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The aim of this meta‐analysis is to compare the clinical outcomes in patients with and without residual osteomyelitis (ROM) after surgical bone resection for diabetic foot osteomyelitis (DFO). We completed a systematic literature search using PubMed, Scopus, and Embase using keywords DFO, Residual OM (ROM), and positive bone margins. The study outcomes included wound healing, antibiotic duration, amputation, and re‐infection. Five hundred and thirty patients were included in the analysis; 319 had no residual osteomyelitis (NROM), and 211 had ROM. There was not a significant difference in the proportion of wounds that healed 0.6 (p = 0.1, 95% confidence intervals [95% CI] 0.3–1.3). The risk of infection was 2.0 times higher (OR = 2.0, p = 0.02, 95% CI 1.1–3.4), and the risk of amputation was 4.3 times higher (OR = 4.3, p = 0.0001, 95% CI 2.4–7.6) in patients with ROM. Patients with ROM received antibiotics significantly longer. The mean difference was 16.3 days (p = 0.02, 95% CI 11.1–21.1). [ABSTRACT FROM AUTHOR]

Ankle and foot orthotics are suggested for gait rehabilitation therapy after a stroke. Clinical practice necessitates adjusting the ankle foot orthosis torque to accommodate each patient's unique stride and body function. The objective of this paper is to develop a customized, cost-effective footplate orthosis from carbon fibers, manufactured using 3D printing, for individuals with partial foot amputations. The footplate is designed for use in developing nations and aimed to be made available with a reduced lead time. The experiment work carried out in this research is used to design, analyze, and validate a prosthetic footplate. A foot of size UK 7 with a 2 mm thick model of the human foot was modeled using Unigraphics-NX. The footplate's design is being tested both conceptually and empirically. The footplate manufactured by applying load at toe and heel shows that the carbon fiber successfully restores leg length and reduces pressure on the feet's delicate distal end. [ABSTRACT FROM AUTHOR]

Diabetic Foot Ulcers (DFU) represent a grave complication often encountered in the advanced stages of diabetes mellitus. They frequently lead to recurrent hospitalizations and, in severe cases, can result in life-threatening conditions such as infections, gangrene, and even amputation Diabetic foot ulcers (DFU), as a serious complication in the late stage of diabetes mellitus, are prone to lead to repeated hospitalization, and in severe cases, infection, gangrene, and even amputation. Although there are many methods for treating diabetic foot, there is no clear and effective method to reduce the amputation rate of diabetic foot patients. In recent years, advancements in the understanding of stem cell therapy for the treatment of DFU have shed light on its potential as a novel therapeutic approach. In recent years, as the research on stem cell therapy for diabetic foot is gradually deepening, stem cells are expected to become a new therapeutic method for treating DFU in the future. Their therapeutic effects are through promoting angiogenesis, secreting paracrine factors, controlling inflammation, promoting collagen deposition, and regulating immunity, etc. Despite numerous studies confirming the efficacy of stem cell therapy in treating DFU, there is still a need for the establishment of standardized treatment protocols. Although numerous studies have shown that stem cell therapy for DFU is real and effective, there has not yet been a standardized treatment protocol. This article reviews studies related to stem cell therapy for DFU, looking at the mechanism of action, types of stem cells, and modes of administration. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer have affected the lives of patients, families, and other care takers for decades and frequently lead to significant morbidity and mortality. If these silent lesions are left undiagnosed or not treated early, they lead to amputations. Methods: The aim of this study is to identify the incidence and risk factors for diabetic foot ulcer leading to lower extremity amputation. Detailed history, examination and investigations were done. Appropriate interventions carried out. The outcome was analyzed and risk factors for amputation were assessed. Conclusion: Most patients belong to low socioeconomic class with late presentation to hospital and advanced disease. Hence amputation rates are higher. Most important preventive measure to reduce amputation will be to bring the primary disease under control. Timely intervention and early diagnosis are key for reducing mortality and amputation rates. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFU) in patients with uncontrolled diabetes mellitus are considered a global public health menace that is highly associated with morbidity and mortality. Pathogenic microorganisms entrenched deep into diabetic foot wounds are the causative agents for delayed healing and escalation of diabetic foot wound severity. Pseudomonas aeruginosa is a common opportunistic pathogen associated with several nosocomial infections, cystic fibrosis, and one of the most critical pathogens often isolated from acute and chronic diabetic foot ulcers. The organism can exhibit resistance to a wide range of antibiotics like ciprofloxacin, cefotaxime, and meropenem, thereby causing severe damage to the host tissues, followed by amputation of the affected foot region. Due to their ability to synthesize biofilms, the wound becomes more chronic and incurable, posing a serious threat to immunocompromised diabetic patients. This review highlights on the insights of pathophysiology and microbiological profile of Diabetic foot ulcers, the resistance mechanisms, and the therapeutics available for dealing with drug-resistant Pseudomonas, which could help clinicians in treating DFUs. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcer is a chief distress of diabetes mellitus. The diabetic foot ulcer (DFU) is the extremely injurious dilemma associated to diabetes mellitus. DFU is a risky illness, and it desires customary cure or else it might direct to foot amputation. When not treated it leads to some health issues and hence a novel method is proposed for efficient classification of DFU images. The DFU in this research is categorized into four classes like normal foot, high risk foot, ulcerated foot, and infected foot. Initially, a DFU dataset is made utilizing hyperspectral DFU images and pre-processing is done with aid of adaptive median filter. Consequently, the image is segmented by improved fuzzy c-means – particle swarm optimization algorithm. Then, a count of second order statistical texture features comprising entropy, energy; correlation, homogeneity, and contrast are produced via Gray Level Co-occurrence Matrix (GLCM). Finally, images are classified with aid of novel hybrid convolution neural network along with support vector machine. Here the novelty is derived by use of a new regularizer. The experiment is done with a manually created dataset. The performance evaluation is done by computing recall, precision, F1-score and accuracy. The results are compared with existing algorithms that show that the proposed hybrid system gives high classification accuracy. [ABSTRACT FROM AUTHOR]

Background/Objectives: Diabetic foot ulcers are one of the complications in patients with diabetes, which can be caused by infection, neuropathy, and blood vessel disorder. Among them, infection is the most common cause, and if it becomes worse, amputation may be necessary. So, it is important to detect and treat infections early, and determining indicators that can confirm infection is also important. Known infection markers include white blood cells (WBCs), the erythrocyte sediment rate (ESR), C-reactive protein (CRP), and procalcitonin, but they are not specific to diabetic foot ulcers. Presepsin, also known as soluble CD14, is known to be an early indicator of sepsis. Recent studies have reported that presepsin can be used as an early indicator of infection. This study investigated whether presepsin could be used as an early marker of severe infection in patients with diabetic foot ulcers. Methods: We retrospectively studied 73 patients who were treated for diabetic foot ulcerations from January 2021 to June 2023 at Yeungnam University Hospital. Results: Out of a total of 73 patients, 46 patients underwent amputations with severe infections, and the WBC level, ESR, and CRP, procalcitonin, and presepsin levels were significantly higher in the group of patients who underwent amputations. The cutoff of presepsin, which can predict serious infections that need amputation, was 675 ng/mL. A regression analysis confirmed that presepsin, HbA1c, and osteomyelitis significantly increased the risk of severe infections requiring amputation. Conclusions: Presepsin will be available as an early predictor of patients with severe infections requiring amputations for diabetic foot ulcerations. [ABSTRACT FROM AUTHOR]

