15 research outputs found
The role of diabetic neuropathy and high plantar pressures in the pathogenesis of foot ulceration
Diabetic foot ulceration is currently a serious medical problem and has,
therefore, attracted much research attention during the last two
decades. Previous foot ulceration, diabetic neuropathy, limited joint
mobility, high plantar pressures, microangiopathy, macroangiopathy and
diabetic nephropathy have already been identified as risk factors for
future foot ulceration. Neuropathy has clearly been shown to be an
essential permissive factor in the development of ulceration in the
non-ischaemic foot. Moreover, the pathogenetic role of high plantar
pressures is crucial in the presence of established clinical neuropathy.
Nowadays, our therapeutic efforts clearly aim to prevent than treat foot
ulcers. This demands specialist and team work in the setting up of a
diabetic foot clinic in an attempt to identify and educate the diabetic
patients at risk and, where possible to use suitable plantar
pressure-reducing systems (footwear, hosiery etc.). Then only would it
be reasonable to postulate that a significant reduction in amputations
of diabetic aetiology could be achieved in the near future
Pretibial myxedema as the initial manifestation of Graves' disease
Pretibial myxedema (PM) is a localized thickening of the pretibial skin
due to accumulation of acid mucopolysacharides (glycosaminoglycans): Its
pathogenesis is still under investigation. Pretibial myxedema,
exophthalmus and thyroid acropachy are the classic extrathyroidal
manifestations of Graves’ disease. Almost invariably, PM follows the
onset of ophthalmopathy, developing after the diagnosis and treatment of
hyperthyroidism. Pretibial myxedema preceding Graves’ ophthalmopathy is
rare.
We report the case of a 28-year-old Greek woman, who presented with
multiple, asymptomatic nodules and plaques of the lower legs in the
absence of other physical findings. Histopathologic examination revealed
deposition of mucopolysacharides in the lower dermis. Laboratory
investigation showed elevated serum T3 and T4 and depressed TSH levels.
In our patient, pretibial myxedema was the earliest manifestation,
leading to the diagnosis of Graves’ disease
The diabetic foot in end stage renal disease
Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations