1/18. Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes.BACKGROUND AND PURPOSE: Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%-57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. CASE DESCRIPTION: The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. OUTCOMES: The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. DISCUSSION: Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/18. Elevated plantar pressure and ulceration in diabetic patients after panmetatarsal head resection: two case reports.Panmetatarsal head resection (variously called forefoot arthroplasty, forefoot resection arthroplasty, the Hoffman procedure, and the Fowler procedure) was developed for the relief of pain and deformity in rheumatoid arthritis. Although there are successful retrospective series reported in the literature, such an approach is not supported by carefully designed controlled trials. This procedure has also been advocated by some for the relief of plantar pressure in diabetic patients who are at risk for plantar ulceration. The efficacy of the procedure in this context is not supported by existing pressure measurements on rheumatoid arthritis patients in the literature, which has tended to show that although pain relief is obtained, the procedure results in elevation of forefoot pressure. case reports are described of two patients (three feet) with sensory neuropathy who presented to our clinic 1 to 2 years after panmetatarsal head resections had been performed. Peak plantar pressures in these feet during first step gait were above the 99th percentile and outside the measuring range of the device used (EMED SF platform; NOVEL electronics Inc., St. Paul, MN). Both patients had also experienced plantar ulcers subsequent to the surgery. Combining the information on patients with rheumatoid arthritis (RA) with that from our two case studies, we conclude that panmetatarsal head resection does not necessarily eliminate focal regions of elevated plantar pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/18. Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus.STUDY DESIGN: Case report with repeated measures. OBJECTIVES: To describe the effects of a tendo-Achilles lengthening (TAL) and total contact casting (TCC) on wound healing, motion, plantar pressure, and function in a patient with diabetes mellitus, peripheral neuropathy, neuropathic ulcer, and limited dorsiflexion range of motion (DFROM). BACKGROUND: Limited DFROM has been associated with increased forefoot pressures and skin breakdown. A TAL was expected to increase DFROM and reduce forefoot pressures during walking, but the influence on muscle performance and function was unknown. methods AND MEASURES: The patient was a 42-year-old man with a 20-year history of type 1 diabetes (NIDDM) and a recurrent neuropathic plantar ulcer. Outcome measures were DFROM, isokinetic plantar flexor muscle peak torque, in-shoe and barefoot peak plantar pressure, physical performance test (PPT) score, and peak ankle and hip moments during walking obtained from an automated gait analysis. All tests were completed pre-TAL, 8 weeks post-TAL (after immobilization in a TCC), and 7 months post-TAL. RESULTS: The wound healed in 40 days. The TAL resulted in a sustained increase in DFROM (0 to 18 degrees). Plantar flexor peak torque was reduced by 21% 8 weeks after the TAL compared with the torque before surgery but recovered fully at 7 months. Seven months following TAL, in-shoe forefoot peak plantar pressure was reduced by 55%, barefoot pressure decreased by 14%, PPT score increased by 24%, peak ankle plantar flexor moment remained decreased by 30%, and the peak hip flexor moment increased by 41% during walking. CONCLUSION: For this patient, a TAL resulted in short-term deficits in peak plantar flexor torque, but a 7-month follow-up showed improvements in ankle DFROM, walking ability, and a decrease in forefoot in-shoe peak plantar pressure.- - - - - - - - - - ranking = 0.77777777777778keywords = pressure (Clic here for more details about this article) |
4/18. pulmonary edema associated with hyperbaric oxygen therapy.We report three cases of pulmonary edema associated with hyperbaric oxygen therapy, including one fatality. All three patients had cardiac disease and reduced left ventricular (LV) ejection fractions (EFs). Two patients had diabetes, and one patient had severe aortic stenosis. Hyperbaric oxygen therapy may contribute to pulmonary edema by increasing LV afterload, increasing LV filling pressures, increasing oxidative myocardial stress, decreasing LV compliance by oxygen radical-mediated reduction in nitric oxide, altering cardiac output between the right and left hearts, inducing bradycardia with concomitant LV dysfunction, increasing pulmonary capillary permeability, or by causing pulmonary oxygen toxicity. We advise caution in the use of hyperbaric oxygen therapy in patients with heart failure or in patients with reduced cardiac EFs.- - - - - - - - - - ranking = 0.11111111111111keywords = pressure (Clic here for more details about this article) |
5/18. One pair must last a lifetime. Case studies of foot care in diabetes.Neuropathy is the second most important of the four major 'traffic light' warnings for future foot problems (vascular, neuropathy, structural, self care). Peripheral neuropathy is a significant clinical problem in 20% of patients with diabetes. Painful neuropathy can disrupt patients lives but simple effective interventions are available. Painless neuropathy is often not perceived to be a problem by the patient or their doctor but puts the foot at risk from trauma (physical, chemical and thermal). patients with neuropathy need systematic reassessment of self and professional diabetes care, and education about footwear and foot care. A podiatrist can be invaluable in prescribing appropriate footwear and orthotics to distribute foot pressure and in educating patients about self care. patients with the 'double whammy' of neuropathy and vascular disease are at extreme risk of limb threatening problems and should have a regular monitoring program by themselves (or their carers) and their professionals as well as an 'action plan' to detect and deal with problems early.- - - - - - - - - - ranking = 0.11111111111111keywords = pressure (Clic here for more details about this article) |