Objective: We assessed equity in the uptake of remote foot temperature monitoring (RTM) for amputation prevention throughout a large, integrated US healthcare system between 2019 and 2021, including comparisons across facilities and between patients enrolled and eligible patients not enrolled in RTM focusing on the Reach and Adoption dimensions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Material and methods: To assess whether there was equitable use of RTM across facilities, we examined distributions of patient demographic, geographic, and facility characteristics across facility RTM use categories (e.g., no RTM use, and low, moderate, and high RTM use) among all eligible patients (n = 46,294). Second, to understand whether, among facilities using RTM, there was equitable enrollment of patients in RTM, we compared characteristics of patients enrolled in RTM (n = 1066) relative to a group of eligible patients not enrolled in RTM (n = 27,166) using logistic regression and including all covariates. Results: RTM use increased substantially from an average of 11 patients per month to over 40 patients per month between 2019 and 2021. High-use RTM facilities had higher complexity and a lower ratio of patients per podiatrist but did not have consistent evidence of better footcare process measures. Among facilities offering RTM, enrollment varied by age, was inversely associated with Black race (vs. white), low income, living far from specialty care, and being in the highest quartiles of telehealth use prior to enrollment. Enrollment was positively associated with having osteomyelitis, Charcot foot, a partial foot amputation, BMI≥30 kg/m2, and high outpatient utilization. Conclusions: RTM growth was concentrated in a small number of higher-resourced facilities, with evidence of lower enrollment among those who were Black and lived farther from specialty care. Future studies are needed to identify and address barriers to uptake of new interventions like RTM to prevent exacerbating existing ulceration and amputation disparities. [ABSTRACT FROM AUTHOR]

Aims: Pedal medial arterial calcification (MAC) is frequently observed in individuals with diabetic foot ulcers (DFUs). However, the impact of pedal MAC on individuals with DFUs remains uncertain. The main aim of this study was to evaluate the association between pedal MAC with amputation and mortality outcomes. Methods: A prospective, observational cohort study was conducted at West China Hospital from January 2012 to December 2021. Logistic regression analyses, Kaplan–Meier survival method, and Cox proportional hazards models were employed to evaluate the relationship between pedal MAC and amputation as well as mortality. Results: A total of 979 patients were enrolled in the study. Peripheral artery disease (PAD) was observed in 53% of patients with DFUs, and pedal MAC was found in 8%. Over a median follow‐up of 46 (23–72) months, foot amputation was performed on 190 patients, and mortality occurred in 246 patients. Pedal MAC showed a significant association with amputation both in unadjusted analysis (odds ratio [OR] = 2.98, 95% confidence interval [CI] = 1.86–4.76, p <.001) and after adjusting sex, age, albumin levels, hemoglobin levels, and diabetic retinopathy status (OR 2.29, 95% CI 1.33–3.93, p =.003). The risk of amputation was found to be twofold higher in individuals with PAD and pedal MAC compared to those with PAD alone (OR 2.05, 95% CI 1.10–3.82, p =.024). Furthermore, the presence of pedal MAC was significantly associated with an increased risk of mortality (p =.005), particularly among individuals with DFUs but without PAD (HR 4.26, 95% CI 1.90–9.52, p <.001), rather than in individuals presenting with both DFUs and PAD. Conclusion: The presence of pedal MAC is significantly associated with both amputation and mortality in individuals with DFUs. Moreover, pedal MAC could provide additional value to predict amputation other than PAD. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis pooled evidence from randomised controlled trials (RCTs) on the effectiveness of educational programs for people with or at risk of diabetes‐related foot disease (DFD). A systematic search identified RCTs evaluating the effectiveness of educational programs in preventing or managing DFD. The primary outcome was risk of developing a foot ulcer. Secondary outcomes included any amputation, mortality, changes in cardiovascular risk factors, foot‐care knowledge and self‐care behaviours. Meta‐analyses were performed using random effects models. Risk of bias was assessed using Cochrane's ROB‐2 tool. Education programs were tested in 29 RCTs (n = 3891) and reduced risk of a foot ulcer by approximately half although the upper 95% confidence interval (CI) reached 1.00 (odds ratio [OR], OR 0.54; 95% CI 0.29, 1.00, I2 = 65%). Education programs reduced risk of any amputation (OR 0.34; 95% CI 0.13, 0.88, I2 = 38%) and HbA1c levels (standardized mean difference −0.73; 95% CI −1.26, −0.20, I2 = 93%) without affecting all‐cause mortality (OR 1.09; 95% CI 0.57, 2.07, I2 = 0%). Education programs mostly significantly improved DFD knowledge (13 of 16 trials) and self‐care behaviour scores (19 of 20 trials). Only one trial was deemed at low risk of bias. Previously tested education programs have mostly effectively improved participants' knowledge and self‐care behaviours and reduced risk of foot ulceration and amputation. Larger high quality trials with longer follow‐up are needed. [ABSTRACT FROM AUTHOR]

The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the management and prevention of diabetes‐related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline. This was structured around identifying clinically relevant questions in the P(A)ICO format, determining patient‐important outcomes, systematically reviewing the evidence, assessing the certainty of the evidence, and finally moving from evidence to the recommendation. This guideline was developed for healthcare professionals involved in diabetes‐related foot care to inform clinical care around patient‐important outcomes. Two systematic reviews from 2019 were updated to inform this guideline, and a total of 149 studies (62 new) meeting inclusion criteria were identified from the updated search and incorporated in this guideline. Updated recommendations are derived from these systematic reviews, and best practice statements made where evidence was not available. Evidence was weighed in light of benefits and harms to arrive at a recommendation. The certainty of the evidence for some recommendations was modified in this update with a more refined application of the GRADE framework centred around patient important outcomes. This is highlighted in the rationale section of this update. A note is also made where the newly identified evidence did not alter the strength or certainty of evidence for previous recommendations. The recommendations presented here continue to cover various aspects of diagnosing soft tissue and bone infections, including the classification scheme for diagnosing infection and its severity. Guidance on how to collect microbiological samples, and how to process them to identify causative pathogens, is also outlined. Finally, we present the approach to treating foot infections in persons with diabetes, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and bone infections; when and how to approach surgical treatment; and which adjunctive treatments may or may not affect the infectious outcomes of diabetes‐related foot problems. We believe that following these recommendations will help healthcare professionals provide better care for persons with diabetes and foot infections, prevent the number of foot and limb amputations, and reduce the patient and healthcare burden of diabetes‐related foot disease. [ABSTRACT FROM AUTHOR]

Diabetes‐related foot disease results in a major global burden for patients and the healthcare system. The International Working Group on the Diabetic Foot (IWGDF) has been producing evidence‐based guidelines on the prevention and management of diabetes‐related foot disease since 1999. In 2023, all IWGDF Guidelines have been updated based on systematic reviews of the literature and formulation of recommendations by multidisciplinary experts from all over the world. In addition, a new guideline on acute Charcot neuro‐osteoarthropathy was created. In this document, the IWGDF Practical Guidelines, we describe the basic principles of prevention, classification and management of diabetes‐related foot disease based on the seven IWGDF Guidelines. We also describe the organisational levels to successfully prevent and treat diabetes‐related foot disease according to these principles and provide addenda to assist with foot screening. The information in these practical guidelines is aimed at the global community of healthcare professionals who are involved in the care of persons with diabetes. Many studies around the world support our belief that implementing these prevention and management principles is associated with a decrease in the frequency of diabetes‐related lower‐extremity amputations. The burden of foot disease and amputations is increasing at a rapid rate, and comparatively more so in middle to lower income countries. These guidelines also assist in defining standards of prevention and care in these countries. In conclusion, we hope that these updated practical guidelines continue to serve as a reference document to aid healthcare providers in reducing the global burden of diabetes‐related foot disease. [ABSTRACT FROM AUTHOR]

