Diabetic foot treatment in pune,diabetes treatment algorithm 2011 pdf,diabetes type 2 diet menu list - PDF 2016


Our body is a factory that works non-stop, without a break and glucose is the main source of fuel to our body. When food is consumed it gets broken up into fats, proteins and carbohydrates.
But for the cells to convert the glucose in the blood to energy it needs the hormone – Insulin.
Diabetic Neuropathy – Diabetic neuropathy occurs when there is damage to the nerves due to high blood sugar levels. Peripheral Vascular Disease – Peripheral vascular disease is a condition when blood vessels narrow down and restrict the flow of blood. Athlete’s foot is a type of Tinea Fungal infection, the fungus start thriving on the skin of your feet. Fungal nail infection occurs when fungus attacks a toe nail, fingernail or the skin under the nail. Calluses occur due to the accumulation of dead skin cells that hardens and thickens in a particular area. When a toe gets bent because of weakened muscles, the weakened muscles tend to make the tendons shorter. Diabetes results in insufficient supply of blood to the feet, when the supply is minimal wounds or cuts require more time to heal. Good diabetes management and regular foot care help prevent such foot diseases that are difficult to treat and may require amputation. In addition the following foot care tips will help you prevent most of the diseases. Inspect Your Feed Frequently: Inspect your feet for blisters, cuts, sores, cracks, colour change in toe nails. Wash Your Feet Regularly: Washing your foot once a day in warm water helps you keep your foot clean. Remember you are not a Doctor: In order to prevent injury to your feet do not try to remove calluses, warts or corns, you would be doing more bad than good. Quit Smoking: Smoking reduces blood circulation, which in turn will lead to more complications.
Diabetes is certainly a disease not to be ignored and the Foot not be forgotten as it takes the most in daily physical stress.
Boils also known as skin abscesses are local skin infections that are tender, red and often filled with blood or pus. Diabetic boils are infections which are caused by the weakening of the immune system due to diabetes. Check the blood sugar levels regularly if you have diabetes and make sure that you keep it in check. The skin safeguards our body against microbes and other foreign materials that can harm the body. Despite these efforts if you have persistent boils then use hot packs and hot soaks to treat the boils. Exploring the importance of the interprofessional team when caring for Patients with diabetic foot ulcers. An overview of RNAO’s newly released, second edition best practice guideline related to the treatment and management of patients with diabetic foot ulcers. Join tens of thousands of doctors, health professionals and patients who receive our newsletters.
A century since the First World War, gangrene remains a problem, albeit a less deadly problem, for many people. The distinctive smell of that "gas gangrene" was the only means to diagnose the condition in the trenches and on the battlefield. Use this page to learn about the modern-day factors that lead to different forms of gangrene, and how doctors today manage the conditions. Gangrene is a serious, sometimes life-threatening condition in which the skin, muscle and other tissues die as a result of lost blood supply. It is usually external, affecting the extremities, but it can also affect internal tissues. Gangrene is most commonly associated with chronic illness, such as a severe complication of diabetes, or acute causes, such as certain types of injury. Dry gangrene is caused by chronic illness, while wet gangrene - including gas gangrene - is usually an acute form involving bacterial infection and caused by injury, for example. Surgical complication can lead to internal gangrene, which presents with signs of toxic shock. Initial diagnosis is made based on the history leading up to the presentation, and a physical examination, including external appearance and smell. Urgent treatment is important to prevent further serious illness and death, and includes removal of dead tissue or even amputation.
Prevention of gangrene is an important part of living with certain chronic illnesses, including diabetes. Gangrene is a disease of the skin and soft tissues - and sometimes internal tissues and organs - that results in tissue death (necrosis). Gas gangrene (also called clostridial myonecrosis) is a particularly virulent form of wet gangrene.2,3,6,7 This is the condition that is associated with poorly cleansed wounds of the kind suffered in war - deep crushing or penetrating wounds that become infected with bacteria, Clostridium in particular.
The reasons behind necrosis and tissue death differ depending on the specific type of gangrene. Wet gangrene results from a sudden loss of perfusion, and is worsened by the involvement of bacteria. Dry gangrene is more likely to occur in older people with diabