Burning Feet due to Diabetic Neuropathy
Abstract: The authors present the case of a patient with severe burning sensations in the soles of both feet. The patient was diagnosed as having diabetic neuropathy, which can result in extremely variable symptoms ranging from burning, shooting or stabbing pain to complete loss of sensation. The authors discuss treatment of this condition with topical doxepin. Twice daily treatment with doxepin for four weeks eliminated the severe burning sensation without side effects. While it appears that topical doxepin may be an alternative treatment in alleviating neuropathic pain in the diabetic patient, further controlled studies should be conducted to rule out placebo effects.
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Frostbite and Diabetic Neuropathy
[8] Electrodiagnostic testing often cannot identify a superimposed nerve compression in the setting of diabetic neuropathy, even for the most common peripheral nerve entrapment, carpal tunnel syndrome. Nerve compression in the diabetic patient can be treated successfully by surgical decompression of the peripheral nerve at known sites of anatomic narrowing, such as decompression of the carpal tunnel in the upper extremity. Prevention of foot ulceration and amputation by decompression of ...
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Prevalence of Diabetic Neuropathy and Foot Ulceration: Identification of Potential Risk Factors?A Population-Based Study
Abstract: Population-based studies reflecting the true prevalence of a disease need to include a large sample size and to obtain a high response rate in order to truly represent the disease in the community. The aim of this population study was to evaluate the prevalence of peripheral diabetic neuropathy (DN), foot ulceration (FU), and the potential risk factors. Eight-hundred and twenty-one diabetic patients that included 304 men and 781 type 2 patients (80% of the known diabetic population in a county, aged 18?70 years) were studied. Mean age of the patients and known diabetes duration were 59.5 ± 7.46 and 7.6 ± 6.9 years, respectively. Neuropathy was defined clinically by a standardized examination as the presence of abnormalities of at least two of the following criteria: symptoms, sensory, and motor signs (using score techniques). Vibration perception thresholds (VPT) were estimated in all the patients. The prevalence of neuropathy was 33.5 percent (95% confidence limits 30.3?36.7%), prevalence of FU was 4.75 percent (95% confidence limits 3.3?6.2%), and prevalence of peripheral vascular disease (PVD) was 12.7 percent (95% confidence limits 10.7?14.7%). Patients with foot ulcers had more severe neuropathy (NDS 11.6 ± 5.26) and higher VPT (40 ±13.3) than those without foot ulcers (NDS 6.92 ± 2.83, VPT 30 ± 13.8) (p < 0.05). Age, height, fasting glucose, diabetes duration, but not gender were found to be significant risk factors in univariate analyses for DN. Further investigation by multiple logistic regression analysis of the above variables showed that all of them remained significant risk factors for DN (p < 0.05). DN and PVD remained risk factors for FU (p < 0.05). We concluded that a large proportion of the diabetic population are neuropathic and, therefore, at risk of foot ulceration. Strategies to reduce the risk of neuropathy should be developed and should involve all the diabetic population in both rural and urban areas.
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Chronic Wounds: Palliative Management for the Frail Population?PART II
Preface Institutionalized immobile adults with progressive advanced disease(s), who are severely compromised, are defined here as frail patients. This paper focuses on these frail elderly patients with chronic wounds that are unlikely to heal because of the overall status and/or treatment priorities of each individual patient. Chronic wounds have plagued immobile patients with diminished activity and movement levels for centuries. Attempts directed toward the eradication of this complication have enjoyed only limited success. The fact is despite concentrated educational training focused on the prevention of these wounds and the use of punitive measures, such as fines and negligence litigation, the problem persists. This paper attempts to recognize and define the population who do not respond to or who do not want curative treatment goals applied. Recommendations are offered for treating the whole patient who has wounds that are unlikely to heal or for whom healing is not the priority of care. The most important accomplishment of this paper will be to establish a strong foundation for substantive debate on the merits of accepting nonhealing endpoints as appropriate and in the best interest of many frail patients. This paper strives to put forth the collective knowledge about recalcitrant chronic wounds, define the affected population, and outline some treatment options that incorporate the precept of palliative care?relief from suffering. The contributors to the paper reject the notion that the pursuit of palliative treatment objectives without wound healing/closure goals is tantamount to abandoning efforts to improve a patient?s health status. Conversely, this acknowledgment will likely avoid unrealistic expectation and allow caregiver and patient alike to focus on the effective management of symptoms. Chronic wounds have been for too long conceptualized as the sequelae of neglect, incompetence, and/or miscalculation of treatment strategies. There are chronic wounds that will never heal. Therefore, our goa
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Measurements in the Diabetic Foot
Abstract: Diabetic foot syndrome is complex, affects up to 20% of patients with diabetes at least once in their lifetime, and is responsible for the vast majority of amputations in the United States and in Europe. Since its clinical history evolves from an initial nonulcerative phase, to an acute ulcerative phase, an eventual recurrence, and a chronic post-ulcerative phase, measurements related to such a complex condition should explore and exhaustively describe all aspects of the pathology. In the pre-ulcerative phase, evaluation and quantification of risk factors for the development of ulceration are the most important aspects. In this phase, neuropathy and peripheral vascular disease are addressed. In the ulcerative phase, measurements related to the ulcer, including size, location, involvement of deep structures, presence of ischemia, and infection, are all relevant to establish a therapeutic program and a prognosis of the pathologic condition. In the post-ulcerative phase, emphasis should be placed on determining the risk of recurrences and evaluating postural loads and gait imbalances secondary to the outcomes of the acute phase. Such evaluation is important in the prescription of orthesis and shoes that have a protective role with the at-risk foot and thus reduce the risk of recurrences. Measurements in the diabetic foot are of paramount importance to create a quantitative paradigm and reduce empiricism in clinical practice in the management of such a complex pathology.
