February 2, 2025 • 10 mins
This audio provides information on diabetic wounds, a significant complication of diabetes. It details the causes, types, diagnosis, and treatment of these wounds, emphasizing the importance of early detection and intervention. The conversation also highlights preventative measures like foot hygiene and regular inspections. Finally, it promotes the services of a podiatric practice specializing in foot and ankle care, including diabetic foot care.
Disclaimer: The content provided in this podcast is for informational purposes only and should not be construed as medical advice. It is not a substitute for professional diagnosis, treatment, or consultation with a qualified healthcare provider. Always seek the advice of a physician or another qualified health provider with any questions or concerns regarding a medical condition. By listening to this podcast, neither its hosts, guests, nor publishers establish a doctor-patient relationship, and no liability is assumed for any decisions made based solely on the information presented.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Podiatry Insight Hub, the leading informational audio platform for common care
(00:07):
and treatments related to lower extremity.
Get ready for another great podiatry topic in today's post.
Ready, set, here we go.
Disclaimer, the content provided in this audio is for informational purposes only and should
not be construed as medical advice.
It is not a substitute for professional diagnosis, treatment, or consultation with a qualified
healthcare provider.
(00:28):
This is to seek the advice of a physician or another qualified health provider with
any questions or concerns regarding a medical condition.
By listening to this audio platform, neither its hosts, guests, nor publishers establish
a doctor-patient relationship and no liability is assumed for any decisions made based solely
on the information presented.
Welcome back everybody for another deep dive and today we're tackling diabetic foot ulcers.
(00:50):
You sent over some fascinating research on this and one of them is a really big systematic
review from the Cochrane Library.
And then a recent study too that I think is going to be interesting to discuss.
It will be very interesting.
We're going to look at what causes these ulcers and explore some promising new treatments
like skin grafts and tissue replacements.
(01:10):
Great.
So you'll walk away understanding why this matters to you or someone you know.
It's an important topic.
Let's set the scene a little bit.
Imagine you have diabetes and you develop a foot ulcer.
What makes these ulcers so different from say a scrape on your knee?
Well with diabetic foot ulcers they're just tough because it's more than just skin damage.
(01:30):
It's a combination of things.
Neuropathy which is nerve damage.
That's a big factor.
And this means you might not even feel a cut or a blister forming on your foot so it can
go unnoticed and untreated.
Then you've got things like foot deformities which create pressure points and poor circulation
meaning that the ulcers don't get the oxygen and nutrients they need to heal.
(01:51):
It's a lot more complicated than a simple scraper cut.
The Cochrane review that you sent over which is C011255.pdf spells out some standard treatments
that are used and it's quite a list.
Taking pressure off the ulcer, cleaning the wound, controlling infection, managing blood
sugar levels, even vascular reconstruction to improve blood flow.
(02:12):
That's right.
It's a lot.
It is but the challenge is even with all of that sometimes these ulcers just don't heal.
And that's where skin grafts and tissue replacements come in.
So there were patches to help rebuild the damaged skin.
And there are all these different types.
Autographs, allografts, xenografts, even bioengineered options.
Tell me more about those.
(02:32):
So an autographed uses your own skin usually taken from somewhere else on your body.
An allograft is skin from a donor and a xenograft uses skin from an animal like a pig.
Then we have bioengineered options which are basically lab-grown skin substitutes.
Each type has its pros and cons in terms of availability cost and how well it integrates
with the patient's own tissue.
(02:54):
So this big Cochran review looked at 17 studies involving over 1600 people.
Yes, a lot of data.
That's some serious data crunching.
What jumped out at you from this review?
Well, overall it seems that skin grafts and tissue replacements do lead to better healing
rates compared to just standard care alone.
So that's definitely encouraging.
(03:14):
But the review also highlights that the quality of the evidence is rated as low, which means
there were limitations in the studies that make it harder to be absolutely certain about
the results.
Okay.
And I noticed that almost all of the studies had industry involvement.
Right.
Does that make you a little wary?
Well, it's something to be mindful of.
While industry funding is important for research, it's crucial to evaluate the studies carefully
(03:36):
and consider potential biases.
Yeah, for sure.
One of the things that I noticed was that there's a suggestion that these treatments
might reduce amputations.
