==================================CMR30================================== 30. Treatment of plantar ulcers in diabetes. Treatment of the insensitive foot. Ambulatory total contact casting for treatment of foot problems. 1 UI - 87121410 AU - MacFarlane DE ; Baum KF ; Serjeant GR TI - Bacteriology of sickle cell leg ulcers. AB - The bacteria isolated on aerobic and anaerobic culture were compared in 80 unilateral ulcers in patients with homozygous sickle cell (SS) disease, 62 superficial skin lesions, and in 30 diabetic ulcers. In SS disease, the bacterial flora was predominantly aerobic and polymicrobial with Staphylococcus aureus, Pseudomonas aeruginosa and beta-haemolytic streptococci being the major isolates. Repeat sampling of 26 ulcers over a period of 23 weeks indicated the persistence of these three organisms, either singly or in combination in 21 ulcers. Although a variety of Enterobacteriaceae were recovered no single genus predominated and these organisms did not normally persist on follow-up. Simultaneous swabs from bilateral ulcers revealed similar if not identical flora in most cases, indicating good predictive value of a single swab in patients with multiple ulcers. Corynebacterium diphtheriae was recovered from eight ulcers and four of these strains were toxigenic. By contrast, the superficial skin lesions grew mainly S. aureus and beta 6-haemolytic streptococci, and the diabetic ulcers yielded a mixed growth of streptococci, Enterobacteriaceae and anaerobes. The recovery of known skin pathogens from most sickle cell leg ulcers, the persistence of these organisms, and the presence of associated lymphadenopathy, indicates that infection may be a significant factor in the pathology of these lesions. MH - Adolescence ; Adult ; Anemia, Sickle Cell/COMPLICATIONS/ *MICROBIOLOGY ; Bacteria/*ISOLATION & PURIFICATION ; Diabetes Mellitus/COMPLICATIONS ; Female ; Human ; Leg Ulcer/ETIOLOGY/ *MICROBIOLOGY ; Male ; Middle Age ; Pseudomonas Aeruginosa/ ISOLATION & PURIFICATION ; Skin Diseases/MICROBIOLOGY ; Staphylococcus aureus/ISOLATION & PURIFICATION ; Streptococcus/ ISOLATION & PURIFICATION SO - Trans R Soc Trop Med Hyg 1986;80(4):553-6 2 UI - 87120094 AU - Jorup-R:onstr:om C TI - Epidemiological, bacteriological and complicating features of erysipelas. AB - 233 patients with erysipelas, admitted to the Department of Infectious Diseases, Danderyd Hospital, during a 2-year period were analysed for epidemiological, bacteriological and complicating features. Erysipelas was defined clinically as a febrile skin infection with a sudden onset of a red indurated expanding plaque with a distinct border. Common predisposing factors were alcohol abuse, diabetes mellitus and venous insufficiency, and complications were more common among such patients. No seasonal variation was found. 5% of patients with blood culture had streptococcemia (7/149). Erysipelas emerging from an infected ulcer was seen in 52% (122/233) and in 46% of these streptococci were isolated (57/122), 67% of which were of type A (38/57). Staphylococcus aureus was isolated from 59% of ulcerative cases (72/122) and in 3 of them staphylococci were found in the blood. MH - Alcoholism/COMPLICATIONS ; Diabetes Mellitus/COMPLICATIONS ; Erysipelas/COMPLICATIONS/ETIOLOGY/MICROBIOLOGY/*OCCURRENCE ; Female ; Human ; Male ; Prospective Studies ; Skin Ulcer/ COMPLICATIONS/MICROBIOLOGY ; Staphylococcus aureus/ISOLATION & PURIFICATION ; Streptococcus/ISOLATION & PURIFICATION SO - Scand J Infect Dis 1986;18(6):519-24 3 UI - 87110399 AU - Hollander MR ; Holton K ; Mader D TI - Total contact povidone-iodine perfusion cast for the treatment of neuropathic ulcers. AB - The total contact povidone-iodine perfusion cast is an effective, conservative treatment for the neuropathic ulcer. This is accomplished by redistribution of forces exerted on the foot, as well as the antiseptic environment established by the povidone-iodine. The case study presented demonstrates a cost-effective treatment for the diabetic neuropathic