• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.146-149
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• 2009

Purpose: Foot infections are common complications in patients with diabetes. The patients are usually immune-compromised; therefore the pathogens could be resistant to narrow spectrum antibiotics. Those drugs, however, are categorized as specially managed antibiotics, and access are difficult without confirming of the pathogens. Our aim was to analyze the common pathogens in diabetic foot infection and figure out the proper antibiotics. Materials and Methods: We studied 68 patients treated with diabetic foot infection. The pathogens which caused the infection and their sensitivity to initial antibiotics were analyzed. We also investigated the change of the antibiotics after the confirming of the culture result and average time to get the result. Results: Among the 68 patients, 56 (82%) received cephalosporin and beta-lactam antibiotics. Only 12 (18%) who were confirmed the drug resistant pathogens from previous culture, were treated with broad spectrum antibiotics such as vancomycin and tazoperan. Average culture study time was 6 days. Methicillin-resistant staphylococcus aureus (MRSA) was cultured in 19 patients (28%), Methicillin-resistant coagulase negative staphylococcus (MRCNS) in 11 patietns (17%), pseudomonas in 11 patients (17%). Total 44 (65%) including 3 of other antibiotics resistant pathogen needed broad spectrum antibiotics. Thirty two patients (47%) were resistant to initial antibiotics.irt follow up culture, 2 MRSA and 2 MRCNS were found. The antibiotics resistant pathogens were confirmed in 48 (71%) patients at last. Conclusion: Diabetic patients with foot infection need proper antibiotics from initial treatment. The proper broad spectrum antibiotics should assigned to the patients from the first time without the confirming of the culture results.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.208-211
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• 2019

Diabetic foot ulcers can progress to the point where amputation is needed, and so these ulcers require active treatment. Skin grafts or flaps can be performed for coverage of this type of ulcer. Local flap surgery is relatively easy to perform and good results have been previously reported. We performed single-lobed rotation flap on 5 cases of forefoot ulcer around the site of weight bearing. The location of the foot ulcers was the medial part of the first metatarsophalangeal joint in all the patients. The mean size of the defect was 4.70 ㎠. Managing of ulcers, controlling of diabetes and infection, and improving of peripheral blood flow were performed before surgery. In two cases, infection progressed to the articular cartilage and so metatarsophalangeal joint fusions were performed simultaneously. All the cases were completely transplanted. There was no recurrence of the ulcers, and all the patients were able to walk.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.159-164
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• 2014

Purpose: The purpose of this study is to confirm the effect of antiplatelet drugs in diabetic peripheral vasculopathy in diabetic foot patients. Materials and Methods: We designed a retrospective study in diabetic foot patients with diabetic peripheral vasculopathy. From October 2007 to December 2013, 278 cases in 139 patients who took antiplatelet drugs over at least a six-month period were included in this study. We categorized these patients according to the type of drug used. The efficacy of antiplatelet drugs was evaluated using anklebrachial index (ABI) and pulse wave velocity (PWV). Results: Only the aspirin group showed a statistically significant increase of ABI after antiplatelet therapy ($1.10{\pm}0.12$ to $1.12{\pm}0.11$). In addition, only the cilostazol group showed a statistically significant decrease of PWV after antiplatelet therapy ($1,701.20{\pm}396.56$ to $1,627.42{\pm}324.98$). Conclusion: Aspirin and cilostazol may be used in treatment of diabetic peripheral vasculopathy, whereas dual antiplatelet therapy with aspirin and clopidogrel has no specific benefits in diabetic peripheral vasculopathy.