Yes.
But before we get too excited.
Yeah.
It's important to emphasize that only two of the studies in the review even looked at
amputations and the evidence from those was rated very low quality.
Ah, okay.
So more research is definitely needed in this area.
So it doesn't mean that they're a guaranteed way to prevent amputations, but it's a possibility
(04:00):
that needs more investigation.
Absolutely.
It's a glimmer of hope, but we need more data to be sure.
Okay.
So let's talk about this high flow trial.
Okay.
This is a WJ19811.PDF and it looked at a specific type of microvascular tissue allograft called
PMVT.
Right.
What's so special about this particular treatment?
(04:23):
Well, what's remarkable about the high flow trial is they saw significant improvement
not only in healing rates, but also in neuropathy.
Hold on.
Improvement in neuropathy.
So this is doing more than just patching up the ulcer.
Yeah.
It could be addressing one of the root causes.
That's the exciting part.
Wow.
They measured neuropathy using two methods.
The SEMIS-Winestein monofilament test, which assesses how sensitive your feet are to touch.
(04:45):
And the stocking glove technique where they map out areas of numbness.
Both methods showed improvement in the group that received PMVT.
So this raises a big question.
Could PMVT actually be helping to reverse the nerve damage?
Potentially.
That leads to these ulcers in the first place.
That's what researchers are trying to figure out.
We need more research, but the findings from the high flow trial are certainly intriguing.
(05:09):
It sounds like there's a lot of potential here, but I imagine there are also some cautions
to keep in mind.
Of course.
Both the Cochrane review and the high flow trial had limitations.
The studies were relatively small, and we need larger, more diverse studies to confirm
these findings.
Okay.
And I imagine there are other factors that could influence healing too.
(05:29):
Absolutely.
Things like a person's age, overall health, how committed they are to their treatment
plan.
It's never just about one treatment in isolation.
It's about the whole picture, the individual's health status, their lifestyle, their access
to care, and their willingness to actively participate in their own healing.
So the Cochrane review also looked at adverse events, which I think is important.
(05:52):
Nobody wants a treatment that causes more problems than it solves.
What do they find?
Well, the good news is none of the studies in the Cochrane review reported any significant
difference in adverse events between the groups that received skin grafts or tissue replacements
and the groups that received standard care.
So in terms of safety, these treatments seem to be comparable.
(06:13):
That's reassuring to hear.
But were there any common adverse events reported at all?
There were some, but they varied from study to study.
The most common ones included things like infection, pain, bleeding, and allergic reactions.
But these are all potential risks with any wound treatment.
So they're not necessarily unique to skin grafts or tissue replacements.
(06:35):
So it sounds like the safety profile is generally good.
But as with any medical procedure, there are risks to consider.
It's a conversation you should have with your doctor.
They can help you weigh the potential benefits against the risks based on your individual
circumstances.
Let's talk about the elephant in the room, the cost of these treatments.
I imagine that could be a concern for a lot of people.
You're right.
(06:55):
Skin grafts and tissue replacements can be expensive, especially if you need multiple
applications or a longer course of treatment.
And insurance coverage varies widely depending on your plan and the specific treatment.
So this is where it becomes really important to be your own advocate?
Yes.
Do your research, ask questions, and don't be afraid to appeal if you're denied coverage.
(07:18):
Knowledge is power, especially when it comes to navigating the healthcare system.
Before we wrap up, was there anything else that stood out to you from these studies?
Any aha moments or lingering questions?
One thing that really struck me was the potential for these treatments to not only improve healing
rates but also the quality of the healed skin.
Interesting.
(07:38):
That's something we don't always focus on, but it's so important for people living with
these ulcers.
So it's not just about closing the wound.
It's about making sure the healed skin is healthy and less likely to break down again.
Exactly.
That's a huge win for both patients and healthcare providers.
It can mean fewer recurrences, less pain, and a better quality of life overall.
(08:00):
So let's do a quick recap here for our listener.
So we've learned that diabetic foot ulcers are a serious health concern and that even
with standard treatments, some ulcers can be really stubborn about healing.
For sure.
For sure.
Skin grafts and tissue replacements offer a potential solution.
And the research we've looked at suggests they might lead to faster healing and maybe
(08:24):
even a lower risk of amputation.
