Impact of case-mix adjustment on observed variation in the healing of diabetic foot ulcers at 12 weeks using data from the National Diabetes Foot Care Audit of England and Wales: A cohort study.

Aim: This cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics.

Methods: The National Diabetes Foot Care Audit collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer-free 12 weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment.

Rat bite as a cause of diabetic foot ulcer in sub-Saharan Africa.

There have been relatively few reports of foot ulcers in diabetes resulting from rat bite. The findings were derived from people attending a single specialist service in Dar es Salaam for diabetic foot ulcers (DFUs) between 1 January 1999 and 31 December 2016. Details from people presenting for the first time with an ulcer judged to be caused by rat bite were compared with those with from other causes of foot ulcer.

Which diagnostic tests in everyday clinical practice are (not) useful in the management of diabetic foot disease?

This commentary reviews the use of a small number of tests used in the routine management of foot disease in diabetes. The aim is to consider some of the evidence underlying the use of these tests and the difficulties that can be encountered in interpretation. All tests have their limitations and it is important for these to be understood by the clinicians who request them.

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers.

Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin.

Osteomyelitis of the foot: non-surgical management, SPECT/CT scanning and minimising the duration of antibiotic use.

In a paper in this issue of Diabetologia (DOI: https://doi.org/10.1007/s00125-017-4417-x ), Vouillarmet and colleagues have explored the use of single-photon emission computed tomography (SPECT)/computed tomography (CT) to define remission during non-surgical management of osteomyelitis of the foot.

Using image J to document healing in ulcers of the foot in diabetes.

The aim of the study was to assess the reliability of measuring the cross-sectional area of diabetic foot ulcers using Image J software. The inter- and intra-rater reliability of ulcer area measures were assessed using digital images of acetate tracings of ulcers of the foot affecting 31 participants in an off-loading randomised trial. Observations were made independently by five specialist podiatrists, one of whom was experienced in the use of Image J software and educated the other four in a single session.

Dressing and Diabetic Foot Ulcers: A Current Review of the Evidence.

Background: The outcome of ulcers of the foot in diabetes is generally poor with around 1 in 10 resulting in the loss of a limb. There is an urgent need for the development of interventions to improve the outcome for patients. To date, however, the evidence base to support many of the interventions in common use, including wound dressings, is poor.

Reporting standards of studies and papers on the prevention and management of foot ulcers in diabetes: required details and markers of good quality.

The evidence base for many aspects of the management of foot ulcers in people with diabetes is weak, and good-quality research, especially relating to studies of direct relevance to routine clinical care, is needed. In this paper, we summarise the core details required in the planning and reporting of intervention studies in the prevention and management of diabetic foot ulcers, including studies that focus on off-loading, stimulation of wound healing, peripheral artery disease, and infection. We highlight aspects of trial design, conduct, and reporting that should be taken into account to minimise bias and improve quality.

Evidence for the use of biological therapies in ulcers of the foot in diabetes.

Because the chronic ulcer of the foot in diabetes is often unresponsive to standard care, there has been considerable interest in the potential benefit of so-called "advanced wound therapies"--many of which have a biological basis. This article summarizes the findings of earlier systematic reviews, together with the findings of more recent publications. The available evidence suggests that while some biological therapies offer promise, more work is needed to substantiate their role in clinical practice.

Who was first to diagnose and report neuropathic arthropathy of the foot and ankle: Jean-Martin Charcot or Herbert William Page?

In November 1883, Jean-Martin Charcot and Charles Féré reported on bone and joint disease of the foot in cases of tabes dorsalis, and referred to the condition as 'pied tabétique'--a disabling neuropathic osteoarthropathy that we usually now refer to as the Charcot foot. Charcot had originally described neuropathic osteoarthropathy in more proximal joints in 1868, and in his 1883 paper with Féré stated that involvement of the short bones and small joints of the foot had not yet been described. They emphasised in the paper that one of their cases was the first ever observed, two years earlier, in 1881.

Protocol for a systematic review and individual patient data meta-analysis of prognostic factors of foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS).

Background: Diabetes-related lower limb amputations are associated with considerable morbidity and mortality and are usually preceded by foot ulceration. The available systematic reviews of aggregate data are compromised because the primary studies report both adjusted and unadjusted estimates. As adjusted meta-analyses of aggregate data can be challenging, the best way to standardise the analytical approach is to conduct a meta-analysis based on individual patient data (IPD).

Wound healing--a practical algorithm.

The decision-making process involved in the management of diabetic foot wounds is complex but hinges on certain simple principles. The first is to agree the actual aim of management with the patient or their representative - and healing of an open wound may be only a part of this. The agreed plan should be discussed and reviewed if the wound is unresponsive to intervention.

Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population.

Objective: The aim was to compare three ulcer classification systems as predictors of the outcome of diabetic foot ulcers: the Wagner, the University of Texas (UT) and the size (area, depth), sepsis, arteriopathy, denervation system (S(AD)SAD) systems in a specialist clinic in Brazil.

Methods: Ulcer area, depth, appearance, infection and associated ischaemia and neuropathy were recorded in a consecutive series of 94 subjects. A novel score, the S(AD)SAD score, was derived from the sum of individual items of the S(AD)SAD system, and was evaluated.

Charcot neuro-osteoarthropathy.

The classical neurotraumatic and neurotrophic theories for the pathogenesis of the acute Charcot neuro-osteoarthropathy (CN) in diabetes, do not address certain key features of the disease. These features include the facts that the condition usually affects just one side, that it is self-limiting, and that it is also very uncommon. Similarly, it is not known to what extent the condition may depend, as suggested by Jean-Martin Charcot, on pre-morbid osteopenia.

Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents.

Objective: To compare populations with and outcomes of diabetic foot ulcers managed in the U.K., Germany, Tanzania, and Pakistan and to explore the use of a new score of ulcer type in comparing outcomes among different countries.

Rate of healing of neuropathic ulcers of the foot in diabetes and its relationship to ulcer duration and ulcer area.

Objective: To examine the outcome of neuropathic foot ulcers and to seek associations between healing and features of the ulcers at baseline.

Research Design And Methods: Data were collected prospectively during the course of routine management. All patients were selected who presented to a single unit between 1 January 2000 and 31 December 2004 with neuropathic foot ulcers and without evidence of either peripheral arterial disease or infection.

Temporal association between the incidence of foot ulceration and the start of dialysis in diabetes mellitus.

Background: The aim of this study was to seek a temporal association between the start of renal replacement therapy (RRT) and the first recorded foot ulcer in diabetes.

Methods: Details of all patients with diabetes who had received RRT were extracted from the renal database and were cross-checked with the database held in the specialist foot clinic. The date of onset of first registered foot ulcer was taken and compared with the date of onset of RRT.

Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures.

Objective: The purpose of this study was to compare different outcome measures in the audit of management of diabetic foot ulcers

Research Design And Methods: Data collected prospectively in a consecutive cohort of patients referred to a specialist multidisciplinary foot care clinic between 1 January 2000 and 31 December 2003 were analyzed. A single index ulcer was selected for each patient and classified according to both the Size (Area and Depth), Sepsis, Arteriopathy, and Denervation [S(AD)SAD] and University of Texas (UT) systems. Ulcer-related outcomes (healing, resolution by ipsilateral amputation or by death, and persisting unhealed) were determined at 6 and 12 months and compared with patient-related outcomes (survival, any amputation, and being free from any ulcer) at 12 months.