience.

Keeping an eye on the diabetic foot: The connection between diabetic eye disease and wound healing in the lower extremity

Diabetic eye disease is strongly associated with the development of diabetic foot ulcers(DFUs).DFUs are a common and significant complication of diabetes mellitus(DM)that arise from a combination of micro-and macrovascular compromise.Hyperglycemia and associated metabolic dysfunction in DM lead to impaired wound healing,immune dysregulation,peripheral vascular disease,and diabetic neuropathy that predisposes the lower extremities to repetitive injury and progressive tissue damage that may ultimately necessitate amputation.Diabetic retinopathy(DR)is caused by cumulative damage to the retinal microvasculature from hyperglycemia and other diabetes-associated factors.The severity of DR is closely associated with the development of DFUs and the need for lower extremity revascularization procedures and/or amputation.Like the lower extremity,the eye may also suffer end-organ damage from macrovascular compromise in the form of cranial neuropathies that impair its motility,cause optic neuropathy,or result in partial or complete blindness.Additionally,poor perfusion of the eye can cause ischemic retinopathy leading to the development of proliferative diabetic retinopathy or neovascular glaucoma,both serious,visionthreatening conditions.Finally,diabetic corneal ulcers and DFUs share many aspects of impaired wound healing resulting from neurovascular,sensory,and immunologic compromise.Notably,alterations in serum biomarkers,such as hemoglobin A1c,ceruloplasmin,creatinine,low-density lipoprotein,and highdensity lipoprotein,are associated with both DR and DFUs.Monitoring these parameters can aid in prognosticating long-term outcomes and shed light on shared pathogenic mechanisms that lead to end-organ damage.The frequent cooccurrence of diabetic eye and foot problems mandate that patients affected by either condition undergo reciprocal comprehensive eye and foot evaluations in addition to optimizing diabetes management.

Glucose intolerance and diabetes mellitus in ulcerative colitis: Pathogenetic and therapeutic implications

Diabetes mellitus is one of the most frequent co-morbidities of ulcerative colitis patients.The epidemiological association of these diseases suggested a genetic sharing and has challenged gene identification.Diabetes co-morbidity in ulcerative colitis has also relevant clinical and therapeutic implications,with potential clinical impact on the follow up and outcome of patients.These diseases share specific complications,such as neuropathy,hepatic steatosis,osteoporosis and venous thrombosis.It is still unknown whether the coexistence of these diseases may increase their occurrence.Diabetes and hyperglycaemia represent relevant risk factors for postoperative complications and pouch failure in ulcerative colitis.Medical treatment of ulcerative colitis in patients with diabetes mellitus may be particularly challenging.Corticosteroids are the treatment of choice of active ulcerative colitis.Their use may be associated with the onset of glucose intolerance and diabetes,with difficult control of glucose levels andwith complications in diabetic patients.Epidemiologic and genetic evidences about diabetes co-morbidity in ulcerative colitis patients and shared complications and treatment of patients with these diseases have been discussed in the present review.

Consensus on the application of negative pressure wound therapy of diabetic foot wounds

Because China is becoming an aging society,the incidence of diabetes and diabetic foot have been increasing.Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates.Negative pressure wound therapy(NPWT)is one of the most effective techniques for the treatment of diabetic foot wounds and great progress,both in terms of research and its clinical application,has been made in the last 20 years of its development.However,due to the complex pathogenesis and management of diabetic foot,irregular application of NPWT often leads to complications,such as infection,bleeding and necrosis,that seriously affect its treatment outcomes.In 2020,under the leadership of Burns,Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association,the writing group for‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’was established with the participation of scholars from the specialized areas of burns,endocrinology,vascular surgery,orthopedics and wound repair.Drawing on evidence-based practice suggested by the latest clinical research,this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot.The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.

Diabetes and peripheral artery disease:A review

Peripheral arterial disease(PAD)refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs.It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries.The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors.Nonhealing ulcers,limb amputation and physical disability are some of its major complications.Diabetes mellitus(DM)remains a major risk for PAD,with DM patients having more than two-fold increased prevalence of PAD compared with the general population.The clinical presentation in people with DM also differs slightly from that in the general population.In addition,PAD in DM may lead to diabetic foot ulcers(DFUs),which precipitate hyperglycaemic emergencies and result in increased hospital admissions,reduced quality of life,and mortality.Despite the epidemiological and clinical importance of PAD,it remains largely under diagnosed and hence undertreated,possibly because it is largely asymptomatic.Emphasis has been placed on neuropathy as a cause of DFUs,however PAD is equally important.This review examines the epidemiology,pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population.It also highlights recent innovations in the management of PAD.

