RecentTrendsinTreatmentofDiabeticFoot
NayerNaiemWahba;
Abstract
¬Summary
T
hehumanfootisastrongandcomplexmechanicalstructurecontaining26bones,33joints(20ofwhichareactivelyarticulated),andmorethanahundredmuscles,tendons,andligaments.Thejointsofthefootaretheankleandsubtalarjointandtheinterphalangealarticulationsofthefoot.(1)
Thehumanfoothastwolongitudinalarchesandatransversearchmaintainedbytheinterlockingshapesofthefootbones,strongligaments,andpullingmusclesduringactivity.(4)
Themusclesactingonthefootcanbeclassifiedintoextrinsicmuscles,thoseoriginatingontheanteriororposterioraspectofthelowerleg,andintrinsicmuscles,originatingonthedorsal(top)orplantar(base)aspectsofthefoot.(5)
Thefactorsleadingtothedevelopmentofdiabeticneuropathyarenotunderstoodcompletely,andmultiplehypotheseshavebeenadvancedItisgenerallyacceptedtobeamultifactorialprocess(21),asanexample:polyolpathway(23),advancedglycationendproducts(24),oxidativestress(25),andotherrelatedcontributingfactor(26).
Developmentofdiabeticulcersisassociatedwithmanyriskfactorssuchassex(31,32,33),themeandurationofdiabetes(34,35),smoking(37),previousfootulcerandpreviouslowerlimbamputation(39,40),peripheralneuropathy(39),peripheralvasculardisease(37),andpoorglycemiccontrol(40,41).
Themanagementofdiabeticfootulcersbeginswithacomprehensiveassessmentoftheulcerandthepatient'soverallmedicalcondition.Evidenceofinfection,underlyingneuropathy,peripheralarterydisease,andanybonydeformitiesshouldbeactivelysought,andaddressedsystematically(47).
Negativepressurewoundtherapy(NPWT),alsocalledvacuum-assistedwoundclosure,referstowounddressingsystemsthatcontinuouslyorintermittentlyapplysub-atmosphericpressuretothesurfaceofawound.NPWThasbecomeapopulartreatmentmodalityforthemanagementofmanyacuteandchronicwounds(61).
HyperbaricMedicine,alsoknownasHyperbaricOxygenTherapy(HBOT),isthemedicaluseofoxygenatalevelhigherthanatmosphericpressure.Theequipmentrequiredconsistsofapressurechamber,whichmaybeofrigidorflexibleconstruction,andameansofdelivering100%oxygen.HyperbaricOxygenTherapyinvolvesbreathingpureoxygeninapressurizedroomortube.Hyperbaricoxygentherapyisawell-establishedtreatmentfordecompressionsickness,ahazardofscubadiving.Otherconditionstreatedwithhyperbaricoxygentherapyincludeseriousinfections,bubblesofairinyourbloodvessels,woundsthatwon'thealasaresultofdiabetesorradiationinjury,gasgangreneandcarbonmonoxidepoisoning.(79)
Stemcellsareconsideredthemastercells,capableofbothse
T
hehumanfootisastrongandcomplexmechanicalstructurecontaining26bones,33joints(20ofwhichareactivelyarticulated),andmorethanahundredmuscles,tendons,andligaments.Thejointsofthefootaretheankleandsubtalarjointandtheinterphalangealarticulationsofthefoot.(1)
Thehumanfoothastwolongitudinalarchesandatransversearchmaintainedbytheinterlockingshapesofthefootbones,strongligaments,andpullingmusclesduringactivity.(4)
Themusclesactingonthefootcanbeclassifiedintoextrinsicmuscles,thoseoriginatingontheanteriororposterioraspectofthelowerleg,andintrinsicmuscles,originatingonthedorsal(top)orplantar(base)aspectsofthefoot.(5)
Thefactorsleadingtothedevelopmentofdiabeticneuropathyarenotunderstoodcompletely,andmultiplehypotheseshavebeenadvancedItisgenerallyacceptedtobeamultifactorialprocess(21),asanexample:polyolpathway(23),advancedglycationendproducts(24),oxidativestress(25),andotherrelatedcontributingfactor(26).
Developmentofdiabeticulcersisassociatedwithmanyriskfactorssuchassex(31,32,33),themeandurationofdiabetes(34,35),smoking(37),previousfootulcerandpreviouslowerlimbamputation(39,40),peripheralneuropathy(39),peripheralvasculardisease(37),andpoorglycemiccontrol(40,41).
Themanagementofdiabeticfootulcersbeginswithacomprehensiveassessmentoftheulcerandthepatient'soverallmedicalcondition.Evidenceofinfection,underlyingneuropathy,peripheralarterydisease,andanybonydeformitiesshouldbeactivelysought,andaddressedsystematically(47).
Negativepressurewoundtherapy(NPWT),alsocalledvacuum-assistedwoundclosure,referstowounddressingsystemsthatcontinuouslyorintermittentlyapplysub-atmosphericpressuretothesurfaceofawound.NPWThasbecomeapopulartreatmentmodalityforthemanagementofmanyacuteandchronicwounds(61).
HyperbaricMedicine,alsoknownasHyperbaricOxygenTherapy(HBOT),isthemedicaluseofoxygenatalevelhigherthanatmosphericpressure.Theequipmentrequiredconsistsofapressurechamber,whichmaybeofrigidorflexibleconstruction,andameansofdelivering100%oxygen.HyperbaricOxygenTherapyinvolvesbreathingpureoxygeninapressurizedroomortube.Hyperbaricoxygentherapyisawell-establishedtreatmentfordecompressionsickness,ahazardofscubadiving.Otherconditionstreatedwithhyperbaricoxygentherapyincludeseriousinfections,bubblesofairinyourbloodvessels,woundsthatwon'thealasaresultofdiabetesorradiationinjury,gasgangreneandcarbonmonoxidepoisoning.(79)
Stemcellsareconsideredthemastercells,capableofbothse
Other data
| Title | RecentTrendsinTreatmentofDiabeticFoot | Other Titles | الطرق الحديثة فى علاج القدم السكرى | Authors | NayerNaiemWahba | Issue Date | 2016 |
Attached Files
| File | Size | Format | |
|---|---|---|---|
| G12624.pdf | 482.23 kB | Adobe PDF | View/Open |
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