The diabetic foot: Pathophysiology and treatment

Edmonds, M E

doi:10.1016/s0300-595x(86)80079-2

Cited by 119 publications

(60 citation statements)

References 74 publications

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“…In the present study oedema was related to outcome both in neuropathic and neuroischaemic ulcers. Oedema is usually of multi-factorial origin and should be treated accordingly [2,30].…”

Section: Local Factorsmentioning

confidence: 99%

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

et al. 2008

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Aims/hypothesis We sought to identify factors related to shortterm outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. Methods Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n=2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31.The characteristics of the remaining 2,480 patients were: 1,465 men, age 68±15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%. Results The healing rate without major amputation in surviving patients was 90.6% (n=1,867). Sixty-five per cent (n=1,617) were healed primarily, 9% (n=250) after minor amputation and 8% after major amputation; 17% (n=420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to comorbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation. Conclusions/interpretation Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.

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“…In the present study oedema was related to outcome both in neuropathic and neuroischaemic ulcers. Oedema is usually of multi-factorial origin and should be treated accordingly [2,30].…”

Section: Local Factorsmentioning

confidence: 99%

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

et al. 2008

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“…In short, a low ABI may reflect systemic atherosclerosis. However, because 5-10% of diabetic patients have medial arterial calcification, these patients have stiffened, noncompressible peripheral vessels (21). This yields a falsely high ABI value.…”

Section: Aso and Associatesmentioning

confidence: 99%

Results of Blood Inflammatory Markers Are Associated More Strongly With Toe-Brachial Index Than With Ankle-Brachial Index in Patients With Type 2 Diabetes

et al. 2004

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TOSHIHIKO INUKAI, MD 1OBJECTIVE -Three blood markers of inflammation (high-sensitivity C-reactive protein [hsCRP], interleukin [IL]-6, and fibrinogen) were compared with markers of atherosclerotic cardiovascular disease (CVD) (history of stroke or cardiac ischemia and measured toe-brachial index [TBI]) to determine whether inflammatory markers are associated with atherosclerosis in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -Of 103 patients with type 2 diabetes, 26 had CVD. TBI was plethysmographically determined in both great toes. Serum hsCRP was immunonephelometrically determined. Plasma IL-6 was measured by an enzyme immunoassay.RESULTS -Both ABI and TBI were lower in diabetic patients with CVD than in those without CVD (1.05 Ϯ 0.19 vs. 1.14 Ϯ 0.09, P Ͻ 0.05, and 0.75 Ϯ 0.20 vs. 0.95 Ϯ 0.21, P Ͻ 0.001, respectively). By linear regression, right TBI but not right ABI showed a significant negative correlation with serum hsCRP (r ϭ Ϫ0.372, P Ͻ 0.01) and plasma fibrinogen (r ϭ Ϫ0.224, P Ͻ 0.05). Serum hsCRP was also negatively correlated with lower TBI, but not lower ABI. We found no significant correlation between plasma IL-6 and ABI or TBI.CONCLUSIONS -TBI was strongly associated with CVD, serum hsCRP, and plasma fibrinogen. Of these inflammatory markers, serum hsCRP may be the most promising marker for vascular inflammation.

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“…The tarsal-metatarsal joint is most frequently involved, followed by the metatarsophalangeal, ankle, and subtalar joints [7]. Differentiation between neuropathic joint and infection can be difficult in these patients, both from a clinical and an imaging standpoint.…”

mentioning

confidence: 99%

The diabetic foot: magnetic resonance imaging evaluation

et al. 1990

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Fourteen diabetic patients with suspected foot infection and/or neuropathic joint (Charcot Joint) were evaluated with magnetic resonance imaging (MRI) in an attempt to assess the extent of the infection and also to distinguish infection from the changes seen with neuroarthropathy. The majority of patients with infection had more than one site of involvement and the following diagnoses were made by MRI evaluation: osteomyelitis (n = 8), abscess (n = 7), neuropathic joint (n = 5), septic arthritis (n = 4), and tenosynovitis (n = 4). Clinical or surgical/pathological confirmation of the MRI diagnoses was obtained in all but nine sites of infection or cases of neuropathic joint. If the two diagnostic categories of septic arthritis and tenosynovitis are excluded, all but four of the MRI diagnoses were confirmed. A distinctive pattern for neuroarthropathy was identified in five cases, consisting of low signal intensity on T1- and T2-weighted images within the bone marrow space adjacent to the involved joint. We conclude that MRI is a valuable adjunct in the evaluation of the diabetic foot, and that it provides accurate information regarding the presence and extent of infection in this subset of patients. MRI has proven particularly helpful in differentiating neuroarthropathy from osteomyelitis.

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The diabetic foot: Pathophysiology and treatment

Cited by 119 publications

References 74 publications

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

Results of Blood Inflammatory Markers Are Associated More Strongly With Toe-Brachial Index Than With Ankle-Brachial Index in Patients With Type 2 Diabetes

The diabetic foot: magnetic resonance imaging evaluation

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