International endocrinological magazine 4(6)2006
It seemed that the world science has today enough knowledge for solving different medical problems. However the statistic from different sources indicates the increasing of the problems, but not their decreasing. Insular diabetic isn?t an exception to this disastrous rule. Today according to the International Public Health Organization (IPHO) information there are about 171 million people in the world suffer from diabetic and this quantity of diabetic sufferings is increasing to 366 millions.
We won?t study in depth the data on an international scale, but we?ll tell you the incident of local importance, and exactly such incidents make the world statistic. In 2005 Rivne Regional Association for Civic Protection of people suffering from insular diabetic, held a conference which was devoted to diabetic problems. The author of this article was also invited to this event — patentee of exact footprint method. At the beginning of the conference a quick interview was held, during which it was proposed to raise hands to those people, who have problems with feet and musculoskeletal system. Almost all people, who were present in the hall, raised their hands. Than it was proposed to raise the hands to those people, who take any steps directed to the solving of these problems. There were no raised hands, no positive answers.
It gives us a right to make a conclusion that the patients suffering from insular diabetic didn?t pay any attention to their feet. What has changed in 2006, after appearance of the information how to protect ones feet by producing individual corrective insoles according to the method of diabetic footprint pneumatic formation?
Unfortunately we?re just discussing the problem of diabetic foot, and there was no reasonable initiation from those who are in the first place interested in saving their feet, from people suffering from diabetic! There was no proper informational support from certain endocrinologists. What?s the matter? Is this method not topical or there is no interest to accept that, about what the International Diabetic Federation (IDF) continually reports.
IDF published the International Guideline for this diabetic of the 2nd type, in which the important recommendations on feet care were given: to evaluate the condition of the feet of people suffering from ID within the bounds of annual medical examination (existence of any foot ulcer or amputations in anamnesis, symptoms of peripheral arteries diseases, difficulties in self foot care caused by physical condition or visual disorders; existence of foot (mallet or pigeon toes, bone protuberance) or footwear deformation; visual evidence of neuropathy (xerosis, callosity, varicose veins) and initial foot ischemia; nails deformation or injuries); definition of neuropathy by the use of filament (10g) or graduated tuning fork (with frequency 128 Hz); as an additional variant quantitative assessment the bioteziometr can be used (value of critical level for foot ulcer risk > 25V) atraumatic injection (blunt needle), palpation of foot pulse (on dorsal artery of foot and posterior tibial artery) and assessment of capillary filling rate; in case when arteries pulsation reduces to the level, when it is impossible to make a quantitative assessment of pathological changes, the Doppler analysis with estimation of malleolar-brachial index (in occlusal vessels diseases this index is <0,9).
Besides the specialists should discuss with each patient suffering from ID reasons for foot examination in bounds of process of self foot care training, coordinate the plan of foot care on the basis of annual feet examination, definite character of necessary information and provide the training in foot care for each patient taking into consideration his individual needs and the risk of ulcer development and amputation. It is necessary to classify the condition in accordance to examination data in such a way: lack of additional risk (sensitivity is not reduced, there are no symptoms of peripheral arteries diseases and other risk factors); there is risk (the neuropathy or another risk factor is defined); high risk (sensitivity is reduced and there is foot deformation or there are symptoms of peripheral arteries diseases); very high risk (foot ulcer in anamnesis or amputation); foot ulcer or infection (there is foot ulcer).
The patient should be treated according to the damage rate and in accordance to the classification:
1) lack of an additional risk: to coordinate treatment plan with the patient, including foot care training;
2) risk: to plan regular (approximately every 6 months) examination, that should be carried out by the specialists in foot care. During examination: to examine both feet, to provide topical treatment in accordance to the indications; to estimate the peculiarities of footwear and to give corresponding recommendations; to provide training in foot care;
3) high risk: (every 3-6 months) examinations, that should be carried out by the specialists in foot care. During examination: to examine both feet, to provide topical treatment in accordance to the indications; to estimate the peculiarities of footwear and to give recommendations, and if there is any indication to provide wearing of special insoles and footwear; to decide about vessels examination or referral for advice by the specialist; to definite character of necessary information and to provide the foot care training;
4) foot ulcer or infection (including conditions, which require emergency in foot care): during 24 hours to refer a patient to the multifield group of specialists specializing in foot care for:
— appropriate wound treatment, dressing and chirurgic management of wound in accordance to the indications;
— estimation of appropriateness of systemic antibiotic therapy (often the lingering one) because of foot phlegmon or infection with bone involvement in accordance to the indications; as preparation of the first rang in accordance to the indications the penicillin, macrolide, clindamycin or metronidazole are used. As examples of preparations of the second rang cyprophlocsacin and coamocsic-lav (combination of amocsicillin with clavullanic acids);
— optimal foot pressure distribution (retaining unloading bandage if there are any indications or there are no contraindications), referral for examination and treatment in case of circulatory collapse;
— examination with bougie conduction to the bone (for estimation of its damage), X-ray study, scanning, magnetic resonance tomography and biopsy, if there are any indications in connection with suspicions of osteomyelitis;
— optimal control of glucose in blood;
— special footwear and orthopedic aids (e.g. insoles) choosing and also the discussion of relapse prevention after ulcer healing.
