Traitement chirurgical conservateur du mal perforant plantaire en regard des têtes de métatarsiens chez le diabétique. Étude rétrospective cas-témoins

Vanlerberghe, Benoit; Devemy, F.; Duhamel, Alain; Guerreschi, P.; Torabi, D

doi:10.1016/j.anplas.2013.07.008

Cited by 16 publications

(10 citation statements)

References 19 publications

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“…The reason that surgical offloading procedures are recommended for non-healing ulcers is that most trials of these procedures were in those with non-healing ulcers [10,11,41,44]. These trials found that various surgical offloading procedures (when used in conjunction with knee-high offloading devices) mostly produce small-to-moderate desirable effects on better healing [91][92][93][94][95][96][97][98][99][100][101], plantar pressure reductions [102], and longerterm patient satisfaction [95,103], but they also tend to have small undesirable effects on higher adverse events and higher costs [91][92][93]95,99] compared to using knee-high offloading devices alone in patients with non-healing DFU [10,11,41,44]. Thus, surgical procedures are weakly recommended in those patients that have attempted best practice offloading treatments in conjunction with all other best practice DFU treatments for~6 weeks and this has not helped heal their ulcers [11,44].…”

Section: Surgical Offloading Procedures: Non-healing Ulcer Offloading Treatmentmentioning

confidence: 99%

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

Lazzarini

Jarl

2021

Medicina

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Diabetic foot ulcers (DFU) are a leading cause of the global disease burden. Most DFUs are caused, and prolonged, by high plantar tissue stress under the insensate foot of a person with peripheral neuropathy. Multiple different offloading treatments have been used to try to reduce high plantar tissue stress and heal DFUs, including bedrest, casting, offloading devices, footwear, and surgical procedures. The best offloading treatments are those that balance the benefits of maximizing reductions in high plantar tissue stress, whilst reducing the risks of poor satisfaction, high costs and potential adverse events outcomes. This review aimed to summarize the best available evidence on the effects of offloading treatments to heal people with DFUs, plus review their use in clinical practice, the common barriers and solutions to using these treatments, and discuss promising emerging solutions that may improve offloading treatments in future. Findings demonstrate that knee-high offloading devices, non-removable or removable knee-high devices worn for all weight-bearing activities, are the gold standard offloading treatments to heal most patients with DFU, as they are much more effective, and typically safer, quicker, and cheaper to use compared with other offloading treatments. The effectiveness of offloading treatments also seems to increase when increased offloading mechanical features are incorporated within treatments, including customized insoles, rocker-bottom soles, controlled ankle motion, and higher cast walls. However, in clinical practice these gold standard knee-high offloading devices have low rates of prescription by clinicians and low rates of acceptance or adherence by patients. The common barriers resulting in this low use seem to surround historical misperceptions that are mostly dispelled by contemporary evidence. Further, research is now urgently required to close the implementation gap between the high-quality of supporting evidence and the low use of knee-high devices in clinical practice to reduce the high global disease burden of DFU in future.

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Section: Surgical Offloading Procedures: Non-healing Ulcer Offloading Treatmentmentioning

confidence: 99%

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

Lazzarini

Jarl

2021

Medicina

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“…Leprosy may become a global health problem due to the reactivation of latent, previously undiagnosed cases, even in the Western world, due to the use of strong immunosuppressive regimens for various diseases [14]. In cases of doubt, a skin smear and/or biopsy often helps to establish the final diagnosis [1].…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Delayed Diagnosis of Leprosy in Mauritania

Boushab

Fall-Malick

Basco

2018

Case Reports in Dermatological Medicine

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Leprosy is a chronic infectious disease that mainly affects the skin, mucous membranes, and peripheral nervous system. The clinical manifestations of leprosy are numerous and polymorphic with the most frequent signs involving skin and neurological damage. Some of its manifestations, such as joint pain, are unusual. Its elimination as a public health problem in many countries seems to lead to a lack of practical knowledge among health care personnel and as a consequence a risk of late diagnosis. As in other countries, leprosy has become rare in Mauritania. We report two cases of misdiagnosed leprosy in two male patients aged 17 and 65 years. Clinical manifestations included polyarthritis, bilateral plantar perforation, and severely deformed hands and feet in the first case and lichenoid lesions, hypopigmented papules, and unilateral bronchial rales in the second case. The duration of development and persistence of clinical signs before establishment of correct diagnosis was seven to ten years despite the presence of anesthetic, hypochromic maculopapular skin lesions and neurologic signs suggestive of leprosy in both cases. A multilevel chemotherapeutic regimen recommended by the World Health Organization (WHO) was effective, and the patients' condition evolved satisfactorily. The scarcity of leprosy in our health care facilities often leads to a wrong diagnosis. It is imperative to inform physicians to increase their vigilance for appropriate screening and reporting of these cases. The prognosis depends largely on early diagnosis and appropriate treatment.

