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Australian Journal of General Practice May 2020Diabetic foot ulcers are associated with significant morbidity and mortality and can subsequently lead to hospitalisation and lower limb amputation if not recognised and...
BACKGROUND
Diabetic foot ulcers are associated with significant morbidity and mortality and can subsequently lead to hospitalisation and lower limb amputation if not recognised and treated in a timely manner.
OBJECTIVE
The aim of this article is to review the current evidence for preventing and managing diabetic foot ulcers, with the aim to increase clinicians' confidence in assessing and treating these complex medical presentations.
DISCUSSION
All patients with diabetes should have an annual foot review by a general practitioner or podiatrist. A three-monthly foot review is recommended for any patient with a history of a diabetic foot infection. Assessment involves identification of risk factors including peripheral neuropathy and peripheral vascular disease, and examination of ulceration if present. It is essential to identify patients with diabetes who are 'at risk' of ulceration, assess for any early signs of skin breakdown, initiate appropriate management to prevent progression and refer the patient if indicated.
Topics: Diabetic Foot; Humans; Physical Examination; Risk Factors
PubMed: 32416652
DOI: 10.31128/AJGP-11-19-5161 -
The Journal of Cardiovascular Surgery Oct 2018The diabetic foot is a complication of diabetes affecting 15% of diabetics in their lives. It is associated to diabetic neuropathy and peripheral vascular disease and... (Review)
Review
The diabetic foot is a complication of diabetes affecting 15% of diabetics in their lives. It is associated to diabetic neuropathy and peripheral vascular disease and its incidence has increased. The ulceration is the initial cause of a dramatic process leading, if not correctly treated, to amputations. Both neuropathy, neuro-ischemia and infections have a role in determining healing or worsening of the lesions and 85% of all amputations in diabetic patients are preceded by a foot ulceration deteriorating to a severe gangrene or infection. The different causative agents and the different clinical presentations of diabetic foot ask a multidisciplinary approach in order to address treatments to the final goals, the prevention of the amputations and the maintenance of a functional foot able with weight-bearing ability. Many professional figures, diabetologists, surgeons (both general and vascular and orthopedics), interventional radiologists, infectious diseases specialists, specialized nurses, podiatrists, orthotic technicians, are called to apply their knowledges to the diabetic patients affected by diabetic foot in a virtuous circle leading to reach the goals, with the imperative action of the multidisciplinary team. The so organized center will allow both a correct and rapid diagnosis, the use in ambulatorial environments of modern tools, or the hospitalization in multitasking wards, in which all the complications and the necessary treatments are possible, both in emergencies or in elective way, considering both revascularizations and surgery.
Topics: Combined Modality Therapy; Diabetic Foot; Humans; Interdisciplinary Communication; Patient Care Team; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 29808982
DOI: 10.23736/S0021-9509.18.10606-9 -
Journal of the American Academy of... Feb 2019Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc) to inform clinical management... (Review)
Review
Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc) to inform clinical management decisions. Dermoscopic findings or images provided to pathologists offer important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form provide little value to pathologists. Most dermoscopic structures have direct histopathologic correlates, and therefore dermoscopy can act as an excellent communication bridge between the clinician and the pathologist. In the first article in this continuing medical education series, we review dermoscopic features and their histopathologic correlates.
Topics: Adult; Aged; Biopsy, Needle; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dermoscopy; Diagnosis, Differential; Education, Medical, Continuing; Female; Humans; Immunohistochemistry; Male; Middle Aged; Sensitivity and Specificity; Skin Neoplasms
PubMed: 30321581
DOI: 10.1016/j.jaad.2018.07.073 -
Australian Journal of General Practice May 2020Flat foot (pes planus) describes a reduction or absence of the medial longitudinal arch (MLA) of the foot, with or without additional deformities of the foot and ankle....
