by Gregory P. Guyton, and Charles L. Saltzman

Slides:

Advertisements

Similar presentations

Intercalary Allograft Reconstructions Following Resection of Primary Bone Tumors by M.P.A. Bus, P.D.S. Dijkstra, M.A.J. van de Sande, A.H.M. Taminiau,

Advertisements

Early Clinical and Radiographic Characteristics in Fibrodysplasia Ossificans Progressiva by Kenichi Mishima, Hiroshi Kitoh, Takenobu Katagiri, Hiroshi.

Complex Regional Pain Syndrome by Thuan-Tzen Koh, Anne Daly, William Howard, Chong Tan, and Andrew Hardidge JBJS Reviews Volume 2(7):e5 July 22, 2014 ©2014.

Lesser-Toe Abnormalities by Michael J. Coughlin J Bone Joint Surg Am Volume 84(8): August 1, 2002 ©2002 by The Journal of Bone and Joint Surgery,

Avoiding Complications in the Treatment of Humeral Fractures by Jeffrey O. Anglen, Michael T. Archdeacon, Lisa K. Cannada, and Dolfi Herscovici J Bone.

Morbid Obesity: A Significant Risk Factor for Failure of Two-Stage Revision Total Hip Arthroplasty for Infection by Matthew T. Houdek, Eric R. Wagner,

Effectiveness and Safety of Tranexamic Acid in Reducing Blood Loss in Total Knee Arthroplasty: A Meta-Analysis by Zhi-Gao Yang, Wei-Ping Chen, and Li-Dong.

by May Fong Mak, Richard Stern, and Mathieu Assal

Intermediate-Term Follow-up After Ankle Distraction for Treatment of End-Stage Osteoarthritis by Mai P. Nguyen, Douglas R. Pedersen, Yubo Gao, Charles.

Proximal Opening Wedge Osteotomy with Wedge-Plate Fixation Compared with Proximal Chevron Osteotomy for the Treatment of Hallux Valgus by Mark Glazebrook,

Evaluation of Articular Cartilage Progenitor Cells for the Repair of Articular Defects in an Equine Model by David D. Frisbie, Helen E. McCarthy, Charles.

Checkrein Deformity Associated with Intra-Articular Talar Fracture

Complex Total Hip Replacement in a Patient with Epidermolytic Hyperkeratosis by Thomas L. Bernasek, and Elizabeth A. Rommel J Bone Joint Surg Am Volume.

Rheumatoid Forefoot Reconstruction. A Long-Term Follow-up Study*

Bone-Marrow Transplantation in Sickle-Cell Disease. Effect on Osteonecrosis: A Case Report with a Four-Year Follow- up* by P. HERNIGOU, F. BERNAUDIN, P.

Femoral Nerve Palsy in Pavlik Harness Treatment for Developmental Dysplasia of the Hip by M. Lucas Murnaghan, Richard H. Browne, Daniel J. Sucato, and.

Reverse Total Shoulder Arthroplasty: Current Concepts, Results, and Component Wear Analysis by D. Nam, C.K. Kepler, A.S. Neviaser, K.J. Jones, T.M. Wright,

Mechanisms and Risk Factors of Brachial Plexus Injury in the Treatment of Early-Onset Scoliosis with Distraction- Based Growing Implants by Elizabeth R.A.

Rotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and Treatment by Denis Nam, Travis G. Maak, Bradley S. Raphael, Christopher K. Kepler, Michael B.

by P. M. WATERS, and B. A. TAYLOR

Comparison of Fixation of the Femoral Component without Cement and Fixation with Use of a Bone-Vacuum Cementing Technique for the Prevention of Fat Embolism.

Scoliosis in Patients with Duchenne Muscular Dystrophy by Lori A. Karol J Bone Joint Surg Am Volume 89(suppl 1): February 1, 2007 ©2007 by The Journal.

