Diabetic foot ulcers

Jeffcoate, William; Harding, Keith

doi:10.1016/s0140-6736(03)13169-8

Cited by 854 publications

(651 citation statements)

References 108 publications

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“…Diabetes may influence foot wound healing in many ways, including an impairment of peripheral circulation, altered leucocyte function, disturbed balance of cytokines and proteases, and even chronic hyperglycaemia itself [78,79,80]. However, until recently, the role of offloading in impaired wound healing has not been considered [81].…”

Section: Wound Healing and The Importance Of Offloadingmentioning

confidence: 99%

“…Problems with the TCC include the level of skill required to apply the device, the expense of time and materials (the device should be removed and replaced weekly) and the potential of a rigid cast to injure the neuropathic foot [78,82,85]. Accordingly, an alternative to the TCC was proposed, by Armstrong et al, and named the "instant total-contact cast" [90].…”

Section: Wound Healing and The Importance Of Offloadingmentioning

confidence: 99%

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The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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Section: Wound Healing and The Importance Of Offloadingmentioning

confidence: 99%

Section: Wound Healing and The Importance Of Offloadingmentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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“…Given the high costs associated with these ulcers, this disease is not only a major burden to the patient but also to the healthcare system [3], and there is growing awareness that more attention should be given to this condition [4]. The development of a foot ulcer usually involves several mechanisms, such as neuropathy, increased biomechanical stress, external trauma and peripheral arterial disease (PAD) [5].…”

Section: Introductionmentioning

confidence: 99%

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

et al. 2006

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Aims/hypothesis Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries.Methods The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1

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“…D iabetes is commonly associated with skin ulcerations, with a lifetime risk of 15% for any diabetic patient to develop such a complication (1,2). Moreover, 15-27% of all diabetic ulcers result in surgical removal of bone (1,3).…”

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confidence: 99%

Wound Inflammation in Diabeticob/obMice

et al. 2005

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This study focused on the regulation of prostaglandin (PG) production in diabetes-impaired wound tissue. Cyclooxygenase (COX)-1 and -2 expression and activity were severely dysregulated in chronic wounds of diabetic ob/ob mice. Those wounds were characterized by a reduced expression of COX-1 and the presence of strongly elevated levels of COX-2 when compared with conditions observed in healthy animals. Resolution of the diabetic and impaired wound-healing phenotype by systemic administration of leptin into ob/ob mice increased COX-1 expression in wound margin keratinocytes and decreased COX-2 expression in inner wound areas to levels found in wild-type animals. Notably, improved wound healing was characterized by a marked increase in PGE 2 /PGD 2 biosynthesis that colocalized with induced COX-1 in new tissue at the margin of the wound. COX-2 expression did not significantly contribute to PGE 2 /PGD 2 production in impaired wound tissue. Accordingly, only late wound tissue from SC-560 -treated (selective COX-1 inhibitor) but not celecoxibtreated (selective COX-2 inhibitor) ob/ob mice exhibited a severe loss in PGE 2 , PGD 2 , and prostacyclin at the wound site, and this change was associated with reduced keratinocyte numbers in the neo-epithelia. These data constitute strong evidence that a dysregulation of COX-1-coupled prostaglandin contributes to diabetes-impaired wound healing. Diabetes 54: 1543-1551, 2005

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Diabetic foot ulcers

Cited by 854 publications

References 108 publications

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

Wound Inflammation in Diabeticob/obMice

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