Diagnosis and management of the acute hot diabetic foot

Diabetes is an increasing problem in the modern world. Along with the rise in prevalence of the disease the number of diabetic complications presenting is increasing and amongst these is diabetic foot issues. Foot infection and Charcot arthropathy are the two key pathologies that present acutely with a hot swollen foot. Both require timely diagnosis and management to prevent disastrous long-term sequelae.Acutely presenting foot infections are both limb and life threatening and require urgent intervention to improve the chance of limb salvage. The ability to recognize and acutely deal with a diabetic foot requiring urgent surgical drainage is relevant to all orthopaedic surgeons with an on-call commitment and not solely to the foot and ankle specialist.Charcot arthropathy results in foot deformity that increases the likelihood of future ulceration and infection. The differentiation and acute management of the two conditions will be discussed.     

Classification and management of the midfoot Charcot diabetic foot

Charcot neuroarthropathy adversely affects the quality of life of diabetic patients with peripheral neuropathy and therefore early diagnosis is essential. The midfoot is the commonest site for Charcot deformity and can lead to ulceration, deep infection and amputation. The goal of treatment in Charcot arthropathy is to achieve a stable, plantigrade foot without infection and ulceration to allow for ambulation in the long term. The aim of this article is to review the classification of Charcot midfoot deformity and assess the role of non-operative and surgical measures in the management of these patients. We specifically reviewed the indications and literature around surgical exostectomy.     

Oral health care in diabetes mellitus.

Diabetes mellitus produces many complex changes in the lives of those affected. Elevated blood glucose levels, which may occur in the absence of symptoms, lead to late complications from tissue damage. There is an increased susceptibility to infection, poor wound healing and periodontal disease. Furthermore, chronic oral infection itself may contribute to raised blood glucose levels and hence to the later complications of diabetes. Acute infection in the oral cavity needs specific and aggressive management, just as in the acutely infected diabetic foot.' The dental team may not have made a significant contribution to the shared management of the person with diabetes in the past; however, recent findings suggest that the dental team may contribute greatly to the shared care of diabetes with the diabetic team itself, and regular liaison is strongly recommended.     

Oral health care in diabetes mellitus

Diabetes mellitus produces many complex changes in the lives of those affected. Elevated blood glucose levels, which may occur in the absence of symptoms, lead to late complications from tissue damage. There is an increased susceptibility to infection, poor wound healing and periodontal disease. Furthermore, chronic oral infection itself may contribute to raised blood glucose levels and hence to the later complications of diabetes. Acute infection in the oral cavity needs specific and aggressive management, just as in the acutely infected diabetic foot. The dental team may not have made a significant contribution to the shared management of the person with diabetes in the past; however, recent findings suggests that the dental team may contribute greatly to the shared care of diabetes with the diabetic team itself, and regular liaison is strongly recommended.     

(ii) The cavo-varus foot

Cavo-varus foot deformity has many causes but the final common pathway is an imbalance of the muscles acting on the foot. The commonest cause of bilateral deformity is Charcot Marie Tooth disease. Unilateral deformity may arise from spinal pathology. Symptoms range from ankle instability and fatigue fractures to abnormal gait and the effects of joint overload.As well a clinical assessment, patients may require neuro-physiological investigation, and foot and spinal imaging. Treatment ranges from footwear modifications and orthoses to surgical treatment which may include combination of soft tissue releases, tendon transfers or a variety of osteotomies. Severe or recurrent deformities may require joint arthrodesis.     

Diabetes and orthopaedic surgery: a review

Diabetes mellitus (DM) is common, estimated to affect 425 million people worldwide in 2017. It is a condition that is continually growing in prevalence and is often associated with multiple co-morbidities. Its multi-system effects on the body mean that its management can pose a challenge, even to more experienced clinicians. In orthopaedic practice, diabetic patients are commonly encountered owing to their increased fracture risk and complications of the disease such as diabetic foot. An appropriate knowledge of diabetes, its pathophysiology, immunology and the pharmacology of medications used in its treatment is essential, as the consequences of mismanagement can be grave. Optimal treatment of diabetics can often require the involvement of a wider multidisciplinary team. Complications that can be encountered in the perioperative and postoperative periods include, diabetic ketoacidosis, hyperosmolar hyperglycaemic state, surgical site infection and venous thromboembolism. This review outlines current concepts in the perioperative management of diabetes and its manifestations within orthopaedic surgery, with a focus on outcomes and complications. A review of the available literature reveals conflicting conclusions between studies, with no clear effect or consensus yet established for many issues. There is a need for a greater number of well-designed, high-quality, appropriately powered trials to establish the true effect of diabetes on outcomes in orthopaedic surgery.     

