Diabetic Foot Clinic

Almelo and, Netherlands

Diabetic Foot Clinic

Almelo and, Netherlands

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van Netten J.J.,Diabetic Foot Clinic | Price P.E.,University of Cardiff | Lavery L.A.,University of Texas Southwestern Medical Center | Rasmussen A.,Steno Diabetes Center A S | And 2 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2016

Background: Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration. Methods: The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers. Results: From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small. Conclusion: The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is practically nonexistent for the prevention of a first foot ulcer and non-plantar foot ulcer. © 2016 John Wiley & Sons, Ltd.


Aerden D.,Diabetic Foot Clinic | Vanmierlo B.,UZ Brussel | Denecker N.,Diabetic Foot Clinic | Brasseur L.,Diabetic Foot Clinic | And 2 more authors.
International Journal of Lower Extremity Wounds | Year: 2012

In the diabetic foot, osteomyelitis of the first metatarsal head adjacent to a malum perforans may require resection of the metatarsophalangeal joint. This results in a dysfunctional great toe and large tissue defects that take a long time to heal. The authors postulated that transmetatarsal amputation followed by primary closure with a filleted hallux flap would be feasible in selected cases. Patients that required surgery for diffuse bone destruction of the first metatarsal head were included in the study. Transmetatarsal amputation was performed only if tissue removal rendered the hallux functionless. Primary closure with a filleted hallux flap was attempted in four out of sixteen patients. The developed skin flaps invariably were long enough to cover the plantar tissue defect; no flap necrosis or recurrent infection was noted. Mean healing time was 44 days (range 9-69). Long-term results were disappointing due to ulcer recurrences under the remaining metatarsal heads. © The Author(s) 2012.


PubMed | University of Amsterdam, Diabetic Foot Clinic, Steno Diabetes Center A S, Diabetic Foot Unit and 2 more.
Type: | Journal: Diabetes/metabolism research and reviews | Year: 2016

Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration.The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers.From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small.The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is practically nonexistent for the prevention of a first foot ulcer and non-plantar foot ulcer.


Bus S.A.,University of Amsterdam | van Netten J.J.,Diabetic Foot Clinic | Lavery L.A.,University of Texas Southwestern Medical Center | Monteiro-Soares M.,University of Porto | And 3 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2016

Recommendations: To identify a person with diabetes at risk for foot ulceration, examine the feet annually to seek evidence for signs or symptoms of peripheral neuropathy and peripheral artery disease. (GRADE strength of recommendation: strong; Quality of evidence: low) In a person with diabetes who has peripheral neuropathy, screen for a history of foot ulceration or lower-extremity amputation, peripheral artery disease, foot deformity, pre-ulcerative signs on the foot, poor foot hygiene and ill-fitting or inadequate footwear. (Strong; Low) Treat any pre-ulcerative sign on the foot of a patient with diabetes. This includes removing callus, protecting blisters and draining when necessary, treating ingrown or thickened toe nails, treating haemorrhage when necessary and prescribing antifungal treatment for fungal infections. (Strong; Low) To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) Instruct an at-risk patient with diabetes to daily inspect their feet and the inside of their shoes, daily wash their feet (with careful drying particularly between the toes), avoid using chemical agents or plasters to remove callus or corns, use emollients to lubricate dry skin and cut toe nails straight across. (Weak; Low) Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent non-plantar foot ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles or toe orthosis. (Strong; Low) To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressure-relieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) To prevent a first foot ulcer in an at-risk patient with diabetes, provide education aimed at improving foot care knowledge and behaviour, as well as encouraging the patient to adhere to this foot care advice. (Weak; Low) To prevent a recurrent foot ulcer in an at-risk patient with diabetes, provide integrated foot care, which includes professional foot treatment, adequate footwear and education. This should be repeated or re-evaluated once every 1 to 3 months as necessary. (Strong; Low) Instruct a high-risk patient with diabetes to monitor foot skin temperature at home to prevent a first or recurrent plantar foot ulcer. This aims at identifying the early signs of inflammation, followed by action taken by the patient and care provider to resolve the cause of inflammation. (Weak; Moderate) Consider digital flexor tenotomy to prevent a toe ulcer when conservative treatment fails in a high-risk patient with diabetes, hammertoes and either a pre-ulcerative sign or an ulcer on the distal toe. (Weak; Low) Consider Achilles tendon lengthening, joint arthroplasty, single or pan metatarsal head resection, or osteotomy to prevent a recurrent foot ulcer when conservative treatment fails in a high-risk patient with diabetes and a plantar forefoot ulcer. (Weak; Low) Do not use a nerve decompression procedure in an effort to prevent a foot ulcer in an at-risk patient with diabetes, in preference to accepted standards of good quality care. (Weak; Low) © 2016 John Wiley & Sons, Ltd.


PubMed | Diabetic foot clinic
Type: Case Reports | Journal: The international journal of lower extremity wounds | Year: 2012

In the diabetic foot, osteomyelitis of the first metatarsal head adjacent to a malum perforans may require resection of the metatarsophalangeal joint. This results in a dysfunctional great toe and large tissue defects that take a long time to heal. The authors postulated that transmetatarsal amputation followed by primary closure with a filleted hallux flap would be feasible in selected cases. Patients that required surgery for diffuse bone destruction of the first metatarsal head were included in the study. Transmetatarsal amputation was performed only if tissue removal rendered the hallux functionless. Primary closure with a filleted hallux flap was attempted in four out of sixteen patients. The developed skin flaps invariably were long enough to cover the plantar tissue defect; no flap necrosis or recurrent infection was noted. Mean healing time was 44 days (range 9-69). Long-term results were disappointing due to ulcer recurrences under the remaining metatarsal heads.

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