Modes of Failure of Custom Expandable Repiphysis Prostheses by Aditya V. Maheshwari, Patrick F. Bergin, and Robert M. Henshaw J Bone Joint Surg Am Volume.

Reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular Graft by S. Sinan Bilgin J Bone Joint Surg Am Volume.

Injuries to the Ankle Syndesmosis

Treatment of Lumbar Disc Herniation: Epidural Steroid Injection Compared with Discectomy by Glenn R. Buttermann J Bone Joint Surg Am Volume 86(4):

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Common Complications of Total Knee Arthroplasty*† by DAVID C. AYERS, DOUGLAS.

Patient Outcomes after Reoperation on the Lumbar Spine* by GEOFFREY STEWART, and BARTON L. SACHS J Bone Joint Surg Am Volume 78(5): May 1, 1996 ©1996.

The Natural History of Cervical Disc Calcification in Children by Li-Yang Dai, Hua Ye, and Qi-Rong Qian J Bone Joint Surg Am Volume 86(7): July.

Allograft-Prosthesis Composite for Revision of Catastrophic Failure of Total Elbow Arthroplasty by Pierre Mansat, Robert A. Adams, and Bernard F. Morrey.

A Randomized, Prospective Study of Operative and Non- Operative Treatment of Injuries of the Fibular Collateral Ligaments of the Ankle* by P. POVACZ, F.

Calcific Periarthritis: More Than a Shoulder Problem by Larisa M. Lehmer, and Bruce D. Ragsdale J Bone Joint Surg Am Volume 94(21):e157 November 7, 2012.

Use of Imaging Biomarkers for Regulatory Studies by Peter Steiger J Bone Joint Surg Am Volume 91(Supplement 1): February 1, 2009 ©2009 by The Journal.

Twenty-one Years with Congenital Insensitivity to Pain by Dnyanesh G. Lad, and V.M. Khaleel JBJS Case Connect Volume 2(4):e66 November 14, 2012 ©2012 by.

Comparison of Deformity with Respect to the Talus in Patients with Posterior Tibial Tendon Dysfunction and Controls Using Multiplanar Weight-Bearing Imaging.

The Efficacy of an Injection of Steroids for Medial Epicondylitis. A Prospective Study of Sixty Elbows* by SHALOM STAHL, and TEDDY KAUFMAN J Bone Joint.

Computed Tomographic Angiography in Proximal Femoral Focal Deficiency by Jiří Chomiak, Martin Horák, Martin Mašek, Monika Frydrychová, and Pavel Dungl.

Lengthening in Congenital Femoral Deficiency by Sheena R. Black, Michael S. Kwon, Alexander M. Cherkashin, Mikhail L. Samchukov, John G. Birch, and Chan-Hee.

Risk of Injury to the Superior Gluteal Nerve When Using a Proximal Incision for Insertion of a Piriformis-Entry Reamed Femoral Intramedullary Nail by Jason.

The Influence of Insurance Status on Access to and Utilization of a Tertiary Hand Surgery Referral Center by Ryan P. Calfee, Chirag M. Shah, Colin D. Canham,

Total Knee Arthroplasty in Patients with Ankylosing Spondylitis by Javad Parvizi, Gavan P. Duffy, and Robert T. Trousdale J Bone Joint Surg Am Volume 83(9):

by ANDRE R. GAZDAG, and ANDREA CRACCHIOLO

Severe Acute Respiratory Syndrome (SARS) in a Geriatric Patient with a Hip Fracture by Kwok Chuen Wong, Kwok Sui Leung, and Mamie Hui J Bone Joint Surg.

Single-Leg-Stance Radiographs in the Diagnosis of Pelvic Instability by Jodi Siegel, David C. Templeman, and Paul Tornetta J Bone Joint Surg Am Volume.

by Manjunath Koti, and Nicola Maffulli

Percutaneous Autologous Bone-Marrow Grafting for Nonunions by Ph. Hernigou, A. Poignard, F. Beaujean, and H. Rouard J Bone Joint Surg Am Volume 87(7):

Ilizarov Hip Reconstruction for the Late Sequelae of Infantile Hip Infection by S. Robert Rozbruch, Dror Paley, Anil Bhave, and John E. Herzenberg J Bone.

