Cases reported "Diabetic Foot"

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1/6. Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes.

    BACKGROUND AND PURPOSE: Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%-57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. CASE DESCRIPTION: The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. OUTCOMES: The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. DISCUSSION: Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.
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keywords = ray, x-ray
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2/6. Neuropathic osteoarthropathy in the diabetic foot.

    OBJECTIVE: To discuss a case involving a 55-year-old diabetic woman with neuropathic osteoarthropathy initiated by a fall. CLINICAL FEATURES: The patient fell into a hole, injuring her left foot. Because of the anesthesia associated with her diabetic peripheral neuropathy, she did not notice the ensuing plantar puncture wound. The patient assumed that her swelling was a result of a sprain. Mild dislocation and osseous fragmentation was noted within the midfoot on radiographs. The neuropathic osteoarthropathy progressed until the patient was later casted. Plain films taken at the time of cast removal demonstrated resorption and consolidation of fragmentation, but the dislocation was unaltered. INTERVENTION AND OUTCOME: The patient was scheduled for surgery and wound debridement. However, before surgery, complications of a burn sustained on the contralateral foot required fifth ray amputation. Surgery of the left foot has been postponed until adequate postsurgical healing has occurred at the right foot amputation site. CONCLUSION: This article provides tools for the timely diagnosis and treatment of neuropathic osteoarthropathy. An increased understanding of this entity will help lead to a reduction in the incidence of delayed treatment resulting from misdiagnosis.
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ranking = 0.49986869303437
keywords = ray
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3/6. Closure of central defects of the forefoot with external fixation: a case report.

    Excision of 1 or more central rays of the foot may complicate soft tissue coverage because large defects may result. The authors presents a technique in which an Ilizarov external fixator was used to narrow the forefoot after resection of the central rays in a patient with diabetes. After external fixator application for 8 weeks, the central defect healed uneventfully and has not shown any recurrence of ulceration after 4 years of follow-up.
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ranking = 0.99973738606874
keywords = ray
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4/6. Salvage of the first ray in a diabetic patient with osteomyelitis.

    A case report is presented of a 65-year-old diabetic woman with an 18-month history of a penetrating ulcer of the plantar aspect of the first metatarsal head with associated sepsis of the first metatarsophalangeal joint and adjacent underlying osteomyelitis. Salvage of the first metatarsophalangeal joint was performed through aggressive soft-tissue and osseous debridement, external fixation with antibiotic-loaded polymethyl methacrylate bone cement, and delayed interpositional autogenous iliac crest bone graft arthrodesis. Osseous incorporation of the interposed bone graft occurred 12 weeks postoperatively. No soft-tissue or osseous complications occurred during the postoperative period, and at 1-year follow-up there was no evidence of ulceration recurrence, transfer ulceration, shoe-fit problems, or gait abnormalities. A detailed review of the literature on the use of external fixation and interpositional bone graft distraction arthrodesis of the first metatarsophalangeal joint is presented.
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ranking = 1.9994747721375
keywords = ray
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5/6. Aggressive conservative therapy for refractory ulcer with diabetes and/or arteriosclerosis.

    A foot ulcer due to diabetes and/or arteriosclerosis obliterans (ASO) frequently results in an intractable condition that resists treatment. To cope with this condition, we have developed a combination therapy that includes conventional conservative therapy plus surgical therapy. This aggressive conservative therapy using aggressive debridement, trafermin (Fiblast Spray, Kaken, japan) treatment and vacuum-assisted closure (VAC) therapy was adopted to treat seven patients suffering from diabetes and ASO-related refractory foot ulcer accompanied by bone exposure. With the exception of one patient who died during the treatment, the remaining six patients obtained limb salvage. The mean time to cure was 8.3 months. This approach should be considered before amputation. Some patients may refuse amputation or cannot tolerate highly invasive surgical treatment including tissue transplantation. In such cases, this aggressive conservative therapy can be employed as a highly useful and reproducible technique requiring simple techniques.
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ranking = 0.49986869303437
keywords = ray
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6/6. Preservation of the first ray in a diabetic patient with a penetrating ulcer and arterial insufficiency by use of debridement and external fixation.

    Successful preservation of the first ray was achieved in a diabetic patient with a penetrating ulcer with underlying osteomyelitis of the first metacarpophalangeal joint and arterial insufficiency. Resection of the joint followed by stabilisation using an external fixator for four weeks resulted in permanent control of infection and preservation of the toe without recurrence of osteomyelitis or ulceration. Since preservation and correct alignment of the first ray is essential for foot stability, this technique may be beneficial in young and active diabetic patients suffering from this difficult complication of their disease.
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ranking = 2.9992121582062
keywords = ray
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