Diabetes mellitus-related lower extremity amputation increases health burden and reduces patients' quality of life, mortality and morbidity rate in a country like India. The most common complication in DM patients is uncontrolled hyperglycemia and foot ulceration. We report an unpredicted occurrence of right leg amputation in diabetic amputee patients. A 46-year-old male patient developed a complication to his contralateral limb due to poor negligence even after his first above-knee amputation; the patient was again readmitted for the below-knee amputation and hyperglycaemia. Although all the major complications of DM like hyperglycemia, cataracts, diabetic foot and diabetic foot amputation were found in the same index patient. The risk of amputation is high in diabetic patients and the prevalence of amputation is even extremely high in diabetic smokers. Hence proper lifestyle modification is needed along with dietary approaches to prevent and manage diabetes related complications. Regular foot examination and patient education are necessary which alerts the patient and family members to avoid the major risk of DM complications. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD), have a high prevalence of cardiovascular disease and peripheral arterial disease (PAD). Medical treatment is mainly based on risk factor management, and the surgical approach remains the gold standard treatment in specific conditions. Heparin-mediated extracorporeal low-density lipoprotein precipitation (H.E.L.P.) apheresis is effective in reducing circulating lipoprotein, fibrinogen, inflammatory mediators and procoagulant factors, thereby reducing cardiovascular risk in patients with familial hypercholesterolemia and hypertriglyceridemia. These activities may be effective in reducing symptoms and ischemic vascular lesions even in patients with severe PAD. We reported the application of a treatment protocol with H.E.L.P. apheresis in an ESRD patient with severe PAD without clinical improvement after severe revascularization who was not suitable for further surgical approaches, despite normal LDL cholesterol and lipoprotein (a). The H.E.L.P. protocol was characterized by an intensive first phase with weekly treatments followed by a single session every 10–15 days for 6 months of treatment. The overall clinical condition, foot lesions and walking distance improved significantly after the first 2 months of treatment, and foot amputation was avoided. Here, we review the main pathogenetic mechanisms through which LDL apheresis improves microcirculation and clinical outcomes. Its wider application may represent an optimal therapeutic option for patients unresponsive to standard treatment. [ABSTRACT FROM AUTHOR]

Chronic skin wounds represent a prominent etiological factor in the occurrence of non-traumatic foot amputations on a global scale and pose a substantial threat to the patient's well-being and mortality in the absence of effective treatment strategies. There exists a subset of patients that exhibit an insufficient response to different treatment options, comprising antibiotics, dressings, gauze bandages, debridement, rehabilitation, collagen patch, and vacuum-assisted closure. In this patient group, distinct treatment strategies emerge before surgery and amputation. Ozone therapy is one of them. Ozone exhibits a wide variety of effects such as antimicrobial, anti-inflammatory, antioxidant, and trophic. Its trophic effect is mediated by disinfection, stimulation of granulation tissue, acceleration of the angiogenesis process, and detoxification mechanisms. In this article, we presented the beneficial effect of ozone therapy in a case of chronic skin ulcer associated with livedoid vasculopathy. In this context, we aimed to discuss the role of ozone therapy in the management of chronic skin ulcers. Finally, we focused on ozone therapy as a promising method in inflammatory rheumatic diseases. [ABSTRACT FROM AUTHOR]

Introduction: Over 150,000 lower limb amputations every year in the US cost the healthcare system billions due to rising diabetes rates. Clinical state and soft tissue viability determine amputation. Medical optimization and amputation methods are examined. Guillotine, complete, and skin flap patterns are explored for below-knee amputations. Marking an incision, separating nerves and veins, cutting bones, and stabilizing the weight are the procedures. Rehabilitation requires wound care and prosthetic fitting after surgery. Aims and objectives: This study aims to investigate lower limb amputation causes and assessment methodologies for clinical decision-making and patient care. Methods: This prospective observational study at a tertiary care centre, examined lower limb amputations. From medical records, demographics, comorbidities, amputation levels, complications, hospital stays, death, prosthetic use, and functional outcomes were obtained. While protecting privacy and ethics, statistical tests were used to compare patient subgroups. The study aims to improve patient care and treatment after lower limb amputations. Results: Table 1 shows that 51.7% of lower limb amputations were attributable to PVD and 41.7% to diabetic foot. Spread cellulitis was 5% and osteomyelitis was 1.6%. Table 2 demonstrates that transfemoral (58.3%) amputations were more common than transtibial (41.7%), suggesting severe underlying diseases. Table 3 shows that PAOD patients had above-knee amputations and Diabetic Foot patients below-knee ones. The 40-60 age range had 86.70% male patients, as seen in Figure 1. Conclusion: This research emphasizes stump quality over length in amputation recovery and the benefits of early prosthesis fitting and complete care teams for amputee outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to investigate the associations between concurrent atrial fibrillation and diabetes-related complications among patients with diabetes. RESEARCH DESIGN AND METHODS: This nationwide observational cohort study used the health checkup database from the Korean National Health Insurance Service. Patients diagnosed with diabetes who underwent health checkups between 2009 and 2012 were investigated. The patients with atrial fibrillation were matched in a 1:5 ratio with those without atrial fibrillation using propensity scores. Study outcomes included macrovascular, microvascular (diabetic retinopathy and diabetic nephropathy), and diabetic foot complications. The risks of clinical outcomes were measured using hazard ratios (HRs) with 95% CIs. RESULTS: A total of 65,760 patients with diabetes were analyzed (54,800 without atrial fibrillation and 10,960 with atrial fibrillation). After well-balanced propensity score matching, atrial fibrillation was associated with significantly higher risks of macrovascular complications (HR 1.12, 95% CI 1.09–1.16), diabetic nephropathy (HR 1.23, 95% CI 1.16–1.30), and diabetic foot complications (HR 1.13, 95% CI 1.09–1.17) compared with no atrial fibrillation, while the risk of diabetic retinopathy was comparable (HR 0.99, 95% CI 0.96–1.03). Patients with atrial fibrillation had a significantly higher risk of diabetic foot amputation (HR 4.12, 95% CI 1.98–8.56). CONCLUSIONS: Among patients with diabetes, concurrent atrial fibrillation was associated with increased risks for diabetes-related macrovascular complications, diabetic nephropathy, and diabetic foot. Such patients require holistic management to reduce the risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) are considered a major problem for public health, leading to high rates of lower-limb amputations. Moreover, due to the high prevalence rate of predisposing factors, the incidence rate of DFU is still rising. Although DFUs are complex in nature, foot ulceration usually precedes diabetic foot amputations. These impaired chronic wounds usually promote a microbial biofilm, commonly characterized by the presence of multidrug-resistant microorganisms, hampering the efficacy of conventional antibiotic treatments. Honey has been shown to be an effective antibacterial component, including against multidrug-resistant bacteria. Honey's physical–chemical characteristics, such as the presence of hydrogen peroxide, its low pH levels, and its high sugar and phenolic contents, promote anti-inflammatory and antioxidative activities, improving wound healing. This review aims to explore honey's effects in wound healing, especially for DFUs, and to show how the different physical–chemical features among different honey types might influence the treatment's effectiveness. For this, the mechanisms by which honey can promote wound healing and the potential use of honey dressings in diabetic wounds were investigated in animal models and humans. After revising the diabetic wound impairment mechanisms, we found that most of the clinical studies that treated DFUs with honey in animal models or humans reported accelerated wound healing, greater wound contraction, and lower amputation or hospitalization rates; however, few studies characterized the features of honeys used for wound treatment, hindering the possibility of extensively comparing the different types of honey and identifying characteristics that most successfully promote wound healing. According to this review, honey is a cost-effective and safe option for DFU management. [ABSTRACT FROM AUTHOR]