BACKGROUND
Flat foot (pes planus) describes a reduction or absence of the medial longitudinal arch (MLA) of the foot, with or without additional deformities of the foot and ankle. Flat feet are relatively common in childhood, affecting up to 14% of children. Flexible flat feet can be part of a normal developmental profile, and foot arches usually develop with age, although there is a wide range of normal variation. Up to 25% of the total population has a deficient MLA in at least one foot; therefore, it is likely a general practitioner (GP) will encounter this issue relatively frequently in their practice.
OBJECTIVE
This article outlines a method for paediatric pes planus assessment and management. A multidisciplinary approach involving GPs, rehabilitation physicians, orthopaedic surgeons, physiotherapists, orthotists and podiatrists is discussed.
DISCUSSION
Paediatric pes planus treatment has long been a contentious topic, with a lack of clarity in the literature regarding which children require treatment and the efficacy of intervention. However, there is increasing evidence that non-surgical interventions, such as orthoses and physiotherapy, may be beneficial for certain groups of children.
Topics: Disease Management; Flatfoot; Foot Orthoses; Humans; Pediatrics; Physical Therapy Modalities
PubMed: 32416653
DOI: 10.31128/AJGP-09-19-5089 -
Journal of Wound Care Mar 2020
Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Bandages; Biofilms; Debridement; Detergents; Early Medical Intervention; Humans; Pain Management; Practice Guidelines as Topic; Skin; Surface-Active Agents; Treatment Failure; Wound Healing; Wounds and Injuries
PubMed: 32160083
DOI: 10.12968/jowc.2020.29.Sup3b.S1 -
Foot Self-Care Experiences Among Patients With Diabetes: A Systematic Review of Qualitative Studies.Wound Management & Prevention Apr 2020Research that explores foot self-care practices and clinical foot care recommendations for persons with diabetes mellitus is limited.
UNLABELLED
Research that explores foot self-care practices and clinical foot care recommendations for persons with diabetes mellitus is limited.
PURPOSE
The aim of this systematic review was to understand the gaps between the American Diabetes Association clinical recommendations on preventive foot self-care and perceptions of and actions taken by patients with diabetes and diabetic foot ulcers (DFUs).
METHODS
PubMed, the Cumulative Index of Nursing and Allied Health Literature, Cochrane Online Library, Psychological Information Database, and Google Scholar were systematically searched for qualitative research literature published in English from January 1, 2001, to October 21, 2016, using the MeSH terms diabetes mellitus, diabetic foot ulcers, foot care, experiences, and perception to examine the experiences of patients with diabetes regarding foot self-care practices. Publications were screened for inclusion according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and The Standard for Reporting Qualitative Research was used to appraise trustworthiness and publication bias. Publication details (author, year, title, country in which the study was conducted, and the type of publication), study aims, design (study methodology, method of sampling, and analysis method), and participant details were abstracted to Excel sheets for analysis of foot self-care experiences and to determine common themes (foot self-care issues) among patients with diabetes.
RESULTS
Of the 14 publications identified, 9 (that included 113 patients with diabetes [95 with or history of DFUs and 18 with no DFUs] and 28 health care professionals [14 podiatrists, 8 physicians, and 6 registered nurses]) met the inclusion criteria for analysis. Research included 4 qualitative descriptive design studies, 2 descriptive phenomenology studies, 1 grounded theory study, 1 interpretive phenomenology study, and 1 exploratory qualitative design study. Four (4) studies were found to lack transparency, and 7 studies did not address trustworthiness. The common themes identified were the high clinical and lifestyle burden of DFUs, poor foot self-care knowledge, perception barriers and resistance, adoption of self-management practices, and discordance between patient and provider impressions and expectations.
CONCLUSION
Several barriers to optimal foot care in persons with diabetes with and without foot ulcers were identified and may be explained and addressed by considering the Health Belief Model. Clinical interventions should be individualized to identify and address patient-specific barriers to optimal foot self-care. Future clinical studies are needed to examine the outcomes of individualized interventions.
Topics: Diabetes Mellitus; Diabetic Foot; Humans; Self Care
PubMed: 32294056
DOI: 10.25270/wmp.2020.4.1625