Analyzing Testing in Peripheral Neuropathy

Patients diagnosed with peripheral neuropathy appear to undergo a numerous yet highly variable number of tests, according to findings from a large database review. Nearly one-quarter (23.2%) of patients with peripheral neuropathy underwent high-cost, low-yield MRI, while few underwent low-cost, high-yield glucose tolerance testing. Abstract: Archives of Internal Medicine, January 23,...
A New Strategy to Manage Charcot Foot

A New Strategy to Manage Charcot Foot

Each year in the United States, over 60,000 lower extremity amputations occur in patients with diabetes, and about a half million people have a diabetic foot infection. Charcot foot, a diabetes-associated neuropathic osteoarthropathy, has gotten increased recognition as a debilitating disease that frequently leads to severe disability and poor quality of life. The increasing incidence of morbidly obese patients with diabetes may be partially responsible for the increased prevalence of Charcot foot. Over the past decade, it has been recognized that patients with diabetes who develop Charcot foot arthropathy often experience a significant decline in their quality of life—the disability associated with foot ulcer, foot infection, or Charcot foot is comparable to that of a below-the-knee amputation. This potentially devastating condition consumes significant healthcare resources for multiple surgical procedures and often leads to lower extremity amputation and premature death. As a result, there has been growing interest in the medical community to address surgical correction of acquired foot deformities, with the goal being to improve walking independence. Current Treatments Are Lacking Traditionally, the primary intervention for treating Charcot foot has been non-weight-bearing immobilization with a total contact cast until the problem is resolved. This approach, however, can often lead to severe structural deformity of the foot and ankle. Additionally, obese patients may have difficulty walking in a cast and are often forced to confinement in a wheelchair. Following removal of the cast, patients are then accommodated with cumbersome, protective therapeutic shoes and braces, but these can significantly limit overall function. Data have shown that surgical correction of foot deformities so that the foot remains flat on the ground can...