Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy.

Background: Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection.

Remote Temperature Monitoring of the Diabetic Foot: From Research to Practice.

Introduction: Diabetic foot ulcers (DFUs) are devastating, common, and costly. The mortality of veterans following a DFU is sobering with ulceration recognized as a significant marker of disease severity. Given the dramatic impact of diabetic foot complications to the veteran and the US health care system, the US Department of Veterans Affairs (VA) has long recognized the importance of preventive care for those at risk.

Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.

Objective: Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations.

Research Design And Methods: This is a nested case-control study of a cohort of patients with diabetes aged<60 years and treated in the US Department of Veterans Healthcare system in 2003.

Treatment of postoperative lower extremity wounds using human fibroblast-derived dermis: a retrospective analysis.

Human fibroblast-derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast-derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity.

Ultrasound imaging for diagnosis of plantar plate ruptures of the lesser metatarsophalangeal joints: a retrospective case series.

Tears of the plantar plate can be a source of significant forefoot pain, leading to alterations of foot function and gait. The objective of the present retrospective study was to further determine the value of ultrasound imaging in diagnosing plantar plate tears after clinical evaluation through a comparison of the ultrasound and intraoperative examination findings. Eight patients were identified who had undergone surgical intervention for a painful lesser metatarsophalangeal joint after ultrasound examination to diagnose a plantar plate pathologic entity.

A review of the foot function index and the foot function index - revised.

Background: The Foot Function Index (FFI) is a self-report, foot-specific instrument measuring pain and disability and has been widely used to measure foot health for over twenty years. A revised FFI (FFI-R) was developed in response to criticism of the FFI. The purpose of this review was to assess the uses of FFI and FFI-R as were reported in medical and surgical literature and address the suggestions found in the literature to improve the metrics of FFI-R.

Correction of varus heel pad in patients with Syme's amputations.

Syme's amputations can provide a reliable alternative to more proximal amputations, but they are not without their occasional complication. Varus heel pad migration has been well documented as a complication following Syme's amputations. We describe a technique of resection of soft tissue and bone combined with anchoring of the lateral band of the plantar fascia in order to treat patients with the complication of varus heel pad migration.

Dislocation of the fifth metatarsal base following partial fourth and fifth ray amputation: a case report.

This case report presents a rare postoperative dislocation of the fifth metatarsal base following a healed open partial fourth and fifth ray amputation of a 62-year-old male veteran with poorly controlled diabetes mellitus. The dislocated fifth metatarsal base subsequently created a chronic ulceration and an inhibition of normal gait. The patient was taken to the operating room where the fifth metatarsal base was resected with transfer of the peroneus brevis tendon to the cuboid to maintain biomechanical stability.

Obesity paradox in amputation risk among nonelderly diabetic men.

The association between BMI and amputation risk is not currently well known. We used data for a cohort of diabetic patients treated in the US Department of Veterans Affairs Healthcare System in 2003. Men aged <65 years at the end of follow-up were examined for their amputation risk and amputation-free survival during the next 5 years (2004-2008).

Significant J-shaped association between body mass index (BMI) and diabetic foot ulcers.

Background: Disagreement exists regarding the relationship between body weight and foot ulceration risk among diabetic persons.

Methods: We used a nested case-control design to estimate the association between body mass index (BMI) and 1-year and 5-year foot ulceration risk. We obtained data on all diabetic patients < 60 years of age who were treated in the US Department of Veterans Affairs healthcare system in 2003.

Diagnostic accuracy of existing methods for identifying diabetic foot ulcers from inpatient and outpatient datasets.

Background: As the number of persons with diabetes is projected to double in the next 25 years in the US, an accurate method of identifying diabetic foot ulcers in population-based data sources are ever more important for disease surveillance and public health purposes. The objectives of this study are to evaluate the accuracy of existing methods and to propose a new method.

Methods: Four existing methods were used to identify all patients diagnosed with a foot ulcer in a Department of Veterans Affairs (VA) hospital from the inpatient and outpatient datasets for 2003.