Yeah, but it's important to remember that there's still a lot we don't know.
We need more research to confirm these findings and to explore the long-term effects of these
treatments.
And of course, we can't forget about the cost and the insurance hurdles that many people
face.
Absolutely.
Those are all important factors to consider.
But despite the challenges, there's reason for optimism.
(08:46):
The research is ongoing and scientists are constantly working to develop new and better
treatments.
That's right.
And they're also going to be new to be proactive about foot health.
Well, the most important thing is to manage your diabetes effectively.
Work closely with your doctor to keep your blood sugar levels under control.
That makes sense.
And what about daily foot care?
Any tips?
(09:06):
Yeah, inspect your feet every day.
Look for any cuts, blisters, redness, swelling or changes in skin color.
And don't forget to check between your toes.
Those areas can be tricky.
Oh yeah, good point.
And moisturize to prevent dry skin from cracking.
Yes, but not between the toes.
And not between the toes.
Yeah, too much moisture there can lead to fungal infections.
Good to know.
What about footwear?
(09:28):
Wear comfortable, well-fitting shoes that don't rub or create pressure points.
And avoid going barefoot even at home.
So it's all about being aware and taking those small steps to protect your feet.
Any final mind-blowing thoughts for our listener to ponder?
Well, what if someday we could regenerate not just skin, but also nerves?
(09:49):
Imagine being able to reverse the neuropathy that contributes to these ulcers.
Wow.
That would be a game changer.
That would be incredible.
Science fiction becoming reality.
It might sound far-fetched, but research in areas like stem cell therapy and gene editing
is advancing rapidly.
The possibilities are exciting.
That is really exciting.
Well, listener, I don't know about you, but I'm feeling inspired.
(10:12):
We've covered a lot of ground today.
And I hope you're walking away feeling more informed and empowered.
Yeah, and remember, this is just the beginning of the conversation.
Keep learning, keep asking questions, and keep those feet happy and healthy.
That's great advice.
Thanks for joining us on this deep dive.
Until next time, stay curious.
Disclaimer, the content provided in this audio is for informational purposes only and should
(10:34):
not be construed as medical advice.
It is not a substitute for professional diagnosis, treatment, or consultation with a qualified
healthcare provider.
Always seek the advice of a physician or another qualified health provider with any questions
or concerns regarding a medical condition.
By listening to this audio platform, neither its hosts, guests, nor publishers establish
a doctor-patient relationship, and no liability is assumed for any decisions made based solely
on the information presented.
Welcome to the Podiatry Insight Hub, the leading informational audio platform for common care
(00:07):
and treatments related to lower extremity.
Get ready for another great podiatry topic in today's post.
Ready, set, here we go.
Disclaimer, the content provided in this audio is for informational purposes only and should
not be construed as medical advice.
It is not a substitute for professional diagnosis, treatment, or consultation with a qualified
healthcare provider.
(00:28):
This is to seek the advice of a physician or another qualified health provider with
any questions or concerns regarding a medical condition.
By listening to this audio platform, neither its hosts, guests, nor publishers establish
a doctor-patient relationship and no liability is assumed for any decisions made based solely
on the information presented.
Welcome back everybody for another deep dive and today we're tackling diabetic foot ulcers.
(00:50):
You sent over some fascinating research on this and one of them is a really big systematic
review from the Cochrane Library.
And then a recent study too that I think is going to be interesting to discuss.
It will be very interesting.
We're going to look at what causes these ulcers and explore some promising new treatments
like skin grafts and tissue replacements.
(01:10):
Great.
So you'll walk away understanding why this matters to you or someone you know.
It's an important topic.
Let's set the scene a little bit.
Imagine you have diabetes and you develop a foot ulcer.
What makes these ulcers so different from say a scrape on your knee?
Well with diabetic foot ulcers they're just tough because it's more than just skin damage.
(01:30):
It's a combination of things.
Neuropathy which is nerve damage.
That's a big factor.
And this means you might not even feel a cut or a blister forming on your foot so it can
go unnoticed and untreated.
Then you've got things like foot deformities which create pressure points and poor circulation
meaning that the ulcers don't get the oxygen and nutrients they need to heal.
(01:51):
It's a lot more complicated than a simple scraper cut.
