Jan-10

Study Predicts Dramatic Diabetes Increases By 2034

By Brian McCurdy, Senior Editor

   A new study in Diabetes Care predicts the rate of diabetes will nearly double in the next 25 years and total healthcare spending for diabetes will nearly triple in the same period.

   Researchers project that the number of people in America diagnosed with diabetes will be 44.1 million in 2034, up from 23.7 million people in 2009. In the Medicare population, the study projects that the population with diabetes will rise from 8.2 million in 2009 to 14.6 million in 2034. In that time period, the study authors say the rate of obesity will remain consistent at about 65 percent of the population.

   In addition, the study authors say annual medical costs in the United States related to diabetes will increase from $113 billion to $336 billion by 2034. They project that the rate of Medicare diabetes spending will increase from $45 billion to $171 billion by 2034.

Conquering Poor Dietary Choices: Are There Any Solutions?

   While there are environmental and genetic components to diabetes, Lee Rogers, DPM, blames environmental factors for the projected escalation in prevalence. Specifically, Dr. Rogers says poor dietary choices are the primary driver behind nearly two-thirds of Americans being overweight or obese. Barry Rosenblum, DPM, agrees. He says the projected increases are clearly linked to conditions like obesity that are potentially preventable or treatable.

   Despite efforts in the public and private sectors, Dr. Rosenblum says the population needs to see greater results in reducing the obesity rates and possibly the incidence of diabetes. Dr. Rogers notes that the government’s attempts at more accurately labeling foods has not had an effect on obesity.

    “While wildly unpopular, a ‘fat tax’ on soft drinks and fast foods, or financial incentives for being healthy may be needed in order to curb this downward trend,” says Dr. Rogers, an Associate Medical Director of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles.

    “I have always been impressed by plans that aim at the pocketbook of the patient,” concurs Dr. Rosenblum, an Assistant Clinical Professor of Surgery at Harvard Medical School. “If possible, perhaps shifting some of the costs to those ‘guilty’ parties may be of benefit. This, however, makes sense in theory but is impossible to implement in practice.”

What About Rewarding Efforts Geared Toward Prevention?Electrical Stimulation: Can It Help Treat Plantar Fasciitis?

By Brian McCurdy, Senior Editor

   In the quest to find alternate modalities to treat plantar fasciitis, some physicians have turned to modalities such as electrical stimulation. A new study in the Journal of the American Podiatric Medical Association finds that regardless of the use of electrical stimulation, two conservative mainstays are effective treatments.

   The study focused on 26 patients who had plantar fasciitis for less than six months. Patients in the control group received treatment with stretching and prefabricated orthoses alone. The treatment group underwent low-frequency electrical stimulation at 10 Hz or pulses per second as well as stretching and prefab orthotic treatment, according to the study.

   Authors say patients in both groups experienced less pain and improved function at follow-ups conducted both at the end of four weeks of treatment and three months following the end of treatment. However, researchers noted no significant differences in visual analog scale scores between the two groups. Researchers note their study could not demonstrate that low-frequency electrical stimulation reduced pain more effectively than plantar fascia stretching and orthoses alone. The study adds that whether or not patients underwent electrical stimulation, orthotics and stretching provided short-term pain relief and functional improvement.

   Lead study author Michael Stratton, PT, DSc, ATC, emphasizes that electrical stimulation did “significantly” reduce pain in plantar fasciitis patients after four weeks. He has had success in using electrical stimulation for conditions including proximal and distal patellar tendonitis, lateral epicondylitis, posterior tibialis tendonitis and nerve root radiculopathies. Stratton says electrical stimulation with proper pad placement and setting parameters can generate the most blood flow/circulation without irritating the inflamed tissues.

   As Stratton notes, research suggests that specific plantar stretching and OTC orthoses are most effective in the long term for plantar fasciitis. In addition, he has found success by ensuring proper footwear combined with patient education, core, hip abductor and proprioceptive exercises, and any type of cardiovascular exercise to improve circulation. Patients may also want to modify their daily activities, according to Stratton, who is in private practice at the Continuum Wellness Clinic in Gilbert, Ariz.

   Brent Haverstock, DPM, agrees on the efficacy of plantar fascia–specific stretching and prefab orthotics in treating plantar fasciitis. His stretching program addresses both the plantar fascia and the posterior muscle group (gastroc-soleus complex). He uses the PowerStep prefab arch, citing its supportiveness and adds that he “very infrequently” needs custom orthoses for this condition.

   Dr. Haverstock, a Fellow of the American College of Foot and Ankle Surgeons, considers plantar fasciitis to be a self-limiting condition, which usually resolves in 10 to 14 months.

Study Says Ex-Fix Can Reduce Amputation With Charcot Foot

By Lauren Grant, Assistant Editor

   In a recent retrospective study published in Der Orthopäde, a German publication, researchers found that the use of external fixation in patients with diabetic neuropathic osteoarthropathy helped prevent amputation and improved patient activity levels.

   Researchers assessed the results of 205 surgical procedures (performed on 195 patients ) in which surgeons utilized ex-fix or Steinmann pins to help address diabetic neuropathic osteoarthropathy. Authors found that no primary amputations were necessary and only 15 patients needed a secondary amputation. The only minor complication was some recurrence of ulcers in 48 patients, according to the study. The authors noted only seven recurrences of diabetic neuropathic osteoarthropathy.

   Thomas Zgonis, DPM, FACFAS, works very closely with patients who are suffering from Charcot foot and has had success with external fixation in this patient population.

    “External fixation has been effective in our practice and especially when it is used in staged reconstructive procedures,” notes Dr. Zgonis, the Chief and Fellowship Director of the Division of Podiatric Medicine and Surgery at the University of Texas Health Science Center at San Antonio.

   His clinical experience in Charcot foot reconstruction is mostly with a circular type of external fixation (Ilizarov) in contrast to the Hoffmann II external fixator described in the study. However, Dr. Zgonis has also seen little recurrence of Charcot following the use of external fixation.

   If there is recurrence of Charcot foot, he says it typically occurs when “a limited midfoot arthrodesis or a simple midfoot exostectomy is performed and a new Charcot joint develops in the rearfoot/ankle area.” He says this is important to consider prior to Charcot reconstruction and surgeons can address this by “performing extended joint arthrodesis procedures and ensuring protected, prolonged immobilization.”

   To help minimize surgical complications when correcting Charcot foot, Dr. Zgonis recommends that surgeons know the proper tensioning techniques, ensure proper anatomic insertion of pins and transosseous wires, and select the most appropriate type of external fixation device. He says they also must be adept at at atraumatic soft tissue handling, full-thickness flap dissection and adjunctive use of bone grafting and orthobiologics.

    “Without the proper knowledge and tools to perform the surgery, physicians could be creating more complications postoperatively,” explains Dr. Zgonis.

   The study found that approximately half of the patients could benefit with the use of customized orthopedic shoes 18 months after surgery. Dr. Zgonis says customized orthopedic shoes that include postoperative double upright bracing and other diabetic devices “are crucial and mandatory in our practice after Charcot foot reconstruction.” He has found these shoes to be effective and notes they can be used for an extended period of time.