(iii) Arthroscopy of the foot and ankle

The role of arthroscopy in the management of articular pathology is now well established. Its use in the management of foot and ankle pathology is relatively new, but with innovative techniques and modern equipment, the indications are expanding. Procedures that were previously performed through an open approach can now be done using a pure arthroscopic, or arthroscopically assisted, method with the aim of earlier rehabilitation, reducing complications and scarring, and improving outcome. We describe the history, current role and potential future uses of arthroscopy in the treatment of foot and ankle conditions.     

Diabetes mellitus,its management and complications

Diabetes is a condition in which there is a chronically raised blood glucose concentration caused by an absolute or relative lack of insulin due to insufficient production by the pancreas, or a deficit in the insulin action for the body's needs. There are two main types, type 1 which is general acute and seen in children and type 2 which the most common, is chronic and is seen in adults. Pathological effects associated with diabetes include macrovascular (heart, brain and extremities) and microvascular (eye, kidney and nerve tissue) complications. In particular, diabetes is regarded as a form of ischaemic heart disease, involving infarction, heart failure, CVA and paralysis. With regard to the extremities, peripheral vascular disease can lead to ulceration, poor healing, gangrene and possibly amputation. On the microvascular level diabetes can lead to retinopathy, cataracts, glaucoma and blindness, to nephropathy and kidney failure as well as autonomic neuropathy. Early diagnosis is vital so that other systemic consequences can be prevented by effective treatment.     

Dental management of patients with diabetes

Diabetes is a disease of metabolism resulting from impaired insulin secretion, varying degrees of insulin resistance, or both. Management of the diabetic dental patients must take into consideration the impact of dental disease and dental treatment on the management of diabetes as well as an appreciation for the comorbidities that accompany long-standing diabetes. Those comorbidities include obesity, hypertension, and dyslipidemia. Central to the management of diabetes is the intensive regulation of plasma glucose along with management of comorbidities comprising the "metabolic syndrome." Management of the diabetic dental patient should focus on periodontal health and the delivery of comprehensive dental care with minimal disruption of metabolic homeostasis and recognition of diabetic comorbidities.     

Diabetes mellitus and associated oral manifestations: a review

Oral research concerning diabetes mellitus has revealed a number of clinical implications. These include, among others, the need for more intense management of the diabetic patient with periodontal disease because tissue destruction may be accelerated, the need for rapid control of oral infection in these patients in order to prevent exacerbation of the existing metabolic imbalance, and the desirability of performing a screening for diabetes mellitus on all patients exhibiting asymptomatic parotid enlargement. Despite the explosion of knowledge concerning diabetes mellitus that has occurred since the discovery of insulin, its definitive etiology continues to elude the scientific community and its treatment remains in the realm of clinical management rather than in that of prevention and cure. In the past, research on diabetes has focused on the role of insulin in seeking the fundamental etiology of diabetes and its complications. With the progression of research, it has become apparent that the initiation and progression of the disease probably involve the interplay of a multiplicity of factors. Hereditary and immunologic factors, as suggested earlier, appear to be operated on by environmental factors, subsequently altering the body's metabolic milieu with widespread primary and secondary effects. Fertile areas for future oral research in diabetes mellitus will include, therefore, genetics, immunology, enzymology, and basement membrane pathology. On the cellular and molecular levels, particularly, the oral cavity and associated structures comprise a somewhat under-investigated area in diabetes mellitus research and, thus, hold great promise for increasing our knowledge of this complex disease.     

Diabetes mellitus and associated oral manifestations: a review

Oral research concerning diabetes mellitus has revealed a number of clinical implications. These include, among others, the need for more intense management of the diabetic patient with periodontal disease because tissue destruction may be accelerated, the need for rapid control of oral infection in these patients in order to prevent exacerbation of the existing metabolic imbalance, and the desirability of performing a screening for diabetes mellitus on all patients exhibiting asymptomatic parotid enlargement. Despite the explosion of knowledge concerning diabetes mellitus that has occurred since the discovery of insulin, its definitive etiology continues to elude the scientific community and its treatment remains in the realm of clinical management rather than in that of prevention and cure. In the past, research on diabetes has focused on the role of insulin in seeking the fundamental etiology of diabetes and its complications. With the progression of research, it has become apparent that the initiation and progression of the disease probably involve the interplay of a multiplicity of factors. Hereditary and immunologic factors, as suggested earlier, appear to be operated on by environmental factors, subsequently altering the body's metabolic milieu with widespread primary and secondary effects. Fertile areas for future oral research in diabetes mellitus will include, therefore, genetics, immunology, enzymology, and basement membrane pathology. On the cellular and molecular levels, particularly, the oral cavity and associated structures comprise a somewhat under-investigated area in diabetes mellitus research and, thus, hold great promise for increasing our knowledge of this complex disease.     