ulcer. MH - Case Report ; *Casts, Surgical ; Diabetic Neuropathies/DRUG THERAPY/*THERAPY ; Foot Diseases/DRUG THERAPY/*THERAPY ; Human ; Male ; Middle Age ; Perfusion/METHODS ; Povidone/*ANALOGS & DERIVATIVES ; Povidone-Iodine/*ADMINISTRATION & DOSAGE ; Shoes ; Skin Ulcer/DRUG THERAPY/*THERAPY SO - J Foot Surg 1986 Nov-Dec;25(6):484-8 4 UI - 87075098 AU - Dillon RS TI - Successful treatment of osteomyelitis and soft tissue infections in ischemic diabetic legs by local antibiotic injections and the end-diastolic pneumatic compression boot. AB - Thirty-four legs at risk of amputation due to peripheral arterial insufficiency associated with ischemic necrosis, soft tissue infections, osteomyelitis, and variable degrees of peripheral neuropathy were reported in 28 diabetic patients. Amputation had been considered in 27 legs for which standard therapies had failed for the current illness and in two legs in which standard therapy had failed for previous illnesses. Local therapy was the initial form of therapy for five legs in which standard therapy appeared likely to fail. Infection was controlled in all patients with the use of local antibiotics and compression boot therapy. Early leg amputation was avoided in all but one patient. Late leg amputation occurred in two patients who were lost to follow-up care. Osteomyelitis, ischemic necrosis, and advanced soft tissue infection were shown not to be clear-cut indications for amputation in the ischemic diabetic foot. MH - Aged ; Antibiotics/*ADMINISTRATION & DOSAGE ; Combined Modality Therapy ; Connective Tissue Diseases/*THERAPY ; Diabetic Angiopathies/*COMPLICATIONS ; Diabetic Neuropathies/COMPLICATIONS ; Female ; Foot Diseases/*THERAPY ; *G Suits ; Gangrene ; Human ; Infection/THERAPY ; Injections, Intradermal ; Ischemia/ *COMPLICATIONS ; Leg/*BLOOD SUPPLY/PATHOLOGY ; Male ; Middle Age ; Osteomyelitis/*THERAPY SO - Ann Surg 1986 Dec;204(6):643-9 5 UI - 87070015 AU - Vo NM ; Watson S ; Bryant LR TI - Infections of the lower extremities due to gas-forming and non-gas-forming organisms. AB - From 1977 to 1984, 87 above- and below-knee amputations were done on 77 patients for ischemic ulcerations and gangrene of the lower extremities. The overall three-month mortality was 14% and was mainly related to generalized atherosclerosis. Patients having infections with gas formations were more likely to be diabetic (80% vs 15%, P less than .01), have clinical sepsis and a higher preoperative WBC (19,000 vs 12,600/cu mm, P less than .01), and have a higher mortality (40% vs 12%, P less than .05) than those with infections due to non-gas-forming organisms. Mixed bacterial flora were cultured from most wounds. We conclude that infections with gas formation may be due to either clostridial or nonclostridial organisms, mortality is higher if gas accumulates and if the patient is diabetic, gas is more likely to accumulate in infected extremities of diabetic patients, and the combination of gas formation and diabetes is highly lethal. MH - Aged ; Aged, 80 and over ; Amputation ; Atherosclerosis/MORTALITY ; Bacterial Infections/*SURGERY ; Diabetes Mellitus/COMPLICATIONS ; Follow-Up Studies ; Gas Gangrene/*SURGERY ; Human ; Leg Ulcer/ *SURGERY ; Middle Age ; Prognosis SO - South Med J 1986 Dec;79(12):1493-5 6 UI - 87059904 AU - Le Quesne PM ; Fowler CJ TI - A study of pain threshold in diabetics with neuropathic foot lesions. AB - Pain thresholds to a pinch stimulus were measured at eight sites on the dorsum of both feet from 17 diabetic patients. Sixteen feet had neuropathic ulcers and seven had Charcot arthropathy. Vibration perception thresholds, radial nerve action potentials, muscle action potentials of flexor digitorum brevis, autonomic cardiovascular reflexes and reflex sweat output were also measured. Pinch pain threshold was abnormal in 15 diabetic feet, 11 having one or more insensitive sites. There was a greater variability in threshold between sites tested in diabetic than control subjects. MH - Adult ; Aged ; Arthropathy, Neurogenic/PHYSIOPATHOLOGY ; Autonomic Nervous System/PHYSIOPATHOLOGY ; Cardiovascular System/ PHYSIOPATHOLOGY ; Diabetic Neuropathies/*PHYSIOPATHOLOGY ; Foot Diseases/*PHYSIOPATHOLOGY ; Human ; Middle Age ; Pain/ *PHYSIOPATHOLOGY ; Sensation/PHYSIOLOGY ; Sensory Thresholds ; Skin Ulcer/PHYSIOPATHOLOGY ; Support, Non-U.S. Gov't ; Vibration SO - J Neurol Neurosurg Psychiatry 1986 Oct;49(10):1191-4 7 UI - 87053195 AU - Newrick PG ; Boulton AJ ; Ward JD TI - The distribution of diabetic neuropathy in a British clinic population. AB - A survey of over 1,000 diabetic patients attending a routine hospital clinic clinic in a British city revealed 104 with neuropathic symptoms or foot ulceration. Patients could be assigned to one of four clinical neuropathy groups: chronic sensorimotor, predominantly sensory, proximal motor and mononeuropathy. Only duration of diabetes differed significantly between the groups, with the longest duration in the chronic sensorimotor group. Objective measures of neuropathy did not correlate with symptom scores indicating that careful clinical assessment must augment neurophysiological studies. Patients with neuropathic foot ulceration had significantly higher vibration and thermal thresholds compared with neuropathic patients without ulceration, whereas there was no difference in autonomic function between the two groups. MH - Diabetic Neuropathies/COMPLICATIONS/*OCCURRENCE ; England ; Foot Diseases/*ETIOLOGY ; Human ; Outpatient Clinics, Hospital ; Skin Ulcer/*ETIOLOGY SO - Diabetes Res Clin Pract 1986 Sep-Oct;2(5):263-8 8 UI - 87041893 AU - Edmonds ME ; Blundell MP ; Morris ME ; Thomas EM ; Cotton LT ; Watkins PJ TI - Improved survival of the diabetic foot: the role of a specialized foot clinic. AB - A specialized foot clinic for diabetic patients has made a detailed analysis of the presentation of diabetic foot ulcers and from this a new, organised approach to treatment has been derived. Over three years it has achieved a high rate of ulcer healing and reduced the number of major amputations. It has brought together the skills of chiropodist, shoe-fitter, nurse, physician and surgeon to manage the distinctive lesions of the neuropathic and ischaemic diabetic foot. The neuropathic ulcer was invariably associated with callus, whereas the ischaemic ulcer presented as areas of necrosis often from localised pressure of tight shoes. Essential aspects of management are specially constructed shoes, intensive chiropody and precise antibiotic treatment. Healing was achieved in 204 out of 238 (86 per cent) neuropathic ulcers and 107 out of 148 (72 per cent) ischaemic ulcers. Relapse rate in special shoes was 26 per cent compared with 83 per cent who preferred to wear their own shoes. In the two years before the establishment of the clinic, there were 11 and 12 major amputations yearly. This rate has now been reduced to seven, seven and five amputations yearly. MH - Aged ; Antibiotics/THERAPEUTIC USE ; Bacterial Infections/ PREVENTION & CONTROL ; Combined Modality Therapy ; Diabetic Neuropathies/*COMPLICATIONS ; Female ; Foot Diseases/ETIOLOGY/ *THERAPY ; Hospital Units ; Human ; Ischemia/COMPLICATIONS ; London ; Male ; Middle Age ; Patient Acceptance of Health Care ; Prognosis ; Shoes/ADVERSE EFFECTS ; Skin Ulcer/ETIOLOGY/*THERAPY ; Support, Non-U.S. Gov't SO - Q J Med 1986 Aug;60(232):763-71 9 UI - 87037078 AU - Karanfilian RG ; Lynch TG ; Zirul VT ; Padberg FT ; Jamil Z ; Hobson RW 2d TI - The value of laser Doppler velocimetry and transcutaneous oxygen tension determination in predicting healing of ischemic forefoot ulcerations and amputations in diabetic and nondiabetic patients. AB - The ability to predict successful healing of ulcerations and amputations of the ischemic forefoot continues to be a major clinical challenge, particularly in diabetic patients whose systolic Doppler ankle pressures are often artifactually elevated. We have used the techniques of laser Doppler velocimetry (LD) and transcutaneous oxygen tension monitoring (tcPO2) to