Journal of the American Podiatric Medical Association

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Diabetic Foot Update 1996

by Mardon R. Day and Lawrence B. Harkless

J. Am. Podiatr. Med. Assoc. 1997, 87(6), 293-300; https://doi.org/10.7547/87507315-87-6-293 - 1 Jun 1997

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Hyperbaric Oxygen Therapy and The Diabetic Foot

by R. Lee Williams

J. Am. Podiatr. Med. Assoc. 1997, 87(6), 279-292; https://doi.org/10.7547/87507315-87-6-279 - 1 Jun 1997

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Hyperbaric oxygen therapy is an adjunctive wound-healing modality receiving increasing use for problem wounds, particularly diabetic foot wounds. Nevertheless, few clinicians understand the physiologic basis for this modality; how patients are selected, or the expected results. The author reviews the development of hyperbaric [...] Read more.

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The Natural History of Acute Charcot's Arthropathy in a Diabetic Foot Specialty Clinic

by David G. Armstrong, W.F. Todd, L.A. Lavery, L.B. Harkless and T.R. Bushman

J. Am. Podiatr. Med. Assoc. 1997, 87(6), 272-278; https://doi.org/10.7547/87507315-87-6-272 - 1 Jun 1997

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The aim of this longitudinal study was to report on the clinical characteristics and treatment course of acute Charcot's arthropathy at a tertiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 +/- 8.5 years, were studied. All patients were treated with serial total contact casting until quiescence. Following casting and before transfer to prescription footwear, patients were eased into unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 +/- 33.7 weeks following return to shoes. Pain was the most frequent presenting complaint in these otherwise insensate patients (76%). The mean duration of casting was 18.5 +/- 10.6 weeks. Patients returned to footwear in a mean 28.3 +/- 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly longer than the unilateral group (p < 0.02). Surgery was performed on 25% of patients, with approximately two-thirds of these procedures involving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that the ambulatory total contact cast is very effective for this. Regardless of the specific treatment method instituted, it is imperative that appropriate and aggressive treatment be undertaken immediately following diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity. Full article

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Novel Methodology to Obtain Salient Biomechanical Characteristics of Insole Materials

by Lawrence A. Lavery, Steven A. Vela, Hisham R. Ashry, Dan R. Lanctot and Kyriacos A. Athanasiou

J. Am. Podiatr. Med. Assoc. 1997, 87(6), 266-271; https://doi.org/10.7547/87507315-87-6-266 - 1 Jun 1997

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Viscoelastic inserts are commonly used as artificial shock absorbers to prevent neuropathic foot ulcerations by decreasing pressure on the sole of the foot. Unfortunately, there is little scientific information available to guide physicians in the selection of appropriate insole materials. Therefore, a novel methodology was developed to form a rational platform for biomechanical characterizations of insole material durability, which consisted of in vivo gait analysis and in vitro bioengineering measurements. Results show significant differences in the compressive stiffness of the tested insoles and the rate of change over time in both compressive stiffness and peak pressures measured. Good correlations were found between pressure-time integral and Young's modulus (r2 = 0.93), and total energy applied and Young's modulus (r2 = 0.87). Full article

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The Acutely Infected Diabetic Foot Is Not Adequately Evaluated in an Inpatient Setting

by Gary W. Edelson, David G. Armstrong, Lawrence A. Lavery and Gene Caicco

J. Am. Podiatr. Med. Assoc. 1997, 87(6), 260-265; https://doi.org/10.7547/87507315-87-6-260 - 1 Jun 1997

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To evaluate the standard of evaluation and treatment of the infected diabetic foot ulceration at a 551-bed university teaching institution. A retrospective review of a 4-year consecutive sample (1991-1994). Two hundred fifty-five patients who were admitted to a hospital for care of an infected diabetic foot ulceration. Patients were subdivided into the following 4 dichotomous variables: (1) whether the patient underwent a lower-extremity amputation, (2) whether the patient was admitted once or multiple times, (3) whether the patient underwent intraoperative debridement, and (4) whether the patient was admitted to medical or surgical services. All groups that were evaluated had undergone a less than adequate foot examination. Of the admitted patients, 31.4% did not have their pedal pulses documented; 59.7% of the admitted patients were not evaluated for the presence or absence of protective sensation. Nearly 90% of the wounds were not evaluated for involvement of underlying structures, and foot radiographs were not performed in 32.9% of the patients. There were more blood cultures ordered (62.0%) than wound cultures (51.4%). The results of this study highlight the need for a systematic, detailed lower-extremity examination for every diabetic patient who is admitted to a hospital, particularly those who are admitted with a primary diagnosis that involves a foot complication. Full article

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Amputation and Reamputation of The Diabetic Foot

by David G. Armstrong, Lawrence A. Lavery, Lawrence B. Harkless and William H. Van Houtum

J. Am. Podiatr. Med. Assoc. 1997, 87(6), 255-259; https://doi.org/10.7547/87507315-87-6-255 - 1 Jun 1997

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The authors compare the level of foot amputation by age, prevalence of arterial disease as a precipitating factor, gender, and ethnicity in persons with diabetes mellitus. Medical records were abstracted for each hospitalization for a lower extremity amputation from January 1 to December 31, 1993, in six metropolitan statistical areas in south Texas. Amputation level was defined by ICD-9-CM codes and were categorized as foot, leg, and thigh amputations. Foot-level amputations were further subcategorized as hallux or first ray, middle, fifth, multiple digit or ray, and midfoot amputations. Only the highest amputation level for each individual was used in the analysis. Of 1,043 subjects undergoing a lower extremity amputation in south Texas in the year 1993, 477 received their amputation at the level of the foot. African-Americans requiring a foot-level amputation were at significantly higher risk to undergo a midfoot-level amputation than was the rest of the population. Nearly 40% of all subjects undergoing a foot-level amputation had a previous history of amputation. However, nearly 40% of subjects undergoing foot amputations had not been diagnosed either before or during admission with peripheral arterial occlusive disease, suggesting a causal pathway dependent primarily on neuropathy. This implies that better screening of diabetic patients with appropriate risk-directed treatment at the primary care level may significantly impact the large number of preventable diabetes-related lower extremity amputations. Full article

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J. Am. Podiatr. Med. Assoc., Volume 87, Issue 6 (06 1997) – 6 articles , Pages 255-300

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