Knee Injury in Patients Experiencing a High-Energy Traumatic Ipsilateral Hip Dislocation by Gary L. Schmidt, Robert Sciulli, and Gregory T. Altman J Bone.

Metal Ion Levels After Metal-on-Metal Total Hip Arthroplasty by C.A. Engh, S.J. MacDonald, S. Sritulanondha, A. Korczak, D. Naudie, and C. Engh J Bone.

The Efficacy of Ultrasound in the Evaluation of Dynamic Scapholunate Ligamentous Instability by Khiem D. Dao, Daniel J. Solomon, Alexander Y. Shin, and.

Non-Union of the Scaphoid. Treatment with Cannulated Screws Compared with Treatment with Herbert Screws* by THOMAS E. TRUMBLE, TODD CLARKE, and HANS J.

Lateral Unicompartmental Knee Arthroplasty Through a Medial Approach by Alexander P. Sah, and Richard D. Scott J Bone Joint Surg Am Volume 89(9):

Realignment and Extended Fusion with Use of a Medial Column Screw for Midfoot Deformities Secondary to Diabetic Neuropathy by Mathieu Assal, Adrien Ray,

Scapular Winging: A Great Masquerader of Shoulder Disorders

Volar Locking Plate Implant Prominence and Flexor Tendon Rupture

Prediction of Correction of Scoliosis with Use of the Fulcrum Bending Radiograph* by K. M. C. CHEUNG, and K. D. K. LUK J Bone Joint Surg Am Volume 79(8):

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Simulators of Hand Infections*† by STEVEN E. KANN, JOHN B. JACQUEMIN, and.

Operative Treatment of Cervical Spondylotic Myelopathy by Raj D. Rao, Krishnaj Gourab, and Kenny S. David J Bone Joint Surg Am Volume 88(7): July.

Long-Term Results Following Ankle Arthrodesis for Post- Traumatic Arthritis by Lisa M. Coester, Charles L. Saltzman, John Leupold, and William Pontarelli.

Shoulder Hemiarthroplasty for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency by Joaquin Sanchez-Sotelo, Robert H. Cofield, and Charles.

Periacetabular Osteotomy: the Bernese Experience by Klaus A Siebenrock, Michael Leunig, and Reinhold Ganz J Bone Joint Surg Am Volume 83(3): March.

An Association Between Functional Second Metatarsal Length and Midfoot Arthrosis by James S. Davitt, Nancy Kadel, Bruce J. Sangeorzan, Sigvard T. Hansen,

Topics in Medical Economics: Health Care Rationing by Joseph Bernstein J Bone Joint Surg Am Volume 88(11): November 1, 2006 ©2006 by The Journal.

The Uneven Distribution of Women in Orthopaedic Surgery Resident Training Programs in the United States by Ann E. Van Heest, and Julie Agel J Bone Joint.

Femoral Revision with the Wagner SL Revision Stem by Paul Böhm, and Oliver Bischel J Bone Joint Surg Am Volume 83(7): July 1, 2001 ©2001 by The.

Primary Total Hip Arthroplasty with Use of the Modular S- ROM Prosthesis. Four to Seven-Year Clinical and Radiographic Results* by MICHAEL J. CHRISTIE,

Evaluation of Morton's Theory of Second Metatarsal Hypertrophy by Brett R. Grebing, and Michael J. Coughlin J Bone Joint Surg Am Volume 86(7):

Influence of Comorbidity on Self-Assessment Instrument Scores of Patients with Idiopathic Adhesive Capsulitis by Jennifer Moriatis Wolf, and Andrew Green.

Foot deformities. Foot deformities. These sites are frequent locations for diabetic foot ulceration. A: Claw toe deformity. Note the buckling phenomenon.