• Journal of Korean Foot and Ankle Society
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• v.17 no.4
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• pp.243-250
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• 2013

Diabetic Charcot arthropathy is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, limb loss. Although recent research has improved our level of knowledge regarding its etiology and treatment, it still remains a poorly understood disease. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus and its diagnosis is commonly missed upon initial presentation. Clinicians treating diabetic patients should be vigilant in recognizing early signs of acute Charcot arthropathy, such as pain, warmth, edema, or pathologic fracture in a neuropathic foot. Early detection and prompt treatment can prevent joint and bone destruction. If left untreated, it can reduce overall quality of life and dramatically increase morbidity and mortality of patients. The goal of this manuscript is to evaluate the current concepts of Charcot arthropathy through review of various literature and help clinicians decide the treatment strategy.

• Journal of Korean Foot and Ankle Society
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• v.19 no.3
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• pp.107-113
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• 2015

Purpose: The question of surgical versus non-surgical treatment for diabetic foot osteomyelitis remains subject to debate. The aims of this study were to analyse the outcome of conservative treatment (antibiotic treatment and conservative surgery) for diabetic foot osteomyelitis and identify the predictive factors of remission in conservative treatment of diabetic foot osteomyelitis. Materials and Methods: Seventy-seven patients with diabetic foot osteomyelitis who initially received conservative treatment from January 2004 to July 2013 were identified, and their medical records were reviewed. Diabetic foot osteomyelitis was defined by imaging studies or histological evidence. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 12 months after the end of treatment. The demographic, clinical, and therapeutic factors were analysed. Results: The mean age of the patients was $62.7{\pm}12.2$ years, and 47 patients (61.0%) were male. The median diabetes duration was $15.7{\pm}11.2$ years and mean HbA1c was $8.7%{\pm}2.4%$. Forty-eight patients (62.3%) healed with conservative treatment (antibiotic treatment and conservative surgery). Twenty-five patients (32.5%) underwent amputation. In the multivariate analysis, concomitant peripheral artery disease and inadequate antibiotic therapy were associated with failure of conservative treatment. Conclusion: Antibiotics alone, or with conservative surgery, were successful in treatment of diabetic foot osteomyelitis in 62.3% of the patients. Concomitant peripheral artery disease and inadequate antimicrobial therapy were risk factors for remission in conservatively treated diabetic foot osteomyelitis.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.35-39
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• 2002

Purpose: The purpose of this study was to evaluate the effect of hyperbaric oxygen therapy(HBOT) and the resultant amputation rate in the treatment of diabetic foot ulcer. Material and methods: From 2000 Jan. to 2002 April, thirty two diabetic foot patients were admitted for treatment of foot ulcers and infection. Of the thirty two cases, thirteen patients received HBOT and nineteen did not. The results were analyzed by amputation rate and healing time. All were classified according to the Wagner classification. Results: Of the HBOT treated group, three(23%) patients underwent amputation: two below knee and one metatarsophalangeal disarticulations. Of the non-treated group, eleven(58%) patients underwent amputation, : four below knee and seven metatarsophalangeal disarticulations. The healing times, based on hospital days were average 16, 38, 43 days in the HBOT treated group and average 20, 50, 35 days in the non treated group respectively in Wagner grade II, III, IV. Conclusions: HBOT might be effective in decreasing amputation rate and hospital stay in diabetic patients with severe foot ulcers.

• Journal of Korean Foot and Ankle Society
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• v.15 no.3
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• pp.165-169
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• 2011

Purpose: The objective of this study was to analyze diabetic foot patients' direct service costs until the cure of the disease. Materials Methods: The subjects of this study were randomly sampled 60 patients who had been treated for diabetic foot at one of two tertiary hospitals and cured of the disease during from January 2008 to December 2009, and whose diagnostic code was E11.5 or E14.5. Data were collected from medical records and direct service costs were analyzed using data on the payments of individual service charges. Direct service costs spent at other medical institutions for the same disease were excluded. Collected data were analyzed using descriptive statistics. Results: The subjects' mean hospital stay was 29 days, and mean period until cure was 132 days. The inpatient cost per patient was 10,844,648 won, outpatient cost was 715,751 won, and home care services cost was 641,854 won, so total direct service cost per patient was 11,913,419 won. The total direct service cost in patients who had their foot amputated was 12,769,822 won, 1.3 times higher than without amputation, who had vascular intervention was 16,219,477 won, 1.9 times higher than non-vascular intervention, who had both infection and artery occlusion was 17,522,435 won, 2.0 times higher than either infection or artery occlusion. Conclusion: In diabetic foot patients, the direct service cost was highest as 17,522,435 won in patients accompanied with both infection and occlusion of lower extremity artery.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.250-254
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• 2006