quantitatively measure skin blood flow in the distal foot. Fifty-nine limbs were studied (48 patients), of which 37 (63%) were in diabetic and 22 (37%) in nondiabetic patients. All patients were admitted with ischemic ulcerations or gangrenous changes of the forefoot or digit. Twenty transmetatarsal or digital amputations were performed; the remainder of the lesions were d:ebrided and allowed to heal by secondary intention or were covered by a skin graft. Before operation, the systolic pressure (expressed in millimeters of mercury, mean +/- SEM) was measured by Doppler technique at the ankle, and the ankle/arm index calculated (n = 59 limbs). The tcPO2 (also expressed in millimeters of mercury, mean +/- SEM) was measured from the dorsal foot (n = 56). The baseline skin blood flow velocity (SBFV) and pulse wave amplitude (PWA) were measured with the LD (expressed in millivolts, mean +/- SEM) on the plantar aspect of the foot (n = 53 limbs). Criteria for successful healing included a tcPO2 of more than 10 mm Hg, the combination of an LD-SBFV of more than 40 mV and an LD-PWA of more than 4 mV, and an ankle systolic pressure of more than 30 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS) MH - *Amputation Stumps ; Comparative Study ; Diabetes Mellitus/ *COMPLICATIONS ; *Flowmeters ; Foot Diseases/*DIAGNOSIS/ETIOLOGY ; Foot/*BLOOD SUPPLY ; Gangrene ; Human ; Ischemia/*DIAGNOSIS/ ETIOLOGY ; Male ; Middle Age ; *Oxygen Consumption ; Partial Pressure ; Prognosis ; Regional Blood Flow ; Skin Ulcer/ *DIAGNOSIS/ETIOLOGY ; Skin/*METABOLISM ; *Wound Healing SO - J Vasc Surg 1986 Nov;4(5):511-6 10 UI - 87013171 AU - Lord M ; Reynolds DP ; Hughes JR TI - Foot pressure measurement: a review of clinical findings. AB - In this review, a description of what is known about plantar pressure distribution in standing and in gait is followed by sections on clinical findings. Two major clinical areas are treated extensively, namely the diabetic foot and the foot in rheumatoid arthritis. Other applications, including the assessment of surgical procedures for orthopaedic corrections are also included. A large variety of different techniques for foot pressure measurement have been used; interpretation of the results has to be made on the basis of a firm understanding of the technique employed. Often, quantitative results from different pieces of apparatus are difficult to compare, indicating a need for accurate calibration and a standardized presentation. An up-to-date summary of pressure measurement systems reported over the past five years is included. MH - Arthritis, Rheumatoid/PHYSIOPATHOLOGY ; Biomechanics ; Biomedical Engineering ; Diabetes Mellitus/COMPLICATIONS/PHYSIOPATHOLOGY ; Foot Diseases/COMPLICATIONS/PHYSIOPATHOLOGY ; Foot/*PHYSIOLOGY ; Gait ; Human ; Pressure ; Review ; Skin Ulcer/COMPLICATIONS/ PHYSIOPATHOLOGY SO - J Biomed Eng 1986 Oct;8(4):283-94 11 UI - 87010701 AU - Ahmed ME ; Le Quesne PM TI - Quantitative sweat test in diabetics with neuropathic foot lesions. AB - The volume of sweat produced by axon reflex stimulation using acetylcholine was measured in one foot each of 35 control subjects and 52 feet of 37 diabetic patients (28 with neuropathic ulceration, 11 with Charcot arthropathy, nine with somatic neuropathy but no foot lesion and four with no evidence of somatic neuropathy). In controls, the volume of sweat was greater in males than females. A flare response was seen in 94% of control feet. In diabetics, the volume of sweat was within the control range in 17 feet, increased in one, reduced in seven, and absent in 27. Sweating was absent in 75% of feet with a neuropathic ulcer; a flare response was absent in 86% of them. Sweating was only absent in 36% of feet with Charcot arthropathy and was increased in one, whereas the flare response was absent in all. Autonomic cardiovascular reflexes were more frequently abnormal than the sweat test; sweating was absent in only one patient with normal cardiovascular reflexes. MH - Acetylcholine/*DIAGNOSTIC USE ; Adult ; Aged ; Arthropathy, Neurogenic/PHYSIOPATHOLOGY ; Autonomic Nervous System Diseases/ *PHYSIOPATHOLOGY ; Autonomic Nervous System/*PHYSIOPATHOLOGY ; Diabetic Neuropathies/*PHYSIOPATHOLOGY ; Female ; Foot Diseases/ *PHYSIOPATHOLOGY ; Human ; Male ; Middle Age ; Reflex, Abnormal ; Skin Ulcer/PHYSIOPATHOLOGY ; *Sweating ; Tarsal Joint SO - J Neurol Neurosurg Psychiatry 1986 Sep;49(9):1059-62 12 UI - 87010691 AU - Ahmed ME ; Delbridge L ; Le Quesne LP TI - The role of autonomic neuropathy in diabetic foot ulceration. AB - Five standard, non-invasive tests of cardiovascular, autonomic function were performed in each of four groups of 30 subjects: controls, group 1, diabetics without clinical evidence of neuropathy; group 2, diabetics with neuropathy, but without foot ulceration; group 3, diabetics with neuropathic ulceration of the foot. The results showed a significant impairment of autonomic function in diabetics without clinically demonstrable somatic neuropathy compared with controls diabetics with somatic neuropathy compared with those without diabetics with neuropathic ulceration compared with those with neuropathy without ulceration. Parasympathetic function was more seriously affected than sympathetic. In patients who had only mild sensory neuropathy on clinical assessment, those with ulcers had significantly greater impairment of autonomic neuropathy compared with those with uncomplicated neuropathy. MH - Adult ; Aged ; Autonomic Nervous System Diseases/*COMPLICATIONS ; Diabetic Neuropathies/*COMPLICATIONS ; Foot Diseases/*ETIOLOGY ; Human ; Middle Age ; Parasympathetic Nervous System ; Sensation ; Skin Ulcer/*ETIOLOGY ; Support, Non-U.S. Gov't ; Sympathetic Nervous System SO - J Neurol Neurosurg Psychiatry 1986 Sep;49(9):1002-6 13 UI - 86310457 AU - Kay TW ; Martin FI TI - Heel ulcers in patients with long-standing diabetes who wear antiembolism stockings. AB - Four patients with long-standing insulin-dependent diabetes mellitus developed heel ulceration while wearing correctly fitted antiembolism stockings after major surgery. These patients all had evidence of peripheral vascular disease and peripheral neuropathy. Heel ulceration appears to be a significant side-effect of this form of prophylaxis against venous thromboembolism in patients with long-standing diabetes mellitus. The use of antiembolism stockings in such patients, who are likely to have vascular and neurological impairment, should be undertaken with great care, if at all. MH - Aged ; Clothing/*ADVERSE EFFECTS ; Diabetes Mellitus, Insulin-Dependent/*COMPLICATIONS ; Female ; Foot Diseases/ *ETIOLOGY ; Heel ; Human ; Male ; Middle Age ; Postoperative Care ; Skin Ulcer/*ETIOLOGY SO - Med J Aust 1986 Sep 15;145(6):290-1 14 UI - 86298056 AU - Brenner MA TI - Cutaneous stigmata frequently found in the diabetic limb. AB - Dr. Brenner provides us with a look at some of the common skin problems seen in patients who have diabetes mellitus. As he points out, several of these skin conditions precede the actual clinical and laboratory diagnosis of diabetes by several months to several years. Podiatrists may well be the first physicians to see these prodromal dermopathies and be able to make an early diagnosis and aid the patients in obtaining early treatment. MH - Cellulitis/DIAGNOSIS ; Diabetes Mellitus/*COMPLICATIONS ; Diabetic Angiopathies/DIAGNOSIS ; Diabetic Neuropathies/DIAGNOSIS ; Foot Dermatoses/DIAGNOSIS/*ETIOLOGY ; Foot Diseases/DIAGNOSIS/ *ETIOLOGY ; Granuloma/ETIOLOGY ; Human ; Paronychia/DIAGNOSIS ; Sarcoma, Kaposi's/DIAGNOSIS ; Skin Ulcer/ETIOLOGY ; Tinea/ DIAGNOSIS ; Xanthomatosis/DIAGNOSIS SO - Clin Podiatr Med Surg 1986 Jul;3(3):523-32 15 UI - 86291902 AU - Agren MS ; Str:omberg HE ; Rindby A ; Hallmans G TI - Selenium, zinc, iron and copper levels in serum of patients with arterial and venous leg ulcers. AB - The total serum concentrations of selenium, zinc, iron and copper were determined in geriatric patients with and without leg ulcers. The levels of selenium, zinc and iron