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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEvery 30 seconds, a lower limb is lost due to complications of diabetes \u003Ca href=\u0022http:\/\/www.diabeticfootonline.com\u0022\u003Ewww.diabeticfootonline.com\u003C\/a\u003E]. This article discusses management strategies for the treatment of the diabetic foot wound.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDavid G. Armstrong, DPM, MD, PhD, University of Arizona College of Medicine, Tucson, AZ, presented the 2010 Roger Pecoraro Lecture at the American Diabetes Association 70\u003Csup\u003Eth\u003C\/sup\u003E Annual Scientific Sessions, where he discussed management strategies for the treatment of the diabetic foot wound. Every 30 seconds, a lower limb is lost due to complications of diabetes [\u003Ca href=\u0022http:\/\/www.diabeticfootonline.com\u0022\u003Ewww.diabeticfootonline.com\u003C\/a\u003E]. According to the Nord-Trondelag Health Study, foot ulcer history is associated with a 38% increased risk of death among diabetics after adjusting for lifestyle and demographic factors [Iverson MM et al. \u003Cem\u003EScandinavian J Public Health\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDr. Armstrong recommends the team approach to diabetic foot wound management in order to reduce the incidence of amputation. In a study that evaluated 1708 procedures over a period of 32 months, patients who received the team approach to treatment were 61.0% less likely to undergo amputation versus 28.9% in the control group (p\u0026lt;0.0001) [Armstrong DG et al. ADA 2010]. An effective amputation prevention team should include the ability to perform certain tasks, such as site-appropriate culture techniques, vascular assessment and revascularization, neurological evaluation, wound assessment and infection staging\/grading, site-specific bedside and intraoperative incision and debridement, culture- and patient-appropriate antibiotic therapy implementation, and postoperative monitoring with a focus on reulceration and infection risk reduction [Fitzgerald et al. \u003Cem\u003EEPlasty\u003C\/em\u003E 2009; Armstrong DG et al. \u003Cem\u003EJVS\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThere are also many advances being made in the area of wound care that may optimize the management of diabetic foot ulcers. Among them is vacuum-assisted closure (VAC) therapy. This therapy provides several healing advantages, such as promotion of flap and graft survival, removal of interstitial fluid and infectious material, and uniform wound closure through the use of negative pressure [Saxena et al. \u003Cem\u003EPlast Reconstr Surg\u003C\/em\u003E 2004]. VAC therapy resulted in fewer surgical procedures and dressing changes compared with standard moist wound therapy (p\u0026lt;0.0001 for both) [Apelqvist J et al. \u003Cem\u003EAm J Surg\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EReceptor activator of nuclear factor kappa B ligand (RANK-L), osteoprotegerin (OPG), and intranasal calcitonin may also facilitate healing in diabetic foot ulcers. RANK-L and OPG play a key role in bone remodeling and resorption. Dysregulation of RANK-L or OPG may result in bone loss. Upregulation of RANK-L may occur in the presence of peripheral neuropathies. Intranasal calcitonin may reduce bone turnover, a product of the RANK-L\/OPG system, by inhibiting RANK-L. Unlike bisphosphonates, intranasal calcitonin may be used in patients with renal insufficiency [Bern et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2004; Bern et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPreventing a recurrence remains a priority in diabetic foot ulcer management. Cumulative risk for ulceration by foot risk category may be one way of predicting recurrence. The risk groups range from 0 to 3 based on history and the presence of neuropathy or peripheral vascular disease (0=no neuropathy, no PVD; 1=neuropathy+\/\u2212 deformity; 2=PVD +\/\u2212 neuropathy; 3=history of pathology). Skin temperatures may provide important predictive data and indicate impending ulcerations. High temperature gradients between feet may predict the onset of neuropathic ulceration, and regular monitoring of bilateral foot temperatures may allow for early intervention and prevention (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Armstrong DG et al. \u003Cem\u003EPhys Ther\u003C\/em\u003E 1997; Armstrong DG et al. \u003Cem\u003EAm J Med\u003C\/em\u003E 2008; Lavery et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2008]. Monitoring physical activity during drug therapy in the diabetic foot may also be a useful tool in predicting disease progression.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/6\/37\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Are Skin Temperatures Predictive of Ulceration?\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1461900519\u0022 data-figure-caption=\u0022Are Skin Temperatures Predictive of Ulceration?\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/6\/37\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/6\/37\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/6\/37\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11397\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EAre Skin Temperatures Predictive of Ulceration?\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from D. Armstrong, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EOptimal diabetic foot management incorporates innovative strategies, such as a team approach, new technologies, and predictive risk assessment tools. Treating the acute foot wound is a complex endeavor, and preventing recurrence is an important part of successful management.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/6\/37.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmrtq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmrtq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}