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March 2004 Industry News
March 2004 Industry News Industry News: March 2004 Industry News - Diabetic Neuropathy Study Using Anodyne Therapy Published in Diabetes Care Demonstrates Reversal of Symptoms Anodyne® Therapy announces the publication of its second peer-reviewed clinical study to demonstrate restoration of sensation in the feet of patients with diabetes with peripheral neuropathy. For more information, visit www.anodynetherapy.com. HydroCision Sells Advanced Wound Business to Smith & Nephew HydroCision Inc...
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March 2007
In more than 200 unsupported clinical cases, Silverlon dressings reduced both healing time and incidence of infection. Visit http://www.silverlon.com for more information.NPUAP Recognizes and Highlights Wound Care Achievements The National Pressure Ulcer Advisory Panel (NPUAP) honored 2 professionals with the Kosiak and Stewart awards during its biennial consensus ...
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Successful Treatment of Recalcitrant, Diabetic Heel Ulcers with Topical Becaplermin (rhPDGF-BB) Gel
Abstract: Patients with diabetes mellitus have an increased risk of lower-limb amputation compared to the nondiabetic population. Foot ulcers precede 85 percent of all nontraumatic, lower-limb amputations. Heel ulcers have the poorest prognosis among diabetic foot ulcers, because flap reconstruction of the heel area is difficult and significant debridement or amputation of the heel rarely leaves a functionally walking patient. Recent advances for the treatment of diabetic foot ulcers have not had much reported success in heel ulcers: Growth factors are less effective in ischemic tissue, and bioengineered dressings are difficult to maintain in position on the heel. Ten patients with neuropathic, diabetic, heel ulcers were treated with pressure relief, debridement, and topical becaplermin (rhPDGF-BB) gel. Ulcers were followed with photography, wound tracing, and area measurement. Eight patients (80%) achieved 100-percent healing at between 13 days and 4 months. This series, although small, suggests becaplermin can be effective in treating neuropathic, diabetic, heel ulcers.
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August Letter from the Editor
August Letter from the Editor Editor's Message: August Letter from the Editor - David Rovee, PhD Editor, WOUNDS David Rovee, PhD Editor, WOUNDS Dear Readers: In the Evidence Corner, Dr. Laura L. Bolton reviews two published studies reporting the efficacy of pulsed-dye laser (PDL), intralesional corticosteroid, intralesional corticosteroid plus 5-fluorouracil (5-FU), or 5-FU alone on ameliorating surgical and burn wound scars. Comparison of the results obtained by LRR and Duplex scanning ...
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Telemedicine for Problematic Wound Management: Enhancing Communication Between Long-Term Care, Skilled Nursing, and Home Caregivers and a Surgical Wound Specialist
Abstract: A wound care program with trained ?field? specialists (RNs and LVNs) to assess wounds and prepare management plans for patients and residents in long-term care, skilled nursing, and home care has been developed. To communicate effectively with a surgical wound care specialist (board-certified plastic surgeon), a communication tool (electronic patient record and digital wound photographs transmitted as e-mail) was created. The purpose of this study was to assess the accuracy of wound evaluations based on records and images electronically transmitted by a consultant as the same consultant subsequently verified the evaluations during direct encounters with the patient. From 2003 through 2005, 120 patients were seen during the course of telemedicine and subsequent direct consultations. In only 2 cases (1.67%), upon physical examination, the surgeon changed the previously established diagnosis and management plan. Telemedicine consultations provide accurate chronic wound assessment, and management plans created prior to a direct evaluation by a specialist are valid.
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