The amputation should be done just in cases: 1) detailed analysis of vessels condition by the angiologists; 2) inability to suppress the ischemic pain at rest with analgetics or revasculization; 3) inability to treat this life-threatening infection by any other methods; 4) never-healing ulcer, when the effects after it are worse for the patient, as those after amputation.
The stuff of the group deals with the foot care consists of the doctors specializing in the field of diabetic foot problems, specialists in patient training and persons who got an official training in the field of care in cases of foot diseases (usually these are pediatricians or certified nurses).
Foot ulcer and limb amputation are important factors with which health damages and costs for ID treatment are connected. The questions of primary prevention of conditions, which are in the basis of nerves and vessels lesions, are observed in other chapters of the guideline. The secondary intervention for patients with risk factors may reduce the difficulties of these conditions and the costs for the treatment as for the patients, so for the society in general. In connection with potential possibility to better the health level and to reduce the expanses for medical treatment existing information concerning diabetic foot care was revised in last years repeatedly and detailed.
The received conclusions coincide in many points: appropriate planned examination for identification of people from risk group, frequent examinations of patients with defined risk factors and active treatment of patients suffering from foot ulcer and infection can be more than repaid in relation to health level, as to the absence of financial expanses connected with amputation. The training of patients in foot care, additional training of people from risk group and surgical procedure if there is any critical ischemia (including if she forwards ulcer formation) are also standard recommendations which are based on evidence.
In Ukraine on the basis of Rivne Regional Endocrinological Dispensary the favorable conditions are created for rendering medical assistance for patients with symptom of diabetic foot. The existence of diabetic foot room combined with the room of orthopedic aid and individual production of orthopedic insoles in the same premises of dispensary gives indisputable positive results in aiding patients with diabetic foot. Besides the treatment base with qualified medical stuff lead Rivne Regional Endocrinological Dispensary to one of the leading places in Ukraine in uniqueness of aiding patients suffering from insular diabetic.
What are the orthopedic aid room?s possibilities in individual orthopedic insoles production? Firstly, it is meticulous realization of recommendations of IDF in providing special insoles and footwear wearing; special footwear and orthopedic aids (e.g. insoles) choosing and also the discussion of relapse prevention after ulcer healing. The foot care group includes the doctor specializing in diabetic foot problems, specialist in patients training, who had got the special training in care of feet diseases.
Secondly, we got a Ukrainian patent for method of individual orthopedic insoles footprints formation with two enclosures, each of which has elastic surface, filled with fluid and adapted to patient?s weight load. This method consists in application of at least on one indicated elastic surface preliminary warmed-up to the plastic deformation temperature workpiece of thermoplastic material, patient?s weight load on indicated elastic surfaces, pressure regulation of fluid at least in one enclosure for patient setting to the right physiological position and keeping the indicated workpiece under the pressure during the time necessary for the lost of plasticity of received footprint. As a fluid the air is given into enclosures, and the air pressure is regulated in the this enclosure until the standing patient does not get the position at which a conditional line between the overhead points of wings of pelvic bones has horizontal direction.
Such method with the use of air reproduces the patient?s footprint more exactly, is more sparing to the foot sole surface, where ulcerous damages of surface, different amputations, traumas, can be. Therefore the state of patient foot, presence of chafing, plantar callosity, callosities, cracks, traumas, amputations, is taken into consideration, the foot and the whole musculoskeletal system correction, is carried out.
The reason of functional difference of length of lower extremities (FDLLE), in which dislocated patient?s general centre of gravity (GCG), causes wrong position of spine (scoliosis), is eliminated. The putting of foot and musculoskeletal system into functionally correct position prevents different traumas, harmonize the work of internals, including improvement of the endocrine system activity.
Practice shows that individual orthopedic insoles production by the method of exact patient?s footprint constructively differs from mass attitude to the problem and is an objective method, necessary for a prophylaxis and treatment of diabetic foot problems. Doctors emphasize on expedience of practical application of method of individual orthopedic insoles footprint forming in medical practice (therapy, pediatrics, neurology, traumatology, obstetrics, sporting medicine etc.), including foot and musculoskeletal system problems.
Detailed information can be found on the site of http://interhealthstudio.com
Chief editor Volodymyr Ivanovych Pankiv
Chief of editorial board Tronko M.D.