were significantly lower and the copper/zinc ratio was significantly higher in the leg ulcer group compared with control patients. The serum-copper level and the serum-copper/zinc ratio were raised in patients with poor ulcer healing. MH - Aged ; Copper/*BLOOD ; Diabetes Mellitus/BLOOD ; Female ; Human ; Iron/*BLOOD ; Leg Ulcer/*BLOOD ; Male ; Selenium/*BLOOD ; Serum Albumin/ANALYSIS ; Wound Healing ; Zinc/*BLOOD SO - Acta Derm Venereol (Stockh) 1986;66(3):237-40 16 UI - 86273873 AU - Stess RM ; Sisney PC ; Moss KM ; Graf PM ; Louie KS ; Gooding GA ; Grunfeld C TI - Use of liquid crystal thermography in the evaluation of the diabetic foot. AB - Liquid crystal thermography (LCT) was used to determine temperature variations on the plantar surface of feet. The purpose was to identify thermal emission patterns associated with diabetic foot ulcers. Three population groups were screened: group I, 16 nondiabetic controls; group II, 21 diabetic patients with no history of pedal ulcers; and group III, 28 diabetic patients with active pedal ulceration or history of foot ulcerations. The results demonstrate a generalized increase in plantar foot temperature in group III compared with groups I and II. Temperature readings under metatarsal heads 1-5, great toe, heel, and lateral band were significantly increased (P less than .01) in group III. Additionally, the warm lateral surface displayed by group III patients was not significantly different in temperature from the medial arch of the foot. In groups I and II, the lateral band was significantly cooler (P less than .01) than the medial arch. In group III patients with active ulceration on only one foot, no significant difference in temperature was found between the foot with active ulceration compared with the contralateral nonulcerated foot. When patients with active pedal ulceration were compared with patients with a history of foot ulcers, no significant difference in temperature was seen at five of seven sites tested. A warm concentric color band surrounding active plantar ulcers was identified in group III. This pattern extended from the center of the ulcer to a distance of 8 mm. A significant change in temperature (P less than .01) was noted at 6- and 8-mm distances from the center of the ulcer. In addition, a mottled thermographic pattern was observed more frequently in group III patients than in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Diabetic Angiopathies/*PHYSIOPATHOLOGY ; Foot/BLOOD SUPPLY ; Foot Diseases/ETIOLOGY/*PHYSIOPATHOLOGY ; Human ; Male ; *Skin Temperature ; Skin Ulcer/ETIOLOGY/*PHYSIOPATHOLOGY ; Support, U.S. Gov't, Non-P.H.S. ; Thermography/*METHODS SO - Diabetes Care 1986 May-Jun;9(3):267-72 17 UI - 86211810 AU - Hodges D ; Kumar VN ; Redford JB TI - Management of the diabetic foot. AB - Foot disease in diabetics is caused by peripheral neuropathy and peripheral vascular disease. Initial evaluation involves repeated physical examinations, including careful inspection for infection, and Doppler analysis of perfusion. A tracing of the ulceration should be obtained so that healing can be monitored. Properly fitting shoes are imperative for prophylactic care. Shoe modification is possible using moldable plastics and metatarsal bars. Patient and family education are also important elements of management. MH - Antibiotics/THERAPEUTIC USE ; Bacterial Infections/THERAPY ; Diabetes Mellitus/COMPLICATIONS ; Diabetic Angiopathies/ COMPLICATIONS/*THERAPY ; Diabetic Neuropathies/COMPLICATIONS/ *THERAPY ; Foot/BLOOD SUPPLY ; Foot Diseases/*ETIOLOGY/ REHABILITATION/THERAPY ; Human ; Physical Examination ; Regional Blood Flow ; Shoes SO - Am Fam Physician 1986 May;33(5):189-95 18 UI - 86191777 AU - Boulton AJ ; Bowker JH ; Gadia M ; Lemerman R ; Caswell K ; Skyler JS ; Sosenko JM TI - Use of plaster casts in the management of diabetic neuropathic foot ulcers. AB - Neuropathic foot ulceration is a major medical and economic problem among diabetic patients, and the traditional treatment involves bed rest with complete freedom from weight-bearing. We have investigated the use of walking plaster casts in the management of seven diabetic patients with long-standing, chronic plantar ulcers. Although all ulcers healed in a median time of 6 wk, this therapy was not without side effects, which are described in detail. We conclude that casting is a useful therapy for neuropathic ulcers, although several clinic visits, including cast removal and foot inspection, are necessary to avoid potential side effects caused by the casting of insensitive feet. MH - Adult ; Case Report ; *Casts, Surgical/ADVERSE EFFECTS ; Diabetic Neuropathies/*COMPLICATIONS ; Female ; Foot Diseases/ETIOLOGY/ *THERAPY ; Human ; Male ; Middle Age ; Skin Ulcer/ETIOLOGY/ *THERAPY ; Support, Non-U.S. Gov't SO - Diabetes Care 1986 Mar-Apr;9(2):149-52 19 UI - 86183491 AU - Hewes RC ; White RI Jr ; Murray RR ; Kaufman SL ; Chang R ; Kadir S ; Kinnison ML ; Mitchell SE ; Auster M TI - Long-term results of superficial femoral artery angioplasty. AB - Short-term results of superficial femoral artery and popliteal percutaneous transluminal angioplasty have been good, but long-term results and factors influencing long-term patency are less commonly reported. One hundred thirty-seven superficial femoral artery angioplasties with follow-up for 54 months were reviewed. The 4-year patency for stenoses was 61% and for occlusions was 68%. If the initial result was clinically successful, the 4-year patency was not influenced by the quality or patency of runoff or by the length of the occlusion. Nineteen patients returned for redilatation, eight of whom had developed new lesions. Patency was adversely affected in patients with diabetes or with long-segment stenoses. Modifications of equipment and technique that may improve long-term patency rates are discussed. MH - *Angioplasty, Transluminal/ADVERSE EFFECTS ; Arterial Occlusive Diseases/PATHOLOGY/*THERAPY ; Diabetic Angiopathies/THERAPY ; *Femoral Artery/PATHOLOGY ; Follow-Up Studies ; Gangrene/ETIOLOGY ; Human ; Intermittent Claudication/THERAPY ; Leg Ulcer/ETIOLOGY ; Pain/ETIOLOGY ; Popliteal Artery/PATHOLOGY ; Thrombosis/ ETIOLOGY ; Time Factors SO - AJR 1986 May;146(5):1025-9 20 UI - 86169891 AU - Blissitt PA TI - Nursing management of diabetic peripheral neuropathies. AB - This artiycl e provides a brief description of each of the diabetic peripheral neuropathies. Each distinct peripheral neuropathy is discussed in terms of its incidence, symptomatology, physical signs, medical management, and prognosis. Then Leavell and Clark's Levels of Prevention is used as a framework for nursing intervention for the patient with diabetic peripheral neuropathies. Nursing intervention includes health promotion and specific protection, early diagnosis and prompt treatment, and rehabilitation. MH - Cachexia/DIAGNOSIS ; Cranial Nerve Diseases/DIAGNOSIS ; Diabetic Neuropathies/*NURSING/PREVENTION & CONTROL ; Foot Diseases/ DIAGNOSIS ; Human ; Muscular Atrophy/DIAGNOSIS ; Patient Education ; Primary Prevention SO - J Neurosci Nurs 1986 Apr;18(2):81-5 21 UI - 86152314 AU - Matsen FA 3d ; Wyss CR ; Robertson CL ; Love SJ ; Hammond MC ; Burgess EM TI - Factors relating to the sensory acuity of limbs with peripheral vascular insufficiency. AB - We examined several possible causes for the high incidence of poor sensory acuity in the limbs of 176 patients with moderate to severe peripheral vascular insufficiency. We investigated the relationships of diabetes, alcoholism, and smoking, as well as the severity of peripheral vascular disease, to the integrity of basic sensory modalities such as two-point discrimination and perception of light touch. The presence or absence of diabetes exerted the strongest effect on peripheral sensation. In patients who did not have diabetes, sensation in the limbs was most strongly affected by whether the patient was an alcoholic. Smoking did not have a significant effect on limb sensation. Among nondiabetic, nonalcoholic patients, there was a weak