Preliminary evidence using negative pressure wound therapy to achieve limb salvage for the ischemic diabetic foot

Aim:Negative pressure wound therapy(NPWT)in diabetic foot ulcers(DFU)has been discussed in several studies,but without a focus on peripheral arterial disease(PAD),which is a common comorbidity.This study aims to investigate the feasibility of NPWT in the treatment of DFU with PAD in regards to limb salvage and the clinical course.Methods:The authors retrospectively collected patients with DFU and PAD diagnosed with either Doppler ultrasound or angiography as the PAD study group.Patients with DFU but no PAD were enrolled as the non-PAD comparison group.NPWT was applied to both PAD and non-PAD subjects.Results:There were 10 patients in the PAD group and 3 patients in the non-PAD group.In the PAD group,there was a 70%limb salvage rate with 14.70(±10.33)treatment days.The non-PAD comparison group had a higher limb salvage rate(100%vs.70%,respectively),but a longer treatment time(30.00 vs.14.70 days,P<0.05,respectively)when compared to the PAD group.The 3 patients in the PAD group who failed limb salvage all had issues related to uncontrolled infection.Conclusion:NPWT is a feasible adjuvant therapy for DFU in patients with PAD,with a 70%limb salvage rate.Prolonged treatment time was due to the initial severity of the subjects with multiple comorbidities.The main reason for limb loss was intractable infection.

中药足浴联合西药降糖治疗糖尿病周围神经病变临床观察

目的观察中药足浴联合西药降糖治疗糖尿病周围神经病变的临床效果。方法回顾性选取2021年9月—2023年5月江西省宜丰县人民医院收治的糖尿病周围神经病变患者62例,分为西医降糖药常规治疗联合中药足浴治疗组(联合治疗组)、西医降糖药常规治疗组(常规治疗组)两组,各31例。比较两组中医证候积分,凉温感觉阈值,血糖、血脂水平,震动感觉阈值(VPT),疼痛觉阈值,间歇性跛行距离分级。结果联合治疗组患者的疼痛感、麻木感、烧灼感、异样感积分及中医证候总积分,凉感觉阈值、温感觉阈值,空腹血糖、餐后2 h血糖、胆固醇、三酰甘油水平,足背VPT、第一足趾VPT、疼痛觉阈值均低于常规治疗组(P<0.05)。联合治疗组患者的间歇性跛行距离分级1级比率高于常规治疗组,2级、3级、4级比率均低于常规治疗组(P<0.05)。联合治疗组患者的总缓解率96.77%(30/31)高于常规治疗组的70.97%(22/31)(P<0.05)。结论糖尿病周围神经病变应用西医降糖药常规治疗联合中药足浴治疗的临床效果较西医降糖药常规治疗好。

抗生素骨水泥增强胫骨横向骨搬运治疗感染创面的能力

背景:糖尿病足伴创面感染的患者群体庞大,目前尚无满意的治疗方案。目的:探讨改良胫骨横向骨搬运技术联合抗生素骨水泥治疗顽固性糖尿病足溃疡的临床疗效。方法:选择2020年1月至2023年1月首都医科大学附属北京朝阳医院和北京朝阳中西医结合急诊抢救医院收治的46例糖尿病足溃疡患者,男27例,女19例,平均年龄64.37岁,均接受改良胫骨横向骨搬运手术联合抗生素骨水泥治疗。记录胫骨横向骨搬运术前及术后3个月患者的踝肱指数、伤口/缺血/足部感染分级(WIFi分级)、目测类比评分与溃疡面积。结果与结论:①46例患者溃疡平均愈合时间为(58.07±24.82)d,46例患者胫骨横向骨搬运术后3个月的踝肱指数、目测类比评分、溃疡面积、WIFi分级均较术前明显改善(P<0.05)。随访期间,2例患者出现钉道感染,未出现溃疡或感染复发。②结果显示,改良胫骨横向骨搬运术联合抗生素骨水泥可有效缓解糖尿病足溃疡患者的疼痛、改善下肢血运、控制感染并促进溃疡的愈合。