Psychosocial research in the diabetic foot: Are we making progress?

Abstract

Background/Methods This review summarizes recent advances regarding the role of psychological factors in people with a diabetic foot ulcer (DFU). It describes the detrimental effects of diabeticfoot complications and in particular, Charcot Neuroarthropathy (CN), on health status and quality of life (QoL) and emphasizes the importance of utilizing DFU‐specific assessment tools. Results Diabetic neuropathy (DN)‐related postural instability is key in generating depression in high DFU risk patients and in predicting offloading non‐adherence those with active DFUs. Patients' views of their own DFU risk are largely inconsistent with biomedical models, resulting in a lack of preventive foot self‐care. Furthermore, DFUs are a source of specific emotional responses, with fear of amputation predominant. While fear of amputation is associated with better preventive foot self‐care, it appears to be linked to DFU non‐healing, though mechanisms are yet to be elucidated. Until now, systemically released stress hormones were recognized as the only biological mechanism through which psychological stress influences healing. Recently, the skin has been found to be an extra‐adrenal site for glucocorticoid synthesis with local, tissue‐specific cortisol implicated in DFU non‐healing. Conclusions These observations could potentially lead to future targets for therapeutic and psychological interventions.

Changing the patterns of hospitalized diabetic foot ulcer (DFU) over a 5-year period in a multi-disciplinary setting in Thailand

“…Even though the prevention of lower limb amputation was regarded as the successful parameter in DFU patients [37], it should be emphasized that one of the goals for DFU treatment is to maintain a functional foot and quality of life [38]. The rate of amputation is also influenced by ethnicity from some beliefs and cultures especially in the Asian countries [39]. Many patients desired to have their feet intact via a choice of conservative surgery, an option to remove some parts of infected bone and non-viable soft tissue while maintaining the external appearance of the foot even though the function of foot would be better if an amputation was done.…”

Should weight-bearing activity be reduced during healing of plantar diabetic foot ulcers, even when using appropriate offloading devices?

“…1). Also, it is worth noting that many of the negative side-effects of nonremovable knee-high devices, such as gait and balance impairments [42][43][44][45], low weight-bearing activity level [42], restrictions of daily activities, and low quality of life [46], are already common in this patient group [47][48][49][50][51][52]. Thus, the knee-high devices seem to increase pre-existing gait challenges and their consequences in a patient group that is already burdened.…”

A Severe Diabetic Foot Ulcer With Intermediate Cuneiform Displacement and Multidrug-Resistant Pseudomonas aeruginosa Infection: A Rare Case Report

“…Therefore, infection is a consequence rather than a cause of DFU. All infections initiated as a slight problem may progress into deep tissues, joints, or bones especially if not managed, leading to amputation in some extreme cases (9). In this case, the fracture and displacement of intermediate cuneiform caused by accidental fall damaged deep tissues of left foot but was ignored due to impaired sensibility resulted from DM-associated neuropathy until ulceration and infection occurred.…”