Effects of periodontal disease on glycemic control,complications, and incidence of diabetes mellitus

Diabetes mellitus is a group of metabolic disorders with high mortality and morbidity associated with complications such as cardiovascular disease, kidney disease, and stroke. The prevalence of diabetes is 9.4% in US adults, and prevalence increases markedly with age, with 1 in 4 adults aged ≥65 years affected by diabetes. The estimated number of adults with type 2 diabetes globally almost tripled between 2002 and 2017, reflecting increases seen in the USA and elsewhere. This increase raises concerns about the increased morbidity and mortality associated with the complications of diabetes, including periodontal disease and tooth loss. There is a reciprocal adverse relationship between diabetes and periodontal disease, with diabetes as a major risk factor for periodontal disease, and in those patients with diabetes who also have periodontal disease then there are adverse effects on glycemic control and complications such as cardiovascular disease and end stage renal disease. In this review, those studies detailing the adverse effects of periodontal disease and diabetes will be discussed. Also, evidence is accumulating that periodontitis may play a role in increasing the incidence of new cases of type 2 diabetes, and possibly gestational diabetes. Of course, these studies need to be expanded to better understand the effects of periodontitis on diabetes glycemic control, complications, prediabetes, and the incidence of new cases. However, given the tremendous burden of diabetes on society, the dental profession should be proactive in preventing and treating periodontal disease, not only to preserve the dentition, but also to minimize the adverse effects of periodontitis on diabetes and its complications.     

糖尿病与龋病的相关性研究

糖尿病以高血糖为特征,可引起酮症酸中毒、高血压、动脉粥样硬化、眼病、糖尿病肾病等并发症。糖尿病是牙周病的危险因素之一的观点已得到大多数学者的认同。然而,对糖尿病与龋病的发生发展是否相关仍存在较大的争议,多数学者认为糖尿病导致患龋率增高,但也有学者持否定的观点。本文就糖尿病与龋病相关性的最新研究进展作一综述。     

Type 1 diabetes mellitus, xerostomia, and salivary flow rates

OBJECTIVE: The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between salivary dysfunction and diabetic complications. STUDY DESIGN: The subjects with diabetes were participants in the Pittsburgh Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of participants or persons recruited from the community through advertisements in local newspapers. Assessments of salivary function included self-reported xerostomia measures and quantification of resting and stimulated whole saliva flow rates. RESULTS: Subjects with diabetes reported symptoms of dry mouth more frequently than did control subjects. Salivary flow rates were also impaired in the subjects with diabetes. Regression models of potential predictor variables were created for the 3 self-reported xerostomia measures and 4 salivary flow rate variables. Of the medical diabetic complications studied (ie, retinopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral vascular disease), only neuropathy was found to be associated with xerostomia and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with decreased salivary flow. Resting salivary flow rates less than 0.01 mL/min were associated with a slightly higher prevalence of dental caries. Subjects who reported higher levels of alcohol consumption were less likely to have lower rates of stimulated salivary flow. CONCLUSIONS: Subjects with type 1 diabetes who had developed neuropathy more often reported symptoms of dry mouth as well as symptoms of decreased salivary flow rates. Because of the importance of saliva in the maintenance and the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function.     

Diabetes mellitus and oral care

Diabetes is a common condition. Its incidence is increasing. It can lead to medical complications including visual impairment, neuropathies, renal and cardiovascular disease. Diabetes can have an adverse effect on oral health and healthcare. Conversely, poor oral health can have an adverse effect on blood glucose control. Repeated oral infections can indicate uncontrolled diabetes and lead to its diagnosis. Whereas hyperglycaemia may occur in untreated diabetes, hypoglycaemic episodes are not uncommon in well-controlled diabetes Type 2. The tight glycaemic control required to prevent its long-term complications can be destabilized by infection, anxiety or missed meals.     

The sporting ankle: an update

The ankle is one of the most commonly injured joints during sport, accounting for almost 30% of all musculoskeletal injuries. These result in a spectrum of pathology varying in severity and involving a number of structures around the hind foot. The most common pathologies include lateral ligament and syndesmosis injuries, impingement and osteochondral lesions of the talus. Most of these injuries will resolve with non-operative management, however, more severe injuries may never fully settle and will require surgical intervention. There have been recent developments in the surgical management of these conditions and this review article will focus on the recent advances in the understanding of these injuries and aim to discuss the up-to-date management options.     

