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Hazbiu A, Teobaldi I, Sepe M, Federici G, Meloni M, Uccioli L. The Appropriateness of Footwear in Diabetic Patients Observed during a Podiatric Examination: A Prospective Observational Study. J Clin Med 2024; 13:2402. [PMID: 38673674 PMCID: PMC11051551 DOI: 10.3390/jcm13082402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Adequate compliance with wearing therapeutic footwear (TF) to prevent diabetic foot ulcers is known to be low. The primary aim of this study was to identify population awareness about the ulceration and/or recurrence risk according to footwear choice. The secondary aim was to evaluate the compliance level in footwear choice based on a patient's own risk. Methods: Forty podiatrists participated from 1 September 2017 to 31 August 2018, providing six-section forms which included personal data, risk classification, footwear characteristics and a knowledge questionnaire. Results: This study included 1507 patients. Those with active ulcers were excluded. A total of 43% of patients belonged to risk class 0, 19% to risk class 1, 19% to risk class 2 and 19% to risk class 3. A total of 58% had foot deformities. Conclusions: Nearly half of patients with a high risk of ulceration had knowledge of their own risk but the majority of them did not follow the recommendations. Only a small percentage (36%) of risk class 3 patients wore footwear suitable for their risk class. There was poor consideration of footwear choice among patients. We highlight critical issues in patient education and compliance with wearing footwear appropriate to their risk class.
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Affiliation(s)
- Anisa Hazbiu
- Ambulatorio CIMAU, Via G. Cesare 82, 66054 Vasto, Italy;
| | | | - Mario Sepe
- Centro Podologico Sepe, Via Alcide De Gasperi 4/D, 80036 Palma Campania, Italy;
| | - Giovanni Federici
- Ospedale San Pietro Fatebenefratelli, Via Cassia 600, 00189 Roma, Italy;
| | - Marco Meloni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145 Rome, Italy
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Teobaldi I, Stoico V, Perrone F, Mantovani A, Piccagli P, Grandi F, Baldo B. Effect of a Topical Gel Based on Adelmidrol + Trans-Traumatic Acid in the Treatment of Diabetic Foot Ulcers: An Open-Label Study. J Am Podiatr Med Assoc 2022; 112:20-143. [PMID: 34709395 DOI: 10.7547/20-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetic foot ulceration is a severe complication of diabetes characterized by chronic inflammation and impaired wound healing. This study aimed to evaluate the effect of a medical device gel based on adelmidrol + trans-traumatic acid in the healing process of diabetic foot ulcers. METHODS Thirty-seven diabetic patients with foot ulcers of mild/moderate grade were treated with the gel daily for 4 weeks on the affected area. The following parameters were evaluated at baseline and weekly: 1) wound area, measured by drawing a map of the ulcer and then calculated with photo editing software tools, and 2) clinical appearance of the ulcer, assessed by recording the presence/absence of dry/wet necrosis, infection, fibrin, neoepithelium, exudate, redness, and granulation tissue. RESULTS Topical treatment led to progressive healing of diabetic foot ulcers with a significant reduction of the wound area and an improvement in the clinical appearance of the ulcers. No treatment-related adverse events were observed. CONCLUSIONS The results of this open-label study show the potential benefits of adelmidrol + trans-traumatic acid topical administration to promote reepithelialization of diabetic foot ulcers. Further studies are needed to confirm the observed results.