This Medical News article discusses how multidisciplinary care teams, new drugs and devices, and practical solutions to socioeconomic factors could reduce diabetic foot infections and amputations. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes and frequently necessitates amputation, which lowers quality of life with the distressing prospect of re-amputation and increased mortality. The available classifications for a standardized approach to diabetic foot ulceration, though crucial in predicting clinical outcomes, have their limitations. Aims and Objectives: This study examined the reliability of the University of Texas (UT) classification system in predicting outcomes of diabetic foot in a tertiary center in Kerala, South India. Materials and Methods: In this prospective observational study, 98 DFU patients at Jubilee Mission Medical College and Research Institute, Thrissur, from December 2019 to June 2022 were categorized according to UT classification, and the treatment with outcomes for 6 months was recorded. Results: Among the total population, 24.4% of diabetic feet achieved healing without amputation. We observed an increasing incidence of impairment of healing (P=0.018) and in the number of amputations in Grades 1, 2, and 3 (P=0.000). At 6 months, 52% of diabetic feet, including those who underwent amputation, healed completely. Conclusion: DFU in a lower grade but higher stage according to the UT classification showed impaired healing and higher amputation rates as this system includes infection and ischemia. This classification allows reliable categorization and enables re-allocation of grade and stage of diabetic foot during treatment and follow-up, thereby facilitating effective management and predicting outcome. [ABSTRACT FROM AUTHOR]

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Background: The importance of collaboration between vascular and podiatric surgeons has been well-established. High-level partnerships are integral to the development of multidisciplinary programs and wound care centers, ultimately resulting in improved patient outcomes. This vascular–podiatric integration is not universal, however, and podiatric surgery may not be aligned within a vascular surgery division at many institutions. As one such institution, we reviewed our single-center experience in order to identify opportunities for the impactful integration of vascular–podiatric patient care. Methods: Institutional electronic medical records were retrospectively reviewed for all procedures performed by vascular surgeons at a high volume, safety-net academic medical center. Data were collected on all primary and additional procedures, current procedural terminology (CPT) codes, case type (elective, urgent, emergent), surgeon specialty, and date/time of the procedures performed. CPT codes were linked to the Centers for Medicare & Medicaid Services' Physician Fee Schedule to estimate the work relative value unit (wRVU) per procedure. Results: From 2018 to 2022, vascular surgeons performed a total of 12,206 operations, of which 1102 (9.9%) involved podiatric procedures. The most common vascular-performed podiatry procedures performed were toe amputations (38.1%, n = 420), transmetatarsal foot amputations (20.1%, n = 222), and ankle/foot debridement (16.2%, n = 178). Foot/ankle-specific procedures were identified as the primary procedure in 726 (65.9%) cases and as the adjunct procedure in 376 (34.1%) cases. A substantial proportion of podiatric procedures occurred on an urgent (n = 278, 25.2%) or emergent (n = 28, 2.5%) basis. A total of 163 (14.8%) cases occurred after hours (either before 0600 or after 1800), and 133 (12.1%) cases were performed on a holiday or weekend. Procedure-specific revenue included 4243.39 wRVU for primary procedures and 2108.08 wRVU for additional procedures performed. Conclusions: We report our single-center experience in which vascular surgeons provide a significant proportion of podiatric procedures. Our study underscores the potential for integrating podiatric surgeons within a vascular surgical division and presents opportunities for collaboration and enhanced patient care. [ABSTRACT FROM AUTHOR]

Background: A certified hyperbaric and wound care specialist in the South-west US evaluated three patients who presented with refractory wounds containing substantial necrotic tissue. Aims and Objectives: The primary aim/objective of this study was for the investigator to ascertain if the wound gel, in combination with dietary changes and standard hyperbaric oxygen treatment (HBOT) when placed on refractory wounds evidentiary with necrotic tissue, would result in favorable wound healing outcomes. This study's secondary aim/objective was to determine if this treatment approach could result in avoiding costly and deleterious, lifechanging amputations, and/or surgical reconstructions. Materials and Methods: The physician investigator conducted this qualitative method case study during her regular professional medical practice. She selected study subjects based on the exigency of patients' needs. The three subjects selected met three inclusion criteria. The first inclusion criterion was that the patient had at least one serious refractory wound, which wound did not respond to any previous treatment regimens at any treatment center. The second inclusion criterion was that significant necrotic tissue was evidentiary in the wound(s). The third inclusion criterion was that each patient was facing traumatic surgical intervention - either amputation or excision with reconstruction. The investigator measured wound diameters and tracked the time to wound closure and wound healing. In addition, the investigator noted patient comments during the wound healing. Results: In two cases, patients were scheduled for umbilical reconstruction; in the third, the patient was scheduled for a frontal foot amputation. In 10 weeks, the three patients experienced complete wound healing or substantial wound resolution. Case #2 patient initially only received HBOT at a different wound center and was emergently admitted to the hospital after 2 weeks of HBOT (no dietary alteration or specialized wound gel application). The patient underwent wide excisional debridement with general surgery but received the trifurcated treatment regimen after discharge, resulting in wound healing within 10 weeks. Conclusion: These results warrant further study with more subjects to determine the replicability of findings. If the results are generalizable to this population of patients suffering from advanced refractory wounds and facing limb amputations, the health and quality-of-life benefits for these patients and the prospective cost savings on the U.S. health system could be incalculable. [ABSTRACT FROM AUTHOR]

Background: One of the most devastating complications of diabetes is diabetes-related foot disease (DFD), which is a priority for public health systems. The 2016–2020 Catalonia Health Plan aimed to reduce the incidence of total and major lower-extremity amputations (LEAs) due to DFD by 10% in the population aged 45–74 years. The aim of the present study was to compare the incidence of LEA-DFD 5 years before and after the creation of the Diabetic Foot Multidisciplinary Unit at our Hospital. Methods: We prospectively collected all cases of LEA-DFD performed at Vall d'Hebron University Hospital from 1 January 2016 to 31 December 2020. Cases of LEA-DFD performed from 1 January 2011 to 31 December 2015 were retrospectively reviewed. The incidence of LEA-DFD between these periods was compared. Results: A total of 457 LEAs due to DFD were performed in 316 patients. We observed a reduction of 27.9% [CI: 23.7–32.1%] in the incidence of total LEA in the 2016–2020 period in comparison with the period 2011–2016 (0.8 ± 0.1 vs. 1.1 ± 0.3 per 10.000 inhabitants/year, p < 0.001), as well as a reduction of 49.3% [CI: 44.6–53.9%] in the incidence of major LEA-DFD (0.15 ± 0.1 vs. 0.30 ± 0.1 per 10.000 inhabitants/year, p < 0.001). Conclusions: The implementation of a Diabetic Foot Multidisciplinary Unit resulted in a significant reduction in the rate of amputations due to DFD in the population with diabetes in North Barcelona. [ABSTRACT FROM AUTHOR]

Background: Patients with diabetes and peripheral arterial disease are at increased risk of minor amputation. The aim of study was to assess the rate of re-amputations and death after an initial minor amputation, and to identify associated risk factors. Methods: Data on all patients aged 40 years and over with diabetes and/or peripheral arterial disease, who underwent minor amputation between January 2014 and December 2018, were extracted from Hospital Episode Statistics. Patients who had bilateral index procedures or an amputation in the 3 years before the study were excluded. Primary outcomes were ipsilateral major amputation and death after the index minor amputation. Secondary outcomes were ipsilateral minor re-amputations, and contralateral minor and major amputations. Results: In this study of 22 118 patients, 16 808 (76.0 per cent) were men and 18 473 (83.5 per cent) had diabetes. At 1 year after minor amputation, the estimated ipsilateral major amputation rate was 10.7 (95 per cent c.i. 10.3 to 11.1) per cent. Factors associated with a higher risk of ipsilateral major amputation included male sex, severe frailty, diagnosis of gangrene, emergency admission, foot amputation (compared with toe amputation), and previous or concurrent revascularization. The estimated mortality rate was 17.2 (16.7 to 17.7) per cent at 1 year and 49.4 (48.6 to 50.1) per cent at 5 years after minor amputation. Older age, severe frailty, comorbidity, gangrene, and emergency admission were associated with a significantly higher mortality risk. Conclusion: Minor amputations were associated with a high risk of major amputation and death. One in 10 patients had an ipsilateral major amputation within the first year after minor amputation and half had died by 5 years. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus is a public health problem becoming more prevalent. Diabetic foot is a debilitating condition caused by diabetes mellitus. Diabetic foot, which includes foot ulceration, infection, and destruction of tissues may necessitate amputation. The aim of this review is to derive evidence from existing systematic reviews and meta-analysis on the effectiveness of foot care educational interventions, directly aimed at people living with diabetes. A systematic search was implemented using biomedical citation databases including Embase, CINAHL, MEDLINE, and PsycINFO. Major repositories of systematic reviews such as the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, and the PROSPERO register were also searched. The search also included a grey literature search and manual searches of reference lists contained within review studies and other relevant published reviews. The umbrella review searched for articles published from January 2016 to 2021 to ensure sources were current and reflected the most recent interventions. This umbrella review is the first to collect and summarise the evidence from existing systematic reviews and meta-analyses of foot care educational interventions directly aimed at people living with diabetes. It reports findings from nine systematic reviews on the evaluation of foot care educational interventions. The number of studies included in each review ranged from 6 to 81. A total of 314 primary studies were included. After examining the overlap between studies reported in multiple reviews, 82 were included in the final review. Without providing effective and consistent preventive and prophylactic foot care, creating, and testing interventions, integrating the concept into practice will remain challenging. Currently, most educational foot care intervention programmes concentrate on a single intervention. However, there is insufficient evidence that a single educational intervention effectively reduces the occurrence of ulcers and amputations or improves patients' knowledge and behaviour. Two studies used complex interventions, and they reduced the incidence amputation and foot ulceration incidence for people living with diabetes. [ABSTRACT FROM AUTHOR]