牙周病与糖尿病足临床相关性研究

目的 调查糖尿病足的风险是否与牙周病（PD）相关。方法 选择110例糖尿病足伴牙周病患者,及项目协作组医院口腔科就诊的条件相近的102名非糖尿病的牙周病患者为对照组。采用logistic回归模型,对潜在的混杂因素进行了调整,对本研究中所见的PD危险因素如：高龄、糖尿病病程、口腔保健和患者受教育水平等,采用SPSS 12.0作统计分析。结果 年龄、糖尿病病程、口腔保健和教育水平具统计学意义。在调整性别、年龄、糖尿病病程、口腔保健和教育后,PD和牙列缺损与糖尿病足有独立相关。结论 糖尿病足的风险与牙周病高度相关。     

A murine model of accelerated periodontal disease in diabetes

Diabetes is a risk factor for periodontal disease in humans. In hyperglycemia, glycoxidation of proteins and lipids results in the formation of advanced glycation endproducts, or AGEs. The accumulation of AGEs in the plasma and tissues, and their interaction with their cellular receptor for AGE (RAGE), has been implicated in diabetic complications. In order to establish a model with which to delineate the specific host response factors that underlie the development of periodontal disease in diabetes, male C57BL/6J mice were rendered diabetic with streptozotocin. One month after documentation of diabetes or control state, mice were inoculated with the human periodontal pathogen Porphyromonas gingivalis, strain 381 (P. gingivalis) or treated with vehicle. Infection with P. gingivalis was achieved, as demonstrated by infiltration of gingival tissue with granulocytes, presence of DNA specific for P. gingivalis as well as increased serum antibody titer to P. gingivalis. At 2 and 3 months after infection, increased alveolar bone loss was demonstrated in P. gingivalis–inoculated diabetic vs. non–diabetic mice, along with enhanced tissue–destructive capacity, as demonstrated by increased collagenolytic activity in gingival extracts. Consistent with an important role for AGE–RAGE interaction, increased AGE deposition and expression of vascular and monocyte RAGE were demonstrated in diabetic gingiva compared with non–diabetic controls. Taken together, these data indicate that we have established a murine model of enhanced periodontal disease in diabetes. This model will serve to delineate molecular mechanisms which account for the increased susceptibility of diabetic patients to periodontal disease.     

Update on diabetes mellitus: prevention, treatment, and association with oral diseases

Diabetes mellitus is a prevalent disease that affects millions of people worldwide and has paralleled the growing population of overweight and obese individuals. Early detection of prediabetes and diabetes, as well as lifestyle interventions including diet and exercise, are the overarching objectives in preventing and managing diabetes. For individuals who do not achieve glycemic control with lifestyle modification, there are newer medication classes that assist with weight loss, more physiologic insulins with convenient delivery systems, and old standbys like metformin and thiazolidinediones. Glycemic control along with blood pressure and cholesterol management reduce microvascular and macrovascular disease including cardiovascular events. Mounting evidence demonstrates that diabetes is a risk factor for periodontitis and possibly oral premalignancies and oral cancer. The systemic inflammatory response generated by inflamed periodontal tissue may in turn exacerbate diabetes, worsen cardiovascular outcomes, and increase mortality. Thus, oral medical and surgical physicians are vital in treating oral pathology, recognizing new cases of diabetes, and counseling people with diabetes to promote oral health. This article presents updates in the diagnosis, risk factors, prevention, management, and peri-oral complications of diabetes to assist oral health professionals in providing optimal care to patients with diabetes.     

Diabetes and periodontal disease: two sides of a coin

Diabetes and periodontal disease are two seemingly unrelated disorders whose complex interrelationship is only now being clarified. How does diabetes, a metabolic disease, affect the periodontium? Perhaps even more interesting for the diabetic patient: How does periodontal disease, a bacterial infection that results in inflammation and tissue destruction in the oral cavity, impact the metabolic control of diabetes? Evidence clearly supports diabetes as a risk factor for periodontal disease. The mechanisms by which diabetes adversely influences the periodontium are in many ways similar to the mechanisms responsible for the classic complications of diabetes. In recent years, research has demonstrated that the relationship between periodontal disease and diabetes is more complex than previously realized. Not only does diabetes affect the periodontium, but periodontal infection can adversely impact glycemic control in diabetes. Periodontal treatment that decreases the bacterial challenge and the resulting inflammatory periodontal destruction can improve glycemia in some diabetic patients. These research findings are of importance to diabetic patients and their health care providers, because the findings support the need for examination, diagnosis, treatment, and prevention of periodontal infection.