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Affiliation(s)
- Ilaria Teobaldi
- *Division of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Vincenzo Stoico
- *Division of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Fabrizia Perrone
- *Division of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandro Mantovani
- *Division of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Patrizia Piccagli
- *Division of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Fiorenza Grandi
- *Division of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Barbara Baldo
- *Division of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Teobaldi I, Stoico V, Perrone F, Bruti M, Bonora E, Mantovani A. Honey dressing on a leg ulcer with tendon exposure in a patient with type 2 diabetes. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180117. [PMID: 30475216 PMCID: PMC6240024 DOI: 10.1530/edm-18-0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/25/2018] [Indexed: 01/13/2023] Open
Abstract
Honey has been used as a wound dressing for hundreds of years by ancient civilizations, but only recently it has acquired scientific interest because of its relevant biological properties. In the last decade, indeed, several trials and observational studies have reported that, compared to conventional treatment (e.g. antiseptics, polyurethane film, paraffin gauze, soframycin-impregnated gauze), honey dressings seem to be better in healing time of different types of wounds, including diabetic foot ulcers. However, to date, information about a potential favorable biological effect of honey dressings on diabetic ulcers with exposed tendon are still scarce. Notably, foot or leg ulcers with exposed tendon are serious complications in patients with type 2 diabetes, as they are associated with an increased risk of adverse outcome. Therefore, the use of effective and safe treatments to bring these lesions to timely healing is very important in clinical practice. We herein report the case of a Caucasian adult patient with type 2 diabetes presenting a chronic right posterior lower limb ulcer (Texas University Classification (TUC) 2D) with tendon exposure that was successfully treated with honey dressings (glucose oxidase (GOX) positive with peroxide activity) in addition to systemic antibiotic therapy, surgical toilette and skin graft. In our case, the use of honey dressing for treating exposed tendon tissue probably allowed the timely wound healing. Although further studies are required, such treatment may constitute part of the comprehensive management of diabetic wounds, including those with tendon exposure, and should be considered by clinicians in clinical practice.
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Affiliation(s)
- Ilaria Teobaldi
- Division of Endocrinology Diabetes and Metabolism, Department of Medicine
| | - Vincenzo Stoico
- Division of Endocrinology Diabetes and Metabolism, Department of Medicine
| | - Fabrizia Perrone
- Division of Endocrinology Diabetes and Metabolism, Department of Medicine
| | - Massimiliano Bruti
- Division of Plastic Surgery, Department of Surgery, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology Diabetes and Metabolism, Department of Medicine
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Mantovani A, Teobaldi I, Stoico V, Perrone F, Zannoni M, Cima L, Bruti M, Mingolla L, Trombetta M, Bonora E. Cutaneous squamous carcinoma in a patient with diabetic foot: an unusual evolution of a frequent complication. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180065. [PMID: 30083351 PMCID: PMC6075372 DOI: 10.1530/edm-18-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 11/08/2022] Open
Abstract
After basal cell carcinoma, the cutaneous squamous cell carcinoma (cSCC) is the second most frequent non-melanoma skin cancer worldwide, and, classically, arises from the upper coats of the epidermis of sun-exposed areas or from skin areas constantly exposed to a chronic inflammatory stimulus. The occurrence of cSCC seems to be linked to several factors, including exposure to sunlight (or other ultraviolet radiations), immunosuppression, chronic scarring conditions and some familial cancer syndromes. Although the majority of cSCCs are adequately eradicated by surgical excision, a subgroup of cSCC may be linked with an increased risk of recurrence, metastasis and death. The incidence of type 2 diabetes mellitus is constantly increasing worldwide. Importantly, diabetes mellitus is a strong risk factor for cancers (including cutaneous tumors) and is highly related with poor cancer outcomes. At present, in the literature, squamous cell carcinoma developing in association with diabetic foot ulcers has been already reported in some reports; however, additional data are needed to make the clinicians aware of this rare, although possible, complication. Therefore, we herein report an unusual case of an elderly man with T2DM and a positive oncological history, presenting a cSCC involving the skin overlying the first toe of left foot. The growing cSCC appeared approximately 3 years after the appearance of a diabetic ulcer.