The high prevalence of lower extremity ulceration and amputation in people with diabetes is strongly linked to difficulties in achieving and maintaining a reduction of high plantar pressures (PPs) which remains an important risk factor. The effectiveness of current offloading footwear is opposed in part by poor patient adherence to these interventions which have an impact on everyday living activities of patients. Moreover, the offloading devices currently available utilize primarily passive techniques, whereas PP distribution is a dynamically changing process with frequent shifts of high PP areas under different areas of the foot. Thus, there is a need for pressure offloading footwear capable of regularly and autonomously adapting to PPs of people with diabetes. The aim of this article is to summarize the concepts of intelligent pressure offloading footwear under development which will regulate PPs in people with diabetes to prevent and treat diabetic foot ulcers. Our team is creating this intelligent footwear with an autocontouring insole which will continuously read PPs and adapt its shape in the forefoot and heel regions to redistribute high PP areas. The PP-redistribution process is to be performed consistently while the footwear is being worn. To improve adherence, the footwear is designed to resemble a conventional shoe worn by patients in everyday life. Preliminary pressure offloading and user perceptions assessments in people without and with diabetes, respectively, exhibit encouraging results for the future directions of the footwear. Overall, this intelligent footwear is designed to prevent and treat diabetic foot ulcers while enhancing patient usability for the ultimate prevention of lower limb amputations. [ABSTRACT FROM AUTHOR]

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Heel ulcer is one of the severe complications of patients with diabetes mellitus, which poses a high risk for foot infection and amputation, especially in patients with peripheral arterial disease and neuropathy. Researchers have searched for new treatments for treating diabetic foot ulcers in recent years. In this case report, we demonstrated the treatment of large ischemic ulcers for the first time in a diabetic patient. The overall treatment goal of this patient was designed to improve blood supply to her diseased lower extremities and close the ulcer. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at postoperative follow-up. [ABSTRACT FROM AUTHOR]

A 47-year-old female patient with no known disease other than rheumatoid arthritis in remission was admitted to the hospital with complaints of bruising on her feet, breasts, hips, and back. It was determined that her severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test was positive 7 days ago and she received favipiravir treatment for 5 days. In the physical examination, ecchymotic lesions were detected in her both feet, breasts, trochanteric regions, and posterior thoracic regions, which were symmetrical and did not change color with pressure in varying sizes. There were diffuse bilateral ground glass and consolidation areas in the computed tomography of the lungs. Because of the histopathological examination of the biopsy taken from the skin lesions, the patient was diagnosed with leukocytoclastic vasculitis. In the lower extremity venous Doppler ultrasonography examination, there was complete occlusion due to thrombus in the subacute period in the right vena saphena parva. During the subsequent intensive care follow-up period, necrotic lesions progressed to amputation in the right foot, debridement in the left foot, and trochanteric regions, and bilateral mastectomy. Our patient required multidisciplinary management involving many specialties during her long-term stay in the intensive care unit. Here, we present a case of coronavirus disease-2019 leading to severe and diffuse leukocytoclastic vasculitis resulting in amputation. [ABSTRACT FROM AUTHOR]

BACKGROUND Approximately 20% of patients with chronic limb-threatening ischemia have no revascularization options, leading to above-ankle amputation. Transcatheter arterialization of the deep veins is a percutaneous approach that creates an artery-to-vein connection for delivery of oxygenated blood by means of the venous system to the ischemic foot to prevent amputation. METHODS We conducted a prospective, single-group, multicenter study to evaluate the effect of transcatheter arterialization of the deep veins in patients with nonhealing ulcers and no surgical or endovascular revascularization treatment options. The composite primary end point was amputation-free survival (defined as freedom from above-ankle amputation or death from any cause) at 6 months, as compared with a performance goal of 54%. Secondary end points included limb salvage, wound healing, and technical success of the procedure. RESULTS We enrolled 105 patients who had chronic limb-threatening ischemia and were of a median age of 70 years (interquartile range, 38 to 89). Of the patients enrolled, 33 (31.4%) were women and 45 (42.8%) were Black, Hispanic, or Latino. Transcatheter arterialization of the deep veins was performed successfully in 104 patients (99.0%). At 6 months, 66.1% of the patients had amputation-free survival. According to Bayesian analysis, the posterior probability that amputation-free survival at 6 months exceeded a performance goal of 54% was 0.993, which exceeded the prespecified threshold of 0.977. Limb salvage (avoidance of above-ankle amputation) was attained in 67 patients (76.0% by Kaplan–Meier analysis). Wounds were completely healed in 16 of 63 patients (25%) and were in the process of healing in 32 of 63 patients (51%). No unanticipated device-related adverse events were reported. CONCLUSIONS We found that transcatheter arterialization of the deep veins was safe and could be performed successfully in patients with chronic limb-threatening ischemia and no conventional surgical or endovascular revascularization treatment options. [ABSTRACT FROM AUTHOR]

Complications remain despite conventional methods aimed at improving survivorship of lower extremity amputations. High rates of wound dehiscence, readmission, and revision surgery warrant the development of innovative methods to improve amputation survivorship. One such method employs the use of indocyanine green dye (ICG); an inert chemical injected intraoperatively which can be used to visualize dermal blood flow in real time. There is little objective data available to help guide the use of indocyanine green in limb salvage procedures. The present study compares a group of 31 patients undergoing minor lower extremity amputation with the use of indocyanine green with a control group of 62 patients in which traditional methods were used. Minimum follow-up of 9 months was obtained, leaving 93 patients in total for analysis. Success was defined as a healed amputation within 60 days of follow-up. Uneventful amputation healing occurred in 35.5% and 33.9% of indocyanine green and control patients, respectively. Overall, there was no significant difference in outcomes between groups (p =.965), or success versus failure (p = 1.0). Patient undergoing minor lower extremity amputation with the use of ICG fluorescence angiography did not have statistically inferior outcomes to patients who underwent amputations at the same level with traditional assessments of perfusion. Further research involving the use of this technique is warranted. [ABSTRACT FROM AUTHOR]