The Cochrane review that you sent over which is C011255.pdf spells out some standard treatments
that are used and it's quite a list.
Taking pressure off the ulcer, cleaning the wound, controlling infection, managing blood
sugar levels, even vascular reconstruction to improve blood flow.
(02:12):
That's right.
It's a lot.
It is but the challenge is even with all of that sometimes these ulcers just don't heal.
And that's where skin grafts and tissue replacements come in.
So there were patches to help rebuild the damaged skin.
And there are all these different types.
Autographs, allografts, xenografts, even bioengineered options.
Tell me more about those.
(02:32):
So an autographed uses your own skin usually taken from somewhere else on your body.
An allograft is skin from a donor and a xenograft uses skin from an animal like a pig.
Then we have bioengineered options which are basically lab-grown skin substitutes.
Each type has its pros and cons in terms of availability cost and how well it integrates
with the patient's own tissue.
(02:54):
So this big Cochran review looked at 17 studies involving over 1600 people.
Yes, a lot of data.
That's some serious data crunching.
What jumped out at you from this review?
Well, overall it seems that skin grafts and tissue replacements do lead to better healing
rates compared to just standard care alone.
So that's definitely encouraging.
(03:14):
But the review also highlights that the quality of the evidence is rated as low, which means
there were limitations in the studies that make it harder to be absolutely certain about
the results.
Okay.
And I noticed that almost all of the studies had industry involvement.
Right.
Does that make you a little wary?
Well, it's something to be mindful of.
While industry funding is important for research, it's crucial to evaluate the studies carefully
(03:36):
and consider potential biases.
Yeah, for sure.
One of the things that I noticed was that there's a suggestion that these treatments
might reduce amputations.
Yes.
But before we get too excited.
Yeah.
It's important to emphasize that only two of the studies in the review even looked at
amputations and the evidence from those was rated very low quality.
Ah, okay.
So more research is definitely needed in this area.
So it doesn't mean that they're a guaranteed way to prevent amputations, but it's a possibility
(04:00):
that needs more investigation.
Absolutely.
It's a glimmer of hope, but we need more data to be sure.
Okay.
So let's talk about this high flow trial.
Okay.
This is a WJ19811.PDF and it looked at a specific type of microvascular tissue allograft called
PMVT.
Right.
What's so special about this particular treatment?
(04:23):
Well, what's remarkable about the high flow trial is they saw significant improvement
not only in healing rates, but also in neuropathy.
Hold on.
Improvement in neuropathy.
So this is doing more than just patching up the ulcer.
Yeah.
It could be addressing one of the root causes.
That's the exciting part.
Wow.
They measured neuropathy using two methods.
The SEMIS-Winestein monofilament test, which assesses how sensitive your feet are to touch.
(04:45):
And the stocking glove technique where they map out areas of numbness.
Both methods showed improvement in the group that received PMVT.
So this raises a big question.
Could PMVT actually be helping to reverse the nerve damage?
Potentially.
That leads to these ulcers in the first place.
That's what researchers are trying to figure out.
We need more research, but the findings from the high flow trial are certainly intriguing.
(05:09):
It sounds like there's a lot of potential here, but I imagine there are also some cautions
to keep in mind.
Of course.
Both the Cochrane review and the high flow trial had limitations.
The studies were relatively small, and we need larger, more diverse studies to confirm
these findings.
Okay.
And I imagine there are other factors that could influence healing too.
(05:29):
Absolutely.
Things like a person's age, overall health, how committed they are to their treatment
plan.
It's never just about one treatment in isolation.
It's about the whole picture, the individual's health status, their lifestyle, their access
to care, and their willingness to actively participate in their own healing.
So the Cochrane review also looked at adverse events, which I think is important.
(05:52):
Nobody wants a treatment that causes more problems than it solves.
What do they find?
Well, the good news is none of the studies in the Cochrane review reported any significant
difference in adverse events between the groups that received skin grafts or tissue replacements
and the groups that received standard care.
So in terms of safety, these treatments seem to be comparable.
(06:13):
That's reassuring to hear.
But were there any common adverse events reported at all?
There were some, but they varied from study to study.
The most common ones included things like infection, pain, bleeding, and allergic reactions.