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Affiliation(s)
| | - Ilaria Teobaldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine
| | - Vincenzo Stoico
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine
| | - Fabrizia Perrone
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine
| | - Marina Zannoni
- Division of Pathology Unit, Department of Diagnostics and Public Health
| | - Luca Cima
- Division of Pathology Unit, Department of Diagnostics and Public Health
| | - Massimiliano Bruti
- Division of Plastic Surgery, Department of Surgery, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Lucia Mingolla
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine
| | | | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine
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Teobaldi I, Mantovani A. Pressure heel ulcers in patients with type 2 diabetes: Is it T.I.M.E. to customise wound bed preparation according to different heel areas? Int Wound J 2018; 15:849-850. [PMID: 29665271 DOI: 10.1111/iwj.12914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ilaria Teobaldi
- Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Mantovani A, Perrone F, Stoico V, Pichiri I, Salvotelli L, Teobaldi I, Bruti M, Conti M, Cima L, Eccher A, Bonora E. Primary cutaneous B-cell lymphoma and chronic leg ulcers in a patient with type 2 diabetes. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170032. [PMID: 28567289 PMCID: PMC5445424 DOI: 10.1530/edm-17-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022] Open
Abstract
The incidences of type 2 diabetes mellitus and many cancers are rapidly increasing worldwide. Diabetes is a strong risk factor for some cancers (including lymphomas) and is also associated with adverse cancer outcomes. After gastrointestinal tract, the skin is the second most frequent extranodal site involved by non-Hodgkin lymphomas and the cutaneous B-cell lymphomas (CBCLs) range from 25% to 30% of all primary cutaneous lymphomas. The primary cutaneous diffuse large B-cell lymphoma (PCDLBCL) is an aggressive lymphoma with a poor prognosis, representing roughly 20% of all primary CBCLs. Classically, the cutaneous manifestation of this lymphoma is a red or violaceous tumors arising on a leg. To date, despite the large body of evidence suggesting that diabetes is strongly associated with an increased risk of some cancers, very little information is available regarding a possible association between type 2 diabetes and primary cutaneous diffuse large B-cell lymphoma. In this report, we will present the case of a white adult patient with type 2 diabetes with chronic leg ulcers complicated by a primary cutaneous diffuse large B-cell lymphoma.
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Affiliation(s)
| | - Fabrizia Perrone
- Division of EndocrinologyDiabetes and Metabolism, Department of Medicine
| | - Vincenzo Stoico
- Division of EndocrinologyDiabetes and Metabolism, Department of Medicine
| | - Isabella Pichiri
- Division of EndocrinologyDiabetes and Metabolism, Department of Medicine
| | - Laura Salvotelli
- Division of EndocrinologyDiabetes and Metabolism, Department of Medicine
| | - Ilaria Teobaldi
- Division of EndocrinologyDiabetes and Metabolism, Department of Medicine
| | | | - Michela Conti
- Division of Infectious DiseaseDepartment of Medicine and
| | - Luca Cima
- Division of Pathology UnitDepartment of Diagnostics and Public Health, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Albino Eccher
- Division of Pathology UnitDepartment of Diagnostics and Public Health, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enzo Bonora
- Division of EndocrinologyDiabetes and Metabolism, Department of Medicine
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Uccioli L, Giurato L, Ruotolo V, Ciavarella A, Grimaldi MS, Piaggesi A, Teobaldi I, Ricci L, Scionti L, Vermigli C, Seguro R, Mancini L, Ghirlanda G. Two-Step Autologous Grafting Using HYAFF Scaffolds in Treating Difficult Diabetic Foot Ulcers: Results of A Multicenter, Randomized Controlled Clinical Trial With Long-Term Follow-up. INT J LOW EXTR WOUND 2011; 10:80-5. [DOI: 10.1177/1534734611409371] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated the efficacy and tolerability of an autologous tissue-engineered graft—a 2-step HYAFF autograft—in the treatment of diabetic foot ulcers compared with standard care. In all, 180 patients with dorsal or plantar diabetic foot ulcers (unhealed for ≥1 month) were randomized to receive Hyalograft-3D autograft first and then Laserskin autograft after 2 weeks (n = 90; treatment group) or nonadherent paraffin gauze (n = 90; control group). Efficacy and adverse events were assessed weekly for 12 weeks, at 20 weeks, and at 18 months. The primary efficacy outcome was complete ulcer healing at 12 weeks. Wound debridement, adequate pressure relief, and infection control were provided to both groups. At 12 weeks, complete ulcer healing was similar in both groups (24% of treated vs 21% controls). A 50% reduction in ulcer area was achieved significantly faster in the treatment group (mean 40 vs 50 days; P = .018). Weekly percentage ulcer reduction was consistently higher in the treatment group. At 20 weeks, ulcer healing was achieved in 50% of the treated group as compared with 43% of controls. Dorsal ulcers had a 2.17-fold better chance of wound healing per unit time following autograft treatment ( P = .047). In a subgroup with hard-to-heal ulcers, there was a 3.65-fold better chance of wound healing following autograft treatment of dorsal ulcers ( P = .035). Adverse events were similar in both groups. The study results demonstrated the potential of this bioengineered substitutes to manage hard-to-heal dorsal foot ulcers.