Aims: We investigated whether Diabetic Retinopathy (DR) is related to Diabetic Foot Ulcer (DFU) development, adjusted for the stratification of the International Work Group on Diabetic Foot (IWGDF) guidance. Materials and Methods: DR and IWGDF stratification was registered retrospectively in patients hospitalised from 2009 to 2017 for uncontrolled and/or complicated type 2 diabetes. New DFUs were registered until 2020. Survival analyses categorised the subjects for DR, and multivariate Cox regression adjusted for confounders. Results: The 522 patients (57.9% male) were 62 ± 9 years old with a diabetes duration of 14 ± 10 years, HbA1c of 8.7 ± 1.8%, 33.9% macroangiopathies and 44.8% diabetic kidney diseases. Their grades of DFU risk were 0 for 43.3%, 1 for 23.9%, 2 for 7.1%, and 3 for 25.6%. During the 52 months follow‐up (Inter Quartile Range: 32–71), 58 new DFUs and 18 lower‐limb amputations occurred, mostly in patients with DR present in 140 (26.8%) patients. Adjusted for age, sex and conventional risk factors (duration and control of diabetes, arterial hypertension, and dyslipidemia), and other complications (macroangiopathy and diabetic kidney disease), DR was associated with a greater incidence of DFUs. Adjusted for the IWGDF classification, DR was related to new DFUs (HR: 2.51, 95%Confidence Interval [CI]: 1.48–4.26) and amputations (HR: 3.56, 95%CI: 1.26–10.07). This relationship persisted in ascending IWGDF grades with incidences of DFUs from 2/1000 (grade 0, no DR) to 121/1000 patient‐years (grade 3 and DR) and amputations from 0 (grade 0, no DR) to 38/1000 patient‐years (grade 3 and DR). Conclusions: Diabetic retinopathy independently relates to the incidence of foot ulcers and amputations in patients hospitalised for type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a chronic disease that is associated with increased morbidity and mortality. Unfortunately, foot ulcers and amputations due to diabetes are very common in developing countries. The purpose of this study was to characterize the clinical presentation of diabetic foot ulcer (DFU) infections, isolate the causative agent, and analyze the biofilm formation and distribution of biofilm-related genes among isolated Staphylococci. Material and Methods: The study included 100 diabetic patients suffering from DFUs attending Assiut University Hospital. Swabs were collected and antimicrobial susceptibility testing of the isolates was performed. Biofilm formation was tested phenotypically among staphylococcal isolates and the frequency of different biofilm genes was analyzed by PCR. Clinical presentations of diabetic foot ulcers were correlated with bacterial genetic characteristics. Spa types were determined using DNA Gear-a software. Results: Microbiological analysis showed that 94/100 of the DFUs were positive for bacterial growth. The majority of infections were polymicrobial (54%, n=54/100). Staphylococci were the most commonly detected organisms, of which S. aureus represented 37.5% (n=24/64), S. haemolyticus 23.4% (n=15/64), S. epidermidis 34.3% (n=22/64) and other CNS 4.7% (n=3/64). Interestingly, co-infection with more than one species of Staphylococci was observed in 17.1% (n=11/64) of samples. A high level of antibiotic resistance was observed, where 78.1% (n=50/64) of Staphylococci spp were multidrug-resistant (MDR). Phenotypic detection showed that all isolated Staphylococci were biofilm-formers with different grades. Analysis of biofilm-forming genes among Staphylococci showed that the most predominant genes were icaD, spa, and bap. Isolates with a higher number of biofilm-related genes were associated with strong biofilm formation. Sequencing of the spa gene in S. aureus showed that our isolates represent a collection of 17 different spa types. Conclusion: The majority of DFUs in our hospital are polymicrobial. Staphylococci other than S.aureus are major contributors to infected DFUs. MDR and biofilm formation are marked among isolates, which is paralleled by the presence of different categories of virulence-related genes. All severely infected wounds were associated with either strong or intermediate biofilm formers. The severity of DFU is directly related to the number of biofilm genes. [ABSTRACT FROM AUTHOR]

We report the case of a 58-year-old patient with a diabetic foot lesion at high risk of major amputation successfully treated by a new innovative wound environment control system. [ABSTRACT FROM AUTHOR]

Diabetic foot infection (DFI) management requires complex multidisciplinary care pathways with off-loading, debridement and targeted antibiotic treatment central to positive clinical outcomes. Local administration of topical treatments and advanced wound dressings are often used for more superficial infections, and in combination with systemic antibiotics for more advanced infections. In practice, the choice of such topical approaches, whether alone or as adjuncts, is rarely evidence-based, and there does not appear to be a single market leader. There are several reasons for this, including a lack of clear evidence-based guidelines on their efficacy and a paucity of robust clinical trials. Nonetheless, with a growing number of people living with diabetes, preventing the progression of chronic foot infections to amputation is critical. Topical agents may increasingly play a role, especially as they have potential to limit the use of systemic antibiotics in an environment of increasing antibiotic resistance. While a number of advanced dressings are currently marketed for DFI, here we review the literature describing promising future-focused approaches for topical treatment of DFI that may overcome some of the current hurdles. Specifically, we focus on antibiotic-impregnated biomaterials, novel antimicrobial peptides and photodynamic therapy. [ABSTRACT FROM AUTHOR]

Partial foot amputation (PFA) is a common surgical loss of part of either the forefoot or mid-foot. It is usually the sequel to a cascade of physiological foot dysfunction such as peripheral neuropathy (PN). The gait compensation mechanisms associated with these foot disorders aren't well understood yet. The aim of the study was to evaluate pathological gait compensation mechanisms in PFA due to PN versus PN alone through a comprehensive gait analysis. Plantar pressure, GRF, load distribution, footprint length and area, foot progression angle, step length, percentage of double limb support, and stance time were measured on 53 participants assigned into two well-matched groups: (A) 25 subjects with healed unilateral PFA and (B) 28 subjects with PN without ulcer. The gait analysis was conducted at a self-preferred walking speed using the FREEMED baropodometric platform and FREESTEP software. The PFA group showed a significant decrease in load over the remaining toes and metatarsal heads compared to the PN group (p =.001 and p =.003, respectively). Conversely, the PFA group showed a significant increase in load over the mid-foot and peak plantar pressure during mid-stance (p =.007 and p =.016, respectively). All other measured variables showed no significant difference between the two groups (p >.05). Individuals with PFA and PN or PN alone tend to shift their body loads posteriorly and redistribute their loads to compensate for the insufficient support from the forefoot. The PFA group was worse than the PN group. Furthermore, the PFA may not be the primary cause of the altered gait but rather the underlying systemic disease. The PFA surgery only worsens the compensatory mechanism. • Individuals with PFA and PN or PN only receive insufficient support from their forefoot. • As a compensatory mechanism, they shift their weight posteriorly over the mid-foot. • This compensation increases the load over the mid-foot. • Individuals with PFA and PN or PN only are at risk of medial longitudinal arch collapse. • The systemic illness rather than the amputation causes this alteration in PFA gait. [ABSTRACT FROM AUTHOR]

1. Diabetic chronic wounds, mainly foot ulcers, constitute one of the most common complications of poorly managed diabetes mellitus. The most typical reasons are insufficient glycemic management, latent neuropathy, peripheral vascular disease, and neglected foot care. In addition, it is a common cause of foot osteomyelitis and amputation of the lower extremities. Patients are admitted in larger numbers attributable to chronic wounds compared to any other diabetic disease. In the United States, diabetes is currently the most common cause of non-traumatic amputations. Approximately five percent of diabetics develop foot ulcers, and one percent require amputation. Therefore, it is necessary to identify sources of lead with wound-healing properties. Redox imbalance due to excessive oxidative stress is one of the causes for the development of diabetic wounds. Antioxidants have been shown to decrease the progression of diabetic neuropathy by scavenging ROS, regenerating endogenous and exogenous antioxidants, and reversing redox imbalance. Matrix metalloproteinases (MMPs) play vital roles in numerous phases of the wound healing process. Antioxidant and fibroblast cell migration activity of Marantodes pumilum (MP) crude extract has previously been reported. Through their antioxidant, epithelialization, collagen synthesis, and fibroblast migration activities, the authors hypothesise that naringin, eicosane and octacosane identified in the MP extract may have wound-healing properties. 2. The present study aims to identify the bioactive components present in the dichloromethane (DCM) extract of M. pumilum and evaluate their antioxidant and wound healing activity. Bioactive components were identified using LCMS, HPTLC and GCMS. Excision wound on STZ-induced diabetic rat model, human dermal fibroblast (HDF) cell line and colorimetric antioxidant assays were used to evaluate wound healing and antioxidant activities, respectively. Molecular docking and pkCMS software would be utilised to predict binding energy and affinity, as well as ADME parameters. 3. Naringin (NAR), eicosane (EIC), and octacosane (OCT) present in MP displayed antioxidant action and wound excision closure. Histological examination HDF cell line demonstrates epithelialization, collagen production, fibroblast migration, polymorphonuclear leukocyte migration (PNML), and fibroblast movement. The results of molecular docking indicate a substantial attraction and contact between MMPs. pkCMS prediction indicates inadequate blood-brain barrier permeability, low toxicity, and absence of hepatotoxicity. 4. Wound healing properties of (NEO) naringin, eicosane and octacosane may be the result of their antioxidant properties and possible interactions with MMP. [ABSTRACT FROM AUTHOR]

Diabetic sensorimotor polyneuropathy (DSPN) is a serious long-term complication of diabetes, which may lead to foot ulceration and amputation. Among the screening tools for DSPN, the Michigan neuropathy screening instrument (MNSI) is frequently deployed, but it lacks a straightforward rating of severity. A DSPN severity grading system has been built and simulated for the MNSI, utilizing longitudinal data captured over 19 years from the Epidemiology of Diabetes Interventions and Complications (EDIC) trial. Machine learning algorithms were used to establish the MNSI factors and patient outcomes to characterise the features with the best ability to detect DSPN severity. A nomogram based on multivariable logistic regression was designed, developed and validated. The extra tree model was applied to identify the top seven ranked MNSI features that identified DSPN, namely vibration perception (R), 10-gm filament, previous diabetic neuropathy, vibration perception (L), presence of callus, deformities and fissure. The nomogram's area under the curve (AUC) was 0.9421 and 0.946 for the internal and external datasets, respectively. The probability of DSPN was predicted from the nomogram and a DSPN severity grading system for MNSI was created using the probability score. An independent dataset was used to validate the model's performance. The patients were divided into four different severity levels, i.e., absent, mild, moderate, and severe, with cut-off values of 10.50, 12.70 and 15.00 for a DSPN probability of less than 50, 75 and 100%, respectively. We provide an easy-to-use, straightforward and reproducible approach to determine prognosis in patients with DSPN. [ABSTRACT FROM AUTHOR]

Background Osteomyelitis of the diabetic foot remains a significant complication that may result in the need for amputation. Proximal surgical margin histopathology after limb-sparing amputation could be used to guide antimicrobial duration and prognostic management but remains debatable. Here we evaluate if negative proximal bone margins predict outcomes of diabetic foot osteomyelitis at 1 year. Methods A retrospective study assessed adults with diabetes undergoing limb-sparing foot amputations from September 2016 to September 2019. Patients required histopathology confirmation of osteomyelitis, proximal margin histopathology report, and documented electronic medical record follow-up through 12 months. The primary outcome evaluated if no further amputation at the same site was required in the following 12 months. Results Of 92 patients, 57 (61.9%) had pathology-confirmed negative margins for osteomyelitis. Patients with negative margins required less frequent subsequent amputations at the same site within 12 months compared to positive margins (86.0% vs 65.7%; P =.003). Antibiotic duration was shorter in patients with negative margins (mean, 18 vs 30 days; P =.001). Negative-margin patients also noted lower rates of readmission at 12 months (26.3% vs 51.4%; P =.015) for site-specific complications. S taphylococcus aureus was more predominant in patients with positive versus negative margins (57.1% vs 29.8%; P =.017). Conclusions Negative proximal bone margin by histopathology was associated with lower frequency of further amputations at the index surgical site within 12 months. This group also received shorter courses of antibiotic therapy. It was also associated with lower rates of readmission at 12 months for surgical-site complications. Proximal margin histopathology results potentially can be integrated to guide antimicrobial duration and decrease the frequency of further amputation at the original site. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the rate of different amputation levels in diabetic foot patients and the incidence of repetitive foot surgeries and evaluate the factors causing a delay in hospital stay and amputation of patients. METHODOLOGY: This prospective cohort study was conducted in Dr. Ruth K.M. Pfau, Civil Hospital Karachi, Pakistan. The study selected 375 participants from the clinic's daily patient inflow from October 2021 to March 2022 using a non-probability consecutive sampling technique. Those who had a delay in hospital stay and amputation were further followed up from May - October 2022. The chi-square test and Kruskal Wallis test (p-value <0.05) were used to correlate the effect of the level of lower limb amputation and the cause of delay in amputation using SPSS version 24.0. RESULTS: Total 246(65.60%) were males and 129(34.40%) were females. Toe amputation was the most commonly seen amputation in 173(46.1%) participants. About 168(44.8%) patients had some in-hospital delay stay during their treatment. Preoperative hurdles (Uncontrolled RBS, Osteomyelitis, etc.) were the most common factor causing an in-hospital delay in 92(24.5%) patients. The level of amputation performed was found to be statistically significant with factors causing a delay in hospital stay through chi-square (p=0.003*) and Kruskal Wallis test H (2) statistic= 13.3, df = 3, H (2), P=0.004*). CONCLUSION: Diabetic foot is a frequent cause of amputation globally, majorly in developing countries like Pakistan. On-time provision of treatment to these patients can decline the global amputation rate due to diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Background: In the latter stages of many illnesses, such as diabetes mellitus, limb amputation is a life-altering treatment that has social, psychological, and functional repercussions that lower the patient's quality of life. Objective: The current study aimed to assess the health-related quality of life for patients with diabetic foot amputation. Patients and Methods: A descriptive exploratory study was conducted at the Outpatient Clinic affiliated to Beni-Suef University Hospital. A total of 70 diabetic patients, 3 to 18 after amputation operation for follow up, were recruited using a purposive sample. Data of participants were collected using two tools; (I): Structured interviewing questionnaire, it included three parts; socio-demographic characteristics of patients, medical history of patients and knowledge assessment questionnaire. (II) World Health Organization quality of life SF36 questionnaire. Results: About 51.4% of studied patients were in the age group 50 - <60 years, 58.6% of them had unsatisfactory total knowledge level regarding diabetic foot and amputation, and 60% of them had unhealthy or poor quality of life. There was no statistically significant correlation between total knowledge and total quality of life regarding diabetic foot amputation. Conclusion: Developing and implementing an educational programme for patients with diabetic foot amputation for improvement of their quality of life is strongly and urgently needed. [ABSTRACT FROM AUTHOR]

Background: The biothesiometer allows for a quick and accurate measurement of vibration thresholds, which, when combined with centile charts, provides an objective estimate of diabetic peripheral neuropathy progression. The goal of the current study was to assess diabetic patients' early detection of peripheral neuropathy and associated consequences. Materials and Methods: Study was conducted on diabetes patients of medicine department of Maharishi Markandeshwar Super Speciality Hospital, MMIMSR, MM (DU), Mullana, after approval by the Institutional Ethics Committee (IEC). Patients were analysed for the vibration perception threshold (VPT) using Biothesiometer. After receiving their consent, socio-demographic parameters and previous medical history were noted on a case report form and patient's QoL (Quality of Life) was analyzed using Diabetic Neuropathy (DN) 22 QoL questionnaire. The DN4 questionnaire was used to assess the presence of peripheral neuropathy pain. Results: In this research study total of 100 patients participated, of whom 55 were male patients and 45 were female patients The ages of these patients ranged from 26 to 86 years and mean of these patients was 55 years. The patients were divided into two distinct age groups: those under 50 and those above 50. Only 15 patients reported numbness, while the remaining 85 patients reported no abnormal sensations in their feet. However, when left foot and right foot readings were valuate on the biothesiometer, 9 patients had grade 1 say normal (15 volts), 12 patients had grade 2 (16-25 volts), and 79 patients had grade 3 (>25 volts). Conclusion: It was concluded that VPT was determined to be the gold standard or say best fit for detection of peripheral neuropathic pain in diabetes patients. Measuring VPT in diabetic patients with a biothesiometer may reduce the risk of developing neuropathic foot ulcers and foot amputations. [ABSTRACT FROM AUTHOR]

