Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature; in the pathophysiology of diabetic foot ulceration polyneuropathy is important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the still high rates of major amputations.

https://www.mdpi.com/1422-0067/17/6/917/pdf

Neuropathy and Diabetic Foot Syndrome

Das diabetische Fussyndrom ist weltweit eine der bedeutendsten Komplikationen des Diabetes mellitus. Zudem ist es der haufigste Grund fur eine Krankenhausbehandlung. Die Atiologie des diabetischen Fussyndroms ist multifaktoriell und komplex. Pathophysiologisch steht die Polyneuropathie im Vordergrund. Durch geeignete Behandlungsstrategien sowie interdisziplinare und sektorenubergreifende Strukturen ist es moglich, die Amputationsraten zu senken.

Neuropathy and diabetic foot ulcers

Background This prospective study examined the influence of adding magnesium sulfate to bupivacaine in popliteal sciatic nerve block in diabetic foot surgeries. Patients and methods Patients were divided into two equal groups: patients in B group received 28 ml of 0.25% bupivacaine plus 2-ml normal saline, and patients in BM group received 28 ml of 0.25% bupivacaine plus 2-ml magnesium sulfate 10%. The primary end point was postoperative analgesic duration assessment. Secondary aims were to assess the sensory and motor block regarding the onset and the duration and assessment of analgesic requirements postoperatively. Results In B group, the range of analgesic duration was between 450 and 690 min, with a mean of 585.90±78.96 min, whereas in BM group, it ranged from 720 to 1080 min, with a mean of 870.0±100.6 min. A statistically significant higher prolongation in the duration of analgesia was found in the BM group than the B group. Conclusions Magnesium sulfate when added to bupivacaine produced prolongation of analgesic duration postoperatively with decreased analgesic requirements without significant complications.

Ultrasound-guided popliteal sciatic nerve block using bupivacaine alone or combined with magnesium sulfate for diabetic foot surgeries

Background: Diabetic foot ulcers are the most universal cause of non-traumatic amputations of the foot in developing countries. One of the treatment modalities is to improve the peripheral blood supply to the area of ulcer. To this purpose the study was done to evaluate the safety and efficacy of oral Arborium plus (herbal liquid formulation) in the wound closure of diabetic foot patients. Methods: 50 patients were randomly assigned to either of the groups (each group 25 patients) to receive either the test drug (Arborium plus) at tertiary care teaching hospital, it was an open label prospective and interventional parallel group study to evaluate the efficacy and safety of Arborium plus in diabetic foot syndrome. The study participants were randomized into control and intervention groups. Base line measurements of vascular flow was anklebrachial pressure index (ABPI) and wound size measurement. Results: The baseline characteristics of the patients age in years test and control group 68±12.3 and 67±13.4 respectively. Male/female in both groups was 21/4 and 22/3 respectively. Duration of diabetes in years 8.65±8.3 and 8.5±7.6 respectively. BMI was 25.11±4.15 and 24.75±0.85, duration of smoking (years) 17.3±9.5 and 19.5±10.5 respectively in both groups. Among the test group who received the proprietary formulation of Arborium plus, there was a significant reduction in the wound size. Conclusions: Wound healing and ABPI improvements were observed with usage of Arborium plus suggest an improvement in peripheral vascular flow in diabetic foot subjects.

/pdf/the-safety-and-efficacy-of-oral-arborium-plus-a-herbal-480wnim87k.pdf

The safety and efficacy of oral Arborium plus, a herbal liquid formulation in the treatment of diabetic foot syndrome: an open label study

To analyse the main characteristics of patients and the health outcomes obtained and to evaluate the impact of peripheral artery disease (PAD) in patients treated in our multidisciplinary Diabetic Foot Unit.Observational prospective study. 273 patients from two different populations (with and without PAD - classified according to the presence of distal pulses) treated over a 14-month period in the multidisciplinary Diabetic Foot Unit were included. The data on patient characteristics and outcomes were analysed for the purpose of comparison. For the inference study, a comparison of medians with the non-parametric test for independent samples for the quantitative variables and a χ2 test for the comparison of proportions in qualitative variables were performed.Patients with PAD ulcers were older (60 (54-67) vs. 64 (75-81), p=0.000) and had a higher macrovascular burden (8.1% vs. 29% for ischaemic heart disease history, p=0.000; 6.7% vs. 18.1% for cerebrovascular disease history, p=0.004). Their Texas Score was higher (p=0.000) and their major amputation rate was higher (1.4% vs. 12.3%, p=0.001). They had less background of previous ulcers (52.6% vs. 26.8%, p=0.000), their episode duration was shorter (4 (0-10) vs. 0 (0-3) weeks, p=0.000), and their proportional need for antibiotic therapy was lower (64.4% vs. 51.4%, p=0.03).The differences found between ulcers with and without vascular involvement support the need for a different approach and for the inclusion of vascular surgeons on the team. The multidisciplinary care model for diabetic foot patients could be effective and improve health outcomes. 

Outcomes of a multidisciplinary Diabetic Foot Day Unit

Therapy and diagnosis of the diabetic foot syndrome are almost standardized, all procedures are well established. There are no challenges in technical dimensions. But the rate of major amputations remains unacceptably high in Germany. Because there are other causes than lack of medical knowledge, this review describes the somatologic, psychiatric, and philosophic perspectives of the problem.

[The diabetic foot syndrome - an interdisciplinary challenge].

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[The diabetic foot syndrome - an interdisciplinary challenge].