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Scirè V, Leporati E, Teobaldi I, Nobili LA, Rizzo L, Piaggesi A. Effectiveness and safety of using Podikon digital silicone padding in the primary prevention of neuropathic lesions in the forefoot of diabetic patients. J Am Podiatr Med Assoc 2009; 99:28-34. [PMID: 19141719 DOI: 10.7547/0980028] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In diabetic patients with complications from peripheral neuropathy, the hyperpressure areas can rapidly lead to ulcerative lesions in the absence of protective sensation. Partial digital silicone orthoses could provide an innovative and functional therapeutic solution in the management of preulcerative areas of the forefoot in neuropathic diabetic patients. We clinically tested this hypothesis. METHODS Digital off-loading silicone padding was prepared for 89 neuropathic patients with deformities and localized hyperkeratosis in the forefoot. After 3 months and in basal conditions, the number of areas of hyperkeratosis was evaluated together with the hardness of the skin, the number of active lesions, and any adverse events associated with use of the orthosis. The patients were compared to a control group of 78 randomized patients undergoing standard therapy. In a subgroup of 10 patients, a static and dynamic biomechanical evaluation was also conducted with a computerized podobarometric platform. RESULTS Both the number of lesions and the prevalence of hyperkeratosis and skin hardness were significantly lower (P < .01) in the group treated with the silicone orthoses than in the control group. No adverse events were reported during the 3 months of observation. The podobarometric analysis highlighted a significant (P < .001) reduction of peak pressure in the areas undergoing orthotic correction. CONCLUSIONS Silicone padding is effective and safe in the prevention of lesions in neuropathic patients at high risk of ulceration and significantly reduces the incidence of new lesions in the 3-month follow-up period compared to standard treatment.
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Affiliation(s)
- Vincenzo Scirè
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
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Piaggesi A, Macchiarini S, Rizzo L, Palumbo F, Tedeschi A, Nobili LA, Leporati E, Scire V, Teobaldi I, Del Prato S. An off-the-shelf instant contact casting device for the management of diabetic foot ulcers: a randomized prospective trial versus traditional fiberglass cast. Diabetes Care 2007; 30:586-90. [PMID: 17327325 DOI: 10.2337/dc06-1750] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was designed to test the safety, effectiveness, and costs of off-loading with a novel, off-the-shelf irremovable device in the management of diabetic foot ulceration (DFU). RESEARCH DESIGN AND METHODS We prospectively evaluated off-loading of neuropathic plantar ulcers in 40 diabetic outpatients attending our diabetic foot clinic and compared healing rates at the 12-week follow-up, number and severity of adverse events, healing time, costs and applicability of the device, and patients' satisfaction between those randomly assigned to total contact casting (TCC; group A) or to the Optima Diab walker (group B). Deep or infected ulcers were excluded. RESULTS No difference between groups A and B was observed in healing rates at 12 weeks (95 vs. 85%), healing time (6.5 +/- 4.4 vs. 6.7 +/- 3.4 weeks), and number of adverse events (six versus four). Treatment was significantly less expensive in group B, which showed a mean reduction of costs of 78% compared with group A (P < 0.001). Practicability was more favorable in group B, with a reduction of 77 and 58% of the time required for application and removal of the devices, respectively (P < 0.001). Patients' satisfaction with the treatment was higher in group B (P < 0.01). CONCLUSIONS The Optima Diab walker is as safe and effective as TCC in the management of DFU, but its lower costs and better applicability may be of help in spreading the practice of off-loading among the centers that manage the diabetic foot.
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Affiliation(s)
- Alberto Piaggesi
- Section of Diabetes and Metabolic Diseases, Department of Endocrinology and Metabolism, University of Pisa and Azienda Ospedaliera Pisana, Pisa, Italy.
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