But these are all potential risks with any wound treatment.
So they're not necessarily unique to skin grafts or tissue replacements.
(06:35):
So it sounds like the safety profile is generally good.
But as with any medical procedure, there are risks to consider.
It's a conversation you should have with your doctor.
They can help you weigh the potential benefits against the risks based on your individual
circumstances.
Let's talk about the elephant in the room, the cost of these treatments.
I imagine that could be a concern for a lot of people.
You're right.
(06:55):
Skin grafts and tissue replacements can be expensive, especially if you need multiple
applications or a longer course of treatment.
And insurance coverage varies widely depending on your plan and the specific treatment.
So this is where it becomes really important to be your own advocate?
Yes.
Do your research, ask questions, and don't be afraid to appeal if you're denied coverage.
(07:18):
Knowledge is power, especially when it comes to navigating the healthcare system.
Before we wrap up, was there anything else that stood out to you from these studies?
Any aha moments or lingering questions?
One thing that really struck me was the potential for these treatments to not only improve healing
rates but also the quality of the healed skin.
Interesting.
(07:38):
That's something we don't always focus on, but it's so important for people living with
these ulcers.
So it's not just about closing the wound.
It's about making sure the healed skin is healthy and less likely to break down again.
Exactly.
That's a huge win for both patients and healthcare providers.
It can mean fewer recurrences, less pain, and a better quality of life overall.
(08:00):
So let's do a quick recap here for our listener.
So we've learned that diabetic foot ulcers are a serious health concern and that even
with standard treatments, some ulcers can be really stubborn about healing.
For sure.
For sure.
Skin grafts and tissue replacements offer a potential solution.
And the research we've looked at suggests they might lead to faster healing and maybe
(08:24):
even a lower risk of amputation.
Yeah, but it's important to remember that there's still a lot we don't know.
We need more research to confirm these findings and to explore the long-term effects of these
treatments.
And of course, we can't forget about the cost and the insurance hurdles that many people
face.
Absolutely.
Those are all important factors to consider.
But despite the challenges, there's reason for optimism.
(08:46):
The research is ongoing and scientists are constantly working to develop new and better
treatments.
That's right.
And they're also going to be new to be proactive about foot health.
Well, the most important thing is to manage your diabetes effectively.
Work closely with your doctor to keep your blood sugar levels under control.
That makes sense.
And what about daily foot care?
Any tips?
(09:06):
Yeah, inspect your feet every day.
Look for any cuts, blisters, redness, swelling or changes in skin color.
And don't forget to check between your toes.
Those areas can be tricky.
Oh yeah, good point.
And moisturize to prevent dry skin from cracking.
Yes, but not between the toes.
And not between the toes.
Yeah, too much moisture there can lead to fungal infections.
Good to know.
What about footwear?
(09:28):
Wear comfortable, well-fitting shoes that don't rub or create pressure points.
And avoid going barefoot even at home.
So it's all about being aware and taking those small steps to protect your feet.
Any final mind-blowing thoughts for our listener to ponder?
Well, what if someday we could regenerate not just skin, but also nerves?
(09:49):
Imagine being able to reverse the neuropathy that contributes to these ulcers.
Wow.
That would be a game changer.
That would be incredible.
Science fiction becoming reality.
It might sound far-fetched, but research in areas like stem cell therapy and gene editing
is advancing rapidly.
The possibilities are exciting.
That is really exciting.
Well, listener, I don't know about you, but I'm feeling inspired.
(10:12):
We've covered a lot of ground today.
And I hope you're walking away feeling more informed and empowered.
Yeah, and remember, this is just the beginning of the conversation.
Keep learning, keep asking questions, and keep those feet happy and healthy.
That's great advice.
Thanks for joining us on this deep dive.
Until next time, stay curious.
Disclaimer, the content provided in this audio is for informational purposes only and should
(10:34):
not be construed as medical advice.
It is not a substitute for professional diagnosis, treatment, or consultation with a qualified
healthcare provider.
Always seek the advice of a physician or another qualified health provider with any questions
or concerns regarding a medical condition.
By listening to this audio platform, neither its hosts, guests, nor publishers establish
a doctor-patient relationship, and no liability is assumed for any decisions made based solely
on the information presented.
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