Creating a diabetes foot reminder-based registry using the electronic medical record.

Objective: We created a new diabetes foot examination clinical reminder to directly populate a foot risk registry and examined its accuracy versus administrative data.

Methods: A pre- and post-test design assessed accuracy of coding foot risk and clinician acceptability. The intervention hospital's reminder was replaced with a dialogue tick box containing the International Diabetic Foot Classification System to populate risk using health factors.

Lower-extremity amputation risk after charcot arthropathy and diabetic foot ulcer.

Objective: To compare risks of lower-extremity amputation between patients with Charcot arthropathy and those with diabetic foot ulcers.

Research Design And Methods: A retrospective cohort of patients with incident Charcot arthropathy or diabetic foot ulcers in 2003 was followed for 5 years for any major and minor amputations in the lower extremities.

Results: After a mean follow-up of 37 +/- 20 and 43 +/- 18 months, the Charcot and ulcer groups had 4.

Mortality risk of Charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone.

Objective: The purpose of this study was to compare mortality risks of patients with Charcot arthropathy with those of patients with diabetic foot ulcer and those of patients with diabetes alone (no ulcer or Charcot arthropathy).

Research Design And Methods: A retrospective cohort of 1,050 patients with incident Charcot arthropathy in 2003 in a large health care system was compared with patients with foot ulcer and those with diabetes alone. Mortality was determined during a 5-year follow-up period.

Charcot arthropathy risk elevation in the obese diabetic population.

Purpose: To examine the association of obesity, peripheral neuropathy, and other risk factors with the Charcot arthropathy incidence rate in a large diabetic population.

Methods: The Department of Veterans Affairs inpatient and outpatient administrative datasets were used to identify persons with diabetes in 2003. Logistic regressions were used to model the likelihood of a person developing Charcot arthropathy as a function of individual characteristics, obesity, peripheral neuropathy, diabetic control, and comorbidities.

Theoretical model and Rasch analysis to develop a revised Foot Function Index.

Background: The Foot Function Index (FFI) is a widely used self-reported measure of health-related foot function. Several areas have been identified for potential improvement, and this study responds to such criticisms. The objectives of this study were to: (1) develop a theoretical model of foot functioning, (2) develop a revised FFI (FFI-R), and (3) field-test the FFI-R.

Combining bioengineered human dermal replacement and multilayered compression dressings to manage ulcers in a person with diabetes mellitus: a case study.

Multiple modalities exist for the care of lower extremity ulcers associated with venous insufficiency and complications of diabetes mellitus, (eg, neuropathy). Although reports about the use of topical adjunctive treatment modalities in the treatment of foot ulcers in persons with diabetes mellitus exist, little is known about the safety of topical treatment when used in combination with compression therapy to manage venous insufficiency. A patient with diabetes mellitus, neuropathy, a 3.

Syme ankle disarticulation in patients with diabetes.

Background: Syme ankle disarticulation is an amputation level that minimizes disability and preserves function, but it has been used sparingly in patients with diabetes mellitus. Surgeons have avoided this level because of the perceived high risk for wound failure, wound infection, or migration of the heel pad, which makes prosthesis use difficult.

Methods: Ninety-seven adult patients with diabetes mellitus who underwent Syme ankle disarticulation because of a neuropathic foot with an infection or gangrene, or both, during an eleven-year period were studied retrospectively.

Aneurysm of the dorsalis pedis artery -- a case report.

Aneurysms of the pedal arteries are uncommon; however, they can be identified upon clinical exam and confirmed by angiogram and color-flow duplex scan. Surgical treatment options include ligation or primary repair. The authors present a case of an aneurysm of the dorsalis pedis artery in a diabetic patient.

Pedal gangrene secondary to disseminated intravascular coagulation with gastric carcinoma.

Consumptive coagulopathy resulting in a disseminated intravascular coagulation is most often seen in infectious diseases and hematologic malignancies. Solid tumors may be associated with disseminated intravascular coagulation that results in gangrene of the upper extremity. A case report of lower-extremity gangrene as the pathology for gastric carcinoma is presented.