Background and Aim: Diabetic patients have a 15 to 20 time’s higher risk of amputation than non-diabetic patients. In literature, many factors have been mentioned which affect diabetic foot prevalence and its treatment among diabetic patients. Present study was directed to recognize those factors. Identification of those factors would help to bring down the financial burden over patients and healthcare centers. Material and Methods: Present cross-sectional study was conducted among the diabetic (diabetes type Ⅱ) patients who came with problems relevant with diabetic foot in the surgical outpatient department of tertiary care institute of India for the duration of 6 months. Three hundred Patients were categorized into two categories based on the treatment advised to them. One category of patients was treated through amputation whereas, other category of patients was treated with antibiotics and wound dressings. A self-structured questionnaire was built to collect the required data from patients. Chi-square was applied to identify any association. Results: From the total of 300 patients 78 (26%) were advised amputation, whereas, 22 (74%) patients were managed conservatively. The correlation between diabetic foot amputation and various factors which included gender, socioeconomic status, diet modification, blood sugar monitoring, life style, therapy type, smoking (p=0.02), ischemic heart disease, peripheral neuropathy and peripheral arterial disease (p=0.001) was statistically significant. Conclusion: The incidence of foot amputation was high among the patients who had male gender, lower educational status, lower socioeconomic status, longer duration of diabetes, no diet change, no proper blood sugar monitoring, sedentary type of life style, inadequate therapy, poor compliance with treatment, history of smoking, hypertension, ischemic heart disease, stroke, peripheral neuropathy, and peripheral arterial disease and these factors were correlated with incidence of diabetic foot amputation significantly except duration of diabetes. [ABSTRACT FROM AUTHOR]

Delayed wound healing is a serious complication of diabetes and a main reason for foot amputation. Caffeic acid phenethyl ester (CAPE) is a main active constituent of honeybee propolis with reported appealing pharmacological activities. In the current study, CAPE was loaded onto PEG–PLGA nanoparticles and showed a particle size of 198 ± 7.3 nm and polydispersity index of 0.43 ± 0.04. An in vivo study was performed to appraise the wound-healing activity of CAPE-loaded PEG–PLGA nanoparticles (CAPE-NPs) in diabetic rats. Wound closure was significantly accelerated in rats treated with CAPE-NPs. This was confirmed via histological examinations of skin tissues that indicated expedited healing and enhanced collagen deposition. This was accompanied by observed antioxidant activity as evidenced by the prevention of lipid peroxidation and the exhaustion of superoxide dismutase (SOD) and catalase (CAT) activities. In addition, CAPE-NPs showed superior anti-inflammatory activity as compared with the regular formula of CAPE, as they prevented the expression of interleukin-6 (IL-6) as well as tumor necrosis-alpha (TNF-α). The pro-collagen actions of CAPE-NPs were highlighted by the enhanced hyroxyproline content and up-regulation of Col 1A1 mRNA expression. Furthermore, the immunohistochemial assessment of skin tissues indicated that CAPE-NPs enhance proliferation and angiogenesis, as shown by the increased expression of transforming growth factor β1 (TGF-β1) and platelet-derived growth factor subunit B (PDGF-B). In conclusion, CAPE-loaded PEG–PLGA nanoparticles possess potent healing effects in diabetic wounds. This is mediated, at least partially, by its antioxidant, anti-inflammatory, and pro-collagen as well as angiogenic activities. [ABSTRACT FROM AUTHOR]

Diabetes mellitus, as the most common metabolic disease, is common worldwide and represents a crucial global health concern. The purpose of this research was to investigate the related risk factors and to develop a re-amputation risk nomogram in diabetic patients who have undergone an amputation. A observational analysis was performed on 459 patients who have underwent amputation for diabetic foot from January 2014 through December 2019 at the First Affiliated Hospital of Wenzhou Medical University. The least absolute shrinkage and selection operator regression and stepwise regression methods were implemented to determine risk selection for the re-amputation risk model, and the predictive nomogram was established with these features. Calibration curve, receiver operating characteristic curve, and decision curve analysis of this re-amputation nomogram were assessed. Predictors contained in this predictive model included smoking, glycated hemoglobin A1c (HbA1c), ankle-brachial index (ABI) and C-reactive protein (CRP). Good discrimination with a C-index of 0.725 (95% CI, 0.6624–0.7876) and good calibration were displayed with this predictive model. The decision curve analysis showed that this re-amputation nomogram predicting risk adds more benefit than none strategy if the threshold probability of a patient was >6% and <59%. This novel re-amputation nomogram incorporating smoking, glycated hemoglobin A1c (HbA1c), ankle-brachial index (ABI), C-reactive protein (CRP), and smoking could be easily used to predict individual re-amputation risk prediction in diabetic foot patients who have undergone an amputation. In the future, further analysis and external testing will be needed as much as possible to reconfirm that this new Nomogram can accurately predict the risk of toe re-amputation. [ABSTRACT FROM AUTHOR]

Although generally considered to be both a durable and functional procedure for limb preservation, the transmetatarsal amputation (TMA) has high rates of complication, failure, revisional operation, and progression to more proximal amputation. The objective of this investigation was to determine the effect of remnant metatarsal parabola structure on healing outcomes following TMA. A retrospective chart review was performed of subjects undergoing a complete TMA with primary closure. We considered 4 patterns of remnant metatarsal parabola structure. TMA pattern type 1 was a normal parabola with the remnant second metatarsal extending furthest distally and slightly longer than the remnant first and third metatarsals with a gradual lateral taper. TMA pattern type 2 was the first metatarsal remnant extending furthest distally with a gradual lateral taper. TMA pattern type 3 was a relatively long fifth metatarsal remnant without the presence of a gradual lateral taper. And TMA pattern type 4 was a relatively short first metatarsal remnant with a relatively long second metatarsal with a gradual lateral taper. Seventy-three transmetatarsal amputations in 73 subjects met selection criteria. Thirty-nine (53.4%) amputations healed primarily at 90 days. No statistically significant differences were observed between groups with respect to the 90-day primary healing rate (p =.571) or 1-year ambulation rate without wound recurrence or reoperation (p =.811). These results might indicate that the remnant metatarsal structure does not have an effect on transmetatarsal amputation outcome. It is our hope that these results add to the body of knowledge and lead to further investigations into outcomes of limb preservation surgical interventions. [ABSTRACT FROM AUTHOR]

Background: Proteus syndrome is characterized by a progressive segmental or patchy growth of bone, skin, adipose tissue, and central nervous system, associated with a wide range of neoplasms, pulmonary pathology, and thrombotic risk. The main histological findings are diffuse patchy overgrowth of skin and subcutaneous tissue, plantar cerebriform connective tissue nevus, and ossification defects. Case report: We present a patient that met the clinical and histological criteria necessary for the diagnosis of the disease. He required multiple surgical interventions, including amputation of the right foot. Genetic evaluation confirmed an AKT1 mutation. Discussion: CLOVES syndrome, neurofibromatosis 1 or PTEN hamartoma tumor syndrome are partially superimposable entities to Proteus syndrome and may generate diagnostic doubt. Although the clinical criteria and histologic findings are indicative, the diagnostic confirmation of this entity is genetic. [ABSTRACT FROM AUTHOR]