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Case 1.10
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
This is classically due to:peripheral neuropathy,peripheral vascular disease, which may be macro- or microvascular, and/orpressure points from a change in foot shape, e.g., a Charcot foot collapse.
Management of diabetic foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Venu Kavarthapu, Raju Ahluwalia
The reconstruction of a foot affected by CN is one of the most challenging surgical interventions. A deformed Charcot foot is often limb threatening, particularly in the presence of an ulcer. The amputation risk is 7 times higher for diabetes patients with an ulcer and 12 times higher with Charcot and an ulcer (23). The surgical aim of Charcot foot reconstruction is to achieve a normal shaped, plantigrade and stable foot that allows full weight-bearing using routine or modified shoes. Long-term stability of the reconstructed foot requires full deformity correction and solid bone fusion of all bones that are intended for fusion. Vascular assessment prior to the deformity correction, and revascularisation if required, is critical for predictable bone union. Detailed clinical and radiological assessment of the bone and soft tissue components of the deformity is essential for a successful outcome.
Pathophysiology and Management of Type 1 Diabetes
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
Schafer Boeder, Steven Edelman
Although there are many benefits of exercise, potential risks exist. Most adults with diabetes—especially those who have additional cardiovascular risk factors, such as heart disease, a prior stroke, hypertension, dyslipidemia, a history of smoking, or age over 45 years for males or 55 years for females—should consult with their healthcare provider before engaging in increased physical activity or initiating an exercise routine. Diabetes-related complications such as retinopathy, neuropathy, and foot ulcers or Charcot foot can limit exercise options and predispose to injury. In general, patients should start slowly with frequent, low-intensity physical activity and then increase the duration and intensity of exercise as tolerated.
Mid-term results of hindfoot arthrodesis with a retrograde intramedullary nail in 24 patients with diabetic Charcot neuroarthropathy
Published in Acta Orthopaedica, 2020
Mehmet Ersin, Mehmet Demirel, Mehmet Chodza, Fuat Bilgili, Onder Ismet Kiliçoglu
As an alternative approach to amputation, arthrodesis assumes a critical role in limb salvage for Charcot patients (Pinzur and Kelikian 1997, Pinzur and Noonan 2005, van der Ven et al. 2009). Although retrograde intramedullary nailing is a widely accepted method of hindfoot and ankle fusion to yield stability and generate a plantigrade and braceable foot (Pinzur and Kelikian 1997, Pinzur and Noonan 2005, Wukich et al. 2011), the general consensus in the literature is that this procedure is compelling but fraught with complications in diabetic patients (Mendicino et al. 2004, Caravaggi et al. 2006, Chahal et al. 2006, Wukich et al. 2011, Myers et al. 2012). Furthermore, according to our literature review, there has been little research (Pinzur and Kelikian 1997, Mendicino et al. 2004, Pinzur and Noonan 2005, Caravaggi et al. 2006, Pelton et al. 2006, Caravaggi et al. 2012, Chraim et al. 2018) to review the results of retrograde hindfoot arthrodesis nailing in diabetic patients with severe foot and ankle deformity. Therefore, the present study focused specifically on a certain group of patients with diabetic Charcot foot and reflected the results of intramedullary nailing for this challenging combination of disorders.
Modern management of diabetic foot osteomyelitis. The when, how and why of conservative approaches
Published in Expert Review of Anti-infective Therapy, 2018
Javier Aragón-Sánchez, Benjamin A Lipsky
Examination of a bone sample, with microbiological or histopathologic methods, is generally accepted as the most accurate method of diagnosing DFO [7]. Optimally, specimens should be sent for both culture and histopathology; when these agree, the diagnosis is virtually certain. Unfortunately, this criterion standard is infrequently achieved because bone biopsy is not widely used [7]. Culture of a bone biopsy has the key advantage of providing reliable data on the responsible organisms and its antibiotic susceptibility, but false positive (related to contamination of the specimen) and false negative (related to antibiotic therapy or poor culture technique) results can be a problem [2]. Obtaining the bone biopsy through intact skin will avoid the risk of contamination of the sample. Similarly, the reliability of histopathology results may be reduced by the lack of widely agreed diagnostic criteria and false positives related to noninfectious bone disorders. Histopathology of bone specimens subjacent to foot ulcers in patients with diabetes, including those with Charcot foot, may not display any specific changes that allow them to be differentiated from those found in cases with osteomyelitis [43]. Both culture and histopathology may be inaccurate if the bone sampling misses the infected site. In general, reports from the two techniques are diagnostically complementary. For patients who actively or recently treated with antibiotic therapy, histopathology may provide the diagnosis. In one study, 29.1% of patients undergoing surgery for foot infections who had a positive bone culture had no histopathological findings of osteomyelitis, while 25% of those with positive histology had negative cultures [44]. The authors of this study reasonably concluded that the two methods performed similarly in identifying the presence of pedal osteomyelitis.
Railway spine: The advent of compensation for concussive symptoms
Published in Journal of the History of the Neurosciences, 2020
Page has been credited with the first description (in 1881) of the lower limbs-threatening complication of diabetes now termed Charcot foot (Sanders, Edmonds, and Jeffcoate 2013). He is better known, however, for his opposition to the organic nature of railway spine. In his Lancet obituary, he was described as “an invaluable witness at a time when the railway companies considered it necessary to contest excessive claims against them for damages as the result of accidents” (Sprigge 1926, 627).