residual effect related to the severity of the peripheral vascular insufficiency. Even among these patients, however, systemic factors predominated in determining the loss of sensation. We also examined the extent to which loss of sensation might be related to the development of ulcers. Among patients who were not diabetic, there was a highly significant relationship between loss of sensation and the presence of limb ulceration. Surprisingly, however, there was no discernable relationship between the presence of ulcers in diabetic patients and the degree of loss of peripheral sensation. This result suggests that a large percentage of ulcers seen in diabetic patients are not of neurogenic origin. MH - Adult ; Aged ; Alcoholism/COMPLICATIONS ; Arterial Occlusive Diseases/COMPLICATIONS/*PHYSIOPATHOLOGY ; Diabetes Mellitus/ COMPLICATIONS ; Extremities/BLOOD SUPPLY/*INNERVATION ; Female ; Human ; Male ; Middle Age ; Peripheral Nerve Diseases/ COMPLICATIONS ; *Sensation ; Skin Ulcer/COMPLICATIONS ; Smoking ; Support, U.S. Gov't, Non-P.H.S. SO - Surgery 1986 Apr;99(4):455-61 22 UI - 86149891 AU - Kucan JO ; Robson MC TI - Diabetic foot infections: fate of the contralateral foot. AB - Following an initial report urging conservative management of severe diabetic foot infections, the authors have managed 45 patients with a minimum 3-year follow-up. By using standard principles for soft-tissue infection, 78 percent of the patients healed minor amputation sites and maintained biped ambulation following the initial foot involvement. Only 22 percent required a major amputation at the time of the initial foot involvement. The 45 patients were followed and 22 (or 49 percent) developed a severe infection involving the contralateral foot within 18 months. Although 15 of the 22 patients developing contralateral infection (or 33 percent of the total series) required some type of amputation on the contralateral foot, the conservative approach allowed 64 percent of the patients with severe infections in both feet to maintain biped ambulation. This included 40 percent of the patients who required amputation of some portion of both feet. MH - Adult ; Amputation ; Diabetes Mellitus/*COMPLICATIONS ; Diabetic Angiopathies/COMPLICATIONS ; Diabetic Neuropathies/COMPLICATIONS ; Female ; Foot Diseases/ETIOLOGY/PATHOLOGY/*SURGERY ; Gangrene ; Human ; Infection ; Length of Stay ; Male ; Middle Age ; Recurrence SO - Plast Reconstr Surg 1986 Mar;77(3):439-41 23 UI - 86110976 AU - Gooding GA ; Stess RM ; Graf PM ; Moss KM ; Louie KS ; Grunfeld C TI - Sonography of the sole of the foot. Evidence for loss of foot pad thickness in diabetes and its relationship to ulceration of the foot. AB - The hypothesis that loss of tissue mass in the foot contributes to foot ulceration in diabetics has never been quantitated. We developed normal criteria for the thickness of the sole of the foot at the heel, and the five metatarsal heads of both feet, using high-resolution ultrasound (10 MHz). We studied 24 normal patients ranging in weight from 125 to 250 lbs. We examined the soles of the feet of 38 diabetics without foot ulcers and 11 diabetics with foot ulcers or a history of foot ulcers who were in the same weight range as the normals. Of statistical significance, the heel thickness in controls was greater than that of the diabetics, which in turn was greater than that of the diabetics with foot ulcers. The thickness of the sole over the first and second metatarsals was also greater in the controls compared with diabetics. We conclude that high-resolution ultrasound is an effective determinant of the thickness of the sole of the foot and that diabetics have variations from the norm in the heel and at the first and second metatarsal heads. MH - Adipose Tissue/PATHOLOGY ; Diabetes Mellitus/COMPLICATIONS/ *PATHOLOGY ; Diabetic Neuropathies/PATHOLOGY ; Foot/*PATHOLOGY ; Human ; Middle Age ; Muscular Atrophy/PATHOLOGY ; Skin Ulcer/ *ETIOLOGY/PATHOLOGY ; *Ultrasonic Diagnosis SO - Invest Radiol 1986 Jan;21(1):45-8