Purpose: The treatment of diabetic foot ulcers with total contact cast has been reported to be associated with numerous undesirable complications. This study shows that our technique of total contact casting that incorporates high concentration silver coated foam dressing. Materials and Methods: Forty-four diabetic foot ulcers were treated with total contact cast along with high concentration silver coated foam dressing. Complication and healing rates were evaluated. Results: Eighty five percent of the ulcers healed within 6 weeks with an overall complication rate of 7%. There were only two cases (5%) of infection and no recurrent ulceration and no another site new pressure ulcer in our study. Conclusion: Total contact casting incorporates high concentration silver coated foam dressing resulted in fewer complications rate and healing rate that is comparable to other studies.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.50-54
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• 2009

Purpose: The authors evaluated the clinical results and prognosis after amputating the lower extremity due to diabetic foot. Materials and Methods: From 1991 to 2003, the patients who had suffered amputation of his lower extremity due to diabetic foot ulcer were evaluated retrospectively. 79 patients were male and 6 patients were female. The author evaluated the patient who had the ipsilateral additional surgery, contralateral amputation, level of blood sugar, combined disease and mortality rate within 5 years from medical record. Statistical analysis was done by Chi-square test and Kaplan-Meier survival test. Results: Mean age of patients who had first experienced amputation was 63.4 years old. The mean duration of diabetes until amputation was $14.5{\pm}7.5$ years. Major amputations were 50 cases and minor amputations 35 cases. 20 patients (23.5%) were suffered ipsilateral secondary surgery including revised stump. Overall 5-year mortality rate was 18.8% (16 cases). Death rate within 1 year was 8.2% (7 cases), mortality rate within 3 years was 14.1% (12 cases). 5-year mortality rate after major amputation was 20% (10 cases) and after minor amputation was 17.1% (6 cases). It was statistically significant (p<0.05). Patient who underwent more than 2 combined vascular related disease had higher mortality rate than diabetic amputee without combined disease (p<0.05). Conclusion: Mortality rate after major amputation was significant higher than amputation after minor amputation in diabetic patients from our data.

• Journal of Korean Foot and Ankle Society
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• v.20 no.3
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• pp.121-125
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• 2016

Purpose: This study investigates the amputation rate within 1 year after the diagnosis of diabetic foot ulcer and its associated risk factors. Materials and Methods: This study enrolled 60 patients with diabetic foot ulcer. The mean and standard deviation age was $64.4{\pm}12.8years$ (range, 32~89 years); the mean and standard deviation prevalence period for diabetes mellitus was $21.0{\pm}7.5years$ (range, 0.5~36 years). The amputation rate was evaluated by dividing the subjects into two groups - the major and minor amputation groups - within 1 year following the initial diagnosis of diabetic foot ulcer. Multivariate Cox proportional hazards regression analysis was used to identify the risk factors for amputation. Results: The total amputation rate of 38.3% (n=23) was comprised of the amputation rate for the major amputation group (10.0%) and rate for the minor amputation group (23.8%). There was a high correlation between peripheral artery disease (toe brachial pressure index <0.7) and amputation (hazard ratio [HR] 5.81, confidence interval [CI] 2.09~16.1, p<0.01). Nephropathy was significantly correlated with the amputation rate (HR 3.53, CI 1.29~9.64, p=0.01). Conclusion: Clinicians who treat patients with diabetic foot complications must understand the fact that the amputation rate within 1 year is significant, and that the amputation rate of patients with peripheral artery disease or nephropathy is especially high.