Common foot deformities resulting from diabetes complications: A) claw toe deformity (increased pressure is placed on the dorsal and plantar aspects of.

Presentation transcript:

by Gregory P. Guyton, and Charles L. Saltzman The Diabetic Foot by Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am Volume 83(7):1083-1096 July 1, 2001 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Diabetic neuropathy can present in a wide variety of patterns. Diabetic neuropathy can present in a wide variety of patterns. An individual patient may have any combination of the general syndromes listed above. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

The results of the Diabetes Control and Complications Trial (DCCT) indicated that the percentage of patients in whom abnormalities developed was significantly lower in association with intensive glucose control, according to the findings of both neurologic ... The results of the Diabetes Control and Complications Trial (DCCT) indicated that the percentage of patients in whom abnormalities developed was significantly lower in association with intensive glucose control, according to the findings of both neurologic examination and objective nerve-conduction studies. (Adapted, with permission, from: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:982. Copyright ” 1993 Massachusetts Medical Society. All rights reserved.)‏ Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Photograph of the foot of a patient with neuropathic claw toes, showing ulcerations over the prominent dorsal aspects of the proximal interphalangeal joints where the toes rubbed against the shoe. Photograph of the foot of a patient with neuropathic claw toes, showing ulcerations over the prominent dorsal aspects of the proximal interphalangeal joints where the toes rubbed against the shoe. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A and 4-B A radiograph and clinical photograph of the foot of a patient with a midfoot ulceration from Charcot arthropathy with subsequent collapse. Figs. 4-A and 4-B A radiograph and clinical photograph of the foot of a patient with a midfoot ulceration from Charcot arthropathy with subsequent collapse. Osseous deformity resulting from neuroarthropathy is one of the strongest risk factors for the development of ulceration. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A and 4-B A radiograph and clinical photograph of the foot of a patient with a midfoot ulceration from Charcot arthropathy with subsequent collapse. Figs. 4-A and 4-B A radiograph and clinical photograph of the foot of a patient with a midfoot ulceration from Charcot arthropathy with subsequent collapse. Osseous deformity resulting from neuroarthropathy is one of the strongest risk factors for the development of ulceration. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

A patient with diabetic cheiropathy (limited joint mobility) exhibits the “prayer sign.” Subtle contractures at the interphalangeal and metacarpophalangeal joints prevent the fingers from fully opposing each other. A patient with diabetic cheiropathy (limited joint mobility) exhibits the “prayer sign.” Subtle contractures at the interphalangeal and metacarpophalangeal joints prevent the fingers from fully opposing each other. A space is visible between the fingers when a praying posture is attempted. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

The hallux of a patient with severe autonomic neuropathy. The hallux of a patient with severe autonomic neuropathy. In this disorder, the normal sweat function is disrupted, resulting in dry, cracked skin that can serve as a portal for infection. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

A diagram representing a partial explanation of the pathogenesis of microangiopathy. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Diabetic patients with autonomic dysfunction often have engorged vasculature when the foot is dependent (left). Diabetic patients with autonomic dysfunction often have engorged vasculature when the foot is dependent (left). Disordered autoregulation allows the blood to drain rapidly when the foot is elevated, and the color of the leg fades (right). This phenomenon of “dependent rubor” is especially common in patients with neuroarthropathy. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Mönckeberg sclerosis (medial arterial calcification) is readily apparent on radiographs and is strongly associated with autonomic failure and Charcot arthropathy, as it was in this patient. Mönckeberg sclerosis (medial arterial calcification) is readily apparent on radiographs and is strongly associated with autonomic failure and Charcot arthropathy, as it was in this patient. Note the smooth, diffuse pattern of calcification (arrows) instead of the irregular intimal calcifications characteristic of common atherosclerosis. Gregory P. Guyton, and Charles L. Saltzman J Bone Joint Surg Am 2001;83:1083-1096 ©2001 by The Journal of Bone and Joint Surgery, Inc.