Editorial board of Babak O.Y. (Kharkiv) Bobyryova L.Y. (Poltava) Bodnar M.P. (Kyiv) Bolshova ?.V. (Kyiv) Bondarenko V.?. (Kharkiv) Bondarenko L.?. (Kharkiv) Botsyurko V.?. (Ivano-Frankivsk) Vlasenko M.V. (Winnitsya) Gendeleka G.F. (Odessa) Gladkova A.I. (Kharkiv) Gulchiy ?.V. (Kyiv) Demchenko ?.?. (Kharkiv) Yelinska N.B. (Kyiv) Zubkova S.?. (Kyiv) Zueva N.?. (Kyiv) Epshteyn ?.V. (Kyiv) Yefimov ?.S. (Kyiv) Karachentsev Y.?. (Kharkiv) Kyrylyuk ?.L. (Odessa) Kovalenko V.?. (Kyiv) Kozakov ?.V. (Kharkiv) Komisarenko ?.V. (Kyiv) Korpachov V.V. (Kyiv) Kravchenko V.?. (Kyiv) Larin ?.S. (Kyiv) Luchytskyy Y.V. (Kyiv) Maydannyk V.G. (Kyiv) Mankovsky B.?. (Kyiv) Maslyanko V.?. (Chernivtsi) Medved V.?. (Kyiv) Melekhovets O.K. (Sumi) Naumenko V.G. (Kyiv) Neyko Y.?. (Ivano-Frankivsk) Netyazhenko V.Z. (Kyiv) Oliynyk V.?. (Kyiv) Pasechko N.V. (Ternopil) Pertseva ?.?. (Dnipropetrovsk) Pyrig L.?. (Kyiv) Pichkar Y.?. (Uzhgorod) Pishak V.P.(Chernivtsi) Plehova ?.?. (Kharkiv) Poltorak V.V. (Kharkiv) Prylutskyy ?.S. (Donetsk) Prystupyuk ?.?. (Kyiv) Reznikov ?.G. (Kyiv) Selivanova K.F. (Simferopol) Sergiyenko ?.?. (Lviv) Sydorchuk ?.Y. (Chernivtsi) Turchyn ?.S. (Kyiv) Fabri Z.Y. (Uzhgorod) Hyzhnyak ?.?. (Kyiv) Cherenko S.?. (Kyiv) Shved ?.?. (Ternopil) Shidlovsky V.?. (Ternopil) Shkala L.V. (Lugansk)
Chief of editorial council Ferrannini E. (Pisa, Italy)
Editorial council: Ametov ?.S. (Moscow, Russian Federation) Anestiadi Z.G. (Kishinev, Moldova) Aristarhov V.G.(Ryazan, Russian Federation) Balabolkin ?.?.(Moscow, Russian Federation) Gerasimov G.?.(Moscow, Russian Federation) Gordeladze M.R. (Tbilisi, Georgia) Danilova L.?. (Minsk, Belarus) Dedov ?.?.(Moscow, Russian Federation) Ismailov S.I. (Tashkent, Uzbekistan) Kalinin ?.P. (Moscow, Russian Federation) Mamedgasanov R.M.(Baku, Azerbaijan) Mamedov ?.N.(Moscow, Russian Federation) Melnychenko G.?.(Moscow, Russian Federation) Metreveli D. (Tbilisi, Georgia) Mohort ?.V. (Minsk, Belarus) Romanchyshen ?.P. (St. Petersburg, Russian Federation) Svyrydenko N.Y.(Moscow, Russian Federation) Fadeev V.V.(Moscow, Russian Federation) Troshyna K.?.(Moscow, Russian Federation) Holodova ?.?. (Minsk, Belarus) Shestakova M.V.(Moscow, Russian Federation) Prof. P. Beck-Peccoz (Milan, Italy) R.S. Brown (Boston, USA) Prof. F. Delange (ICCIDD) Prof. E. Fliers (Amsterdam, Holland) Prof. Ph. Home(Newcastle, Great Britain) Prof. D. Hryhorczuk (Chicago, USA) Prof. Gang Hu (Helsinki, Finland) Prof. D. Koev (Varna, Bulgaria) Prof. G.E. Krassas (Thessalonike, Greece) Prof. Janusz A. Nauman (Warsaw, Poland) Prof. E. Standl (Munich, Germany) Prof. I. Szabolcs (Budapest, Hungary) Prof. Jan Taton (Warsaw, Poland) Rh. Williams (Swansea, Large Britain) Prof. H. Yki-Jarvinen (Helsinki, Finland) Prof. E. Zbranca (Yassi, Romania) Prof. S. Zgliczynski(Warsaw, Poland)
The article of Vladimir Tarasov, possessor of method and Patents of Ukraine on the individual production of orthopedic insoles, Prizewinner of Allukrainian Competition of inventors and innovators of «Philips: reasonably and simply», possessor of «Prize of the audience likings» chosed on Competition by a majority of visitors votes (100 thousand Kievites and city guests), it can be considered as recognition of expedience of introduction into medical practice the offered method of exact footprint in Ukraine and all over the world!
Confirmation of it is a decision for materials publication in the International endocrinology magazine (specialized theoretical and practical magazine), by the concerted decision of Ukrainian officials, in the person of Main Endocrinologist of Ukraine Pankiv V.I. and Ukrainian medical specialists: Chief of editorial board Tronko M.D. and 55 members of editorial board, world medical specialists: Chief of editorial council Ferrannini E. (Pisa, Italy) and 38 members of editorial council from 18 countries of the world (Russia, Moldova, Georgia, Belarus, Uzbekistan, Azerbaijan, Italy, USA, ICCIDD, Holland, Great Britain, Finland, Bulgaria, Greece, Poland, Germany, Hungary, Romania.