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“…joint arthrodesis + TCC 80,162 ; osteotomy + [non-]removable offloading device 92,133 ; digital flexor tenotomies + removable device 36,51,136 ).…”

Section: Comparison 12: Any Combination Of Offloading Interventions V...mentioning

confidence: 99%

“…See the Comparison 7 SoF tables and forest plots in Supplementary File S2. Note as there was controlled study evidence for six different surgical offloading interventions, we reviewed each separately and produced six SoF tables for this comparison, including Achilles tendon lengthening 81,82,[114][115][116][117][118] (Comparison 7A), metatarsal head resections 34,83,91,93,94,[119][120][121][122][123][124][125] (Comparison 7B), joint arthroplasties 95,96,[126][127][128][129] (Comparison 7C), joint arthrodeses 80 (Comparison 7D), metatarsal osteotomies 92,[130][131][132][133][134] (Comparison 7E), and digital flexor tenotomies 36,50,51,[135][136][137][138][139][140][141][142][143][144][145] (Comparison 7F...…”

Section: Comparisons 7: Surgical Offloading Interventions Versus Non-...mentioning

confidence: 99%

Effectiveness of offloading interventions for people with diabetes‐related foot ulcers: A systematic review and meta‐analysis

Lazzarini

Armstrong

Crews

et al. 2023

Diabetes Metabolism Res

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BackgroundOffloading treatment is crucial to heal diabetes‐related foot ulcers (DFU). This systematic review aimed to assess the effectiveness of offloading interventions for people with DFU.MethodsWe searched PubMed, EMBASE, Cochrane databases, and trials registries for all studies relating to offloading interventions in people with DFU to address 14 clinical question comparisons. Outcomes included ulcers healed, plantar pressure, weight‐bearing activity, adherence, new lesions, falls, infections, amputations, quality of life, costs, cost‐effectiveness, balance, and sustained healing. Included controlled studies were independently assessed for risk of bias and had key data extracted. Meta‐analyses were performed when outcome data from studies could be pooled. Evidence statements were developed using the GRADE approach when outcome data existed.ResultsFrom 19,923 studies screened, 194 eligible studies were identified (47 controlled, 147 non‐controlled), 35 meta‐analyses performed, and 128 evidence statements developed. We found non‐removable offloading devices likely increase ulcers healed compared to removable offloading devices (risk ratio [RR] 1.24, 95% CI 1.09–1.41; N = 14, n = 1083), and may increase adherence, cost‐effectiveness and decrease infections, but may increase new lesions. Removable knee‐high offloading devices may make little difference to ulcers healed compared to removable ankle‐high offloading devices (RR 1.00, 0.86–1.16; N = 6, n = 439), but may decrease plantar pressure and adherence. Any offloading device may increase ulcers healed (RR 1.39, 0.89–2.18; N = 5, n = 235) and cost‐effectiveness compared to therapeutic footwear and may decrease plantar pressure and infections. Digital flexor tenotomies with offloading devices likely increase ulcers healed (RR 2.43, 1.05–5.59; N = 1, n = 16) and sustained healing compared to devices alone, and may decrease plantar pressure and infections, but may increase new transfer lesions. Achilles tendon lengthening with offloading devices likely increase ulcers healed (RR 1.10, 0.97–1.27; N = 1, n = 64) and sustained healing compared to devices alone, but likely increase new heel ulcers.ConclusionsNon‐removable offloading devices are likely superior to all other offloading interventions to heal most plantar DFU. Digital flexor tenotomies and Achilles tendon lengthening in combination with offloading devices are likely superior for some specific plantar DFU locations. Otherwise, any offloading device is probably superior to therapeutic footwear and other non‐surgical offloading interventions to heal most plantar DFU. However, all these interventions have low‐to‐moderate certainty of evidence supporting their outcomes and more high‐quality trials are needed to improve our certainty for the effectiveness of most offloading interventions.

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Traitement chirurgical conservateur du mal perforant plantaire en regard des têtes de métatarsiens chez le diabétique. Étude rétrospective cas-témoins

Cited by 16 publications

References 19 publications

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

Two Cases of Delayed Diagnosis of Leprosy in Mauritania

Effectiveness of offloading interventions for people with diabetes‐related foot ulcers: A systematic review and meta‐analysis

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