Value of radiographs and bone scans in determining the need for therapy in diabetic patients with foot ulcers

Article Abstract:

Diabetic patients often develop foot ulcers which require hospital admission and may lead to loss of a toe, the foot, or the leg itself. These ulcers may be associated with repeated episodes of infection of the soft tissues, and may require administration of intravenous antibiotics and debridement (removal of dead tissue); amputation is necessary if all other treatments fail. A problem occurs when X-rays indicate destructive or lytic changes in the bone in the absence of evidence of local inflammation. It has been observed that these radiographic findings or bone scan results may not correlate with cultures of bone tissue. A prospective study was undertaken of 32 diabetic patients with foot ulcers requiring surgery; the purpose was to determine the correlation between radiographic results and cultures of bone specimens obtained at surgery. There were 25 patients who had bone scans, X-rays and wound and bone cultures performed; the other seven patients underwent all studies except bone scanning. Foot X-rays revealed osteitis (inflammation of the bone) in 15 of 32 patients (47 percent), and bone scans were positive in 16 of 25 patients (64 percent). Of 23 patients with evidence of bone destruction on X-rays, 12 (52 percent) had positive bone cultures. Of 23 patients without X-ray evidence of osteitis, 11 had evidence of bacterial growth on bone culture. Bone scans were positive in 12 of 18 patients (67 percent) with positive cultures, and scans were negative in 6 of 18 (33 percent) with positive bone cultures. It is concluded that neither bone scan nor X-ray alone should be used to determine the need for antibiotics or amputation in diabetic patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bones, Foot ulcer, Radionuclide imaging

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Amputation prevention in an independently reviewed at-risk diabetic population using a comprehensive wound care protocol

Article Abstract:

With the increase in the elderly population and the number of patients with diabetes, more people are at risk for amputation. Diabetic patients are prone to circulatory problems and infection, and diabetics account for 50 to 70 percent of all amputations performed. Amputation rates are rising. On the brighter side, however, there have been improvements in the control of blood sugar in diabetics, as well as revascularization surgery for the legs and topical administration of locally acting growth factors to assist in wound healing. In order to evaluate the results of a comprehensive approach to wound healing in diabetics, a panel consisting of a vascular surgeon, an orthopedic surgeon and an endocrinologist reviewed 71 case histories. All patients were diabetics and had a wound of the leg that had not healed for at least six months. The 71 patients had 124 wounds on 81 legs. Included in the wound-care protocol used for all patients was debridement (removal of devitalized tissue), noninvasive vascular testing, revascularization if necessary, infection control using antibiotics, and topical application of a platelet-derived wound healing formula. The panel of physicians reviewed the medical records of the 71 patients, classified their wounds by severity and identified the limb's risk for amputation. The panel's predicted outcome was compared with the actual patient outcome. The panel predicted that 80 percent of the legs would be saved from amputation, but the actual outcome was even better: 93 percent did not have to be amputated. It was concluded that the wound management program was highly successful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Wound healing, Platelet-derived growth factor

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Prevention of amputation by diabetic education

Article Abstract:

About 5 percent of people in the United States have diabetes mellitus, a metabolic condition caused by inadequate insulin production which may lead to various complications such as circulatory disorders and infections, particularly in the extremities. Diabetic patients account for five out of every six amputations of the major limbs. Prevention of limb amputation is important not only to diabetic patients, but also to society because of the costs of disability. A prospective randomized study was undertaken to evaluate the influence of a simple education program on amputation rates in diabetic patients. There were 203 diabetic patients who had foot infection, foot ulceration, or prior amputation; 103 received education (group 1) and 100 did not (group 2). The two groups had similar risk factors and medical care. Patient education included viewing of slides showing infected diabetic feet and amputated diabetic limbs; patients were given a set of instructions for care of the diabetic foot. Average follow- up was 12 months for group 1 and 9.2 months for group 2. Group 2 had an amputation rate that was three times that of group 1 (21 of 177 limbs, versus 7 of 177). The rate of foot ulcers for group 2 was also three times higher than for group 1. The infection rate was not different. Overall success in group 1 was achieved in 160 of 177 limbs, compared with 128 of 177 limbs for group 2; this difference was highly significant. It is concluded that a simple patient education program can significantly influence the amputation rate in diabetic patients with prior foot problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Education, Diabetics

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