POI0010.1177/0309364614565576Prosthetics and Orthotics InternationalGuest Editorial
INTERNATIONAL SOCIETY FOR PROSTHETICS AND ORTHOTICS
Prosthetics and Orthotics International 2015, Vol. 39(1) 6 © The International Society for Prosthetics and Orthotics 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0309364614565576 poi.sagepub.com
Guest Editorial Karen L Andrews
I am honored to present this issue on neuropathy and the diabetic foot on behalf of Prosthetics and Orthotics International. Diabetes mellitus is among the most common causes of peripheral neuropathy worldwide. The initial articles of this supplement introduce the basic principles of neuropathy, neuropathic pain, and preventative diabetic foot care. One of the articles provides strategies for clinicians taking care of persons with diabetes to understand and optimize the multiple aspects of diabetic foot care. Sensory impairment in persons with diabetes is a major risk factor of plantar ulceration and neurogenic arthropathy (Charcot joints) causing severe morbidity and high healthcare costs. Developing an individualized treatment plan for the patient with painful diabetic sensory polyneuropathy is challenging. However, over the past decade, the treatment of painful peripheral neuropathies has evolved and several treatment algorithms have been established. Treatment recommendations are reviewed to guide effective management of painful diabetic peripheral neuropathy to improve patients’ quality of life. Chronic non-healing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, trauma, history of ulceration or amputation, and impaired visual acuity.
Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. Charcot neuroarthropathy is a progressive, destructive condition that is characterized by acute fracture, dislocation, and joint destruction in a weightbearing neuropathic foot. Diagnosis, classification, and the proper management of patients with Charcot neuroarthropathy are discussed. Publication of this exceptional collection of articles has been accomplished through hard work by an outstanding group of nationally and internationally recognized experts in the management of diabetic neuropathy and associated complications. It has been a great honor to work with each of my esteemed colleagues. The exceptional information presented will be a valuable resource for any medical professional interested in the management of diabetic neuropathy. Rarely has extensive, evidence-based information regarding diabetic neuropathy, neuropathic pain management, wound management, offloading, and management of patients with Charcot neuroarthropathy been consolidated in such a concise, user-friendly format. I hope this supplement enhances your care of high risk diabetic patients serves as a stimulus to promote optimal disease management, achieves favorable rates of limb salvage, improves patients’ quality of life, and makes an impact on the health of the global population.
ascular Ulcer/Wound Healing Clinic, Mayo Clinic Gonda Vascular V Center, Rochester, MN, USA; and Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA Corresponding author: Karen L Andrews, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA. Email: [email protected]
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