6/18. Treating recalcitrant diabetic wounds with hyaluronic acid: a review of patients.The wound healing process in the patient with diabetes can be adversely affected by many factors, including unrelieved pressure, infection, and concurrent underlying conditions. In addition, a static wound may exacerbate patient anxiety or depression and indirectly further delay the healing process while increasing the risk of complications. The polysaccharide hyaluronic acid has long been known to be an integral component of the extracellular matrix in the dermis and other tissues and is implicated in the process of wound healing and tissue repair. research has shown the benefit of using a novel ester of hyaluronic acid to accelerate the healing process and effectively treat diabetic foot ulceration and other difficult-to-heal chronic wounds. The effects of care using hyaluronic acid on three patients with challenging wounds are presented.- - - - - - - - - - ranking = 0.11111111111111keywords = pressure (Clic here for more details about this article) |
7/18. The vacuum assisted closure of complex wounds: report of 3 cases.Treatment of wounds using conventional methods is frequently limited by inadequate local wound conditions, or by a poor systemic clinical situation. vacuum system may promote faster granulation tissue formation, remove excessive exudate, increase blood flow in the wound, and attract the borders of the wound to the center, reducing its dimension. We present 3 cases of patients with difficult wounds, due to bad local conditions, or poor clinical situation, in whom we used a vacuum system to prepare the wound for the surgical closure. One patient had a pressure ulcer, another had a diabetic foot ulcer, and the third one had an open foot stump. In the 3 cases a significant improvement of the wound conditions was achieved after 7 to 8 days, allowing successful surgical treatment with flap or skin grafts.- - - - - - - - - - ranking = 0.11111111111111keywords = pressure (Clic here for more details about this article) |
8/18. Percutaneous tendo Achillis lengthening to promote healing of diabetic plantar foot ulceration.The etiology of ulcerations related to increased plantar pressure in patients with diabetes mellitus is complex but frequently includes a component of gastrocnemius soleus equinus. One viable treatment option is percutaneous tendo Achillis lengthening as a means of increasing dorsiflexory range of motion and decreasing forefoot shear forces. This article presents three case reports illustrating the importance of reducing plantar pressure as a crucial component of treatment of diabetic forefoot ulcerations.- - - - - - - - - - ranking = 0.22222222222222keywords = pressure (Clic here for more details about this article) |
9/18. Relationship between changes in activity and plantar ulcer recurrence in a patient with diabetes mellitus.BACKGROUND AND PURPOSE: Although pressure-reducing interventions have been effective in the healing of neuropathic foot ulcers, these ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to ulcer recurrence for this patient. CASE DESCRIPTION: The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent plantar ulcers. His plantar ulcer healed after total contact casting. OUTCOME: Despite relatively low peak plantar pressure (9.3 N/cm(2)), the patient's ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative plantar tissue stress that was 3.3 times higher on the day of ulcer recurrence than his average value. Although his cumulative plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent ulcers. DISCUSSION: Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of ulcer recurrence.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
10/18. Reconstruction of the diabetic foot using the anterolateral thigh perforator flap.BACKGROUND: The purpose of this study was to evaluate the outcome of the diabetic foot reconstructed with the anterolateral thigh perforator flap. methods: This study reviews 71 cases of salvaged diabetic foot over a 52-month period. patients ranged in age from 33 to 72 years (average, 51 years), with an average follow-up of 11 months. RESULTS: Flaps survived in all but one reconstructed case, resulting in equivocal findings compared with microvascular free tissue transfer of nondiabetic patients. Early complications such as delayed healing with minor wound dehiscence were seen in three cases, and partial flap necrosis was seen in four cases. patients with chronic infections were controlled without recurrences. During the follow-up, 69 patients achieved full weight bearing, acceptable contour, and quality of gait before diabetic foot complications. However, late complications such as recurrence of ulceration was noted in one patient, who was blind and unable to perform daily inspection of the foot. CONCLUSIONS: The anterolateral thigh perforator flap provides well-vascularized tissue that controls infection, a thin flap that provides one-stage contouring and minimizes shearing, and a skin paddle that resists pressure and improves durability. The flap can also be combined with vastus lateralis muscle to increase bulk and blood supply against large dead spaces and chronic infections. Anterolateral thigh perforator flaps can be used to achieve acceptable function and aesthetic results for diabetic foot reconstruction.- - - - - - - - - - ranking = 0.11111111111111keywords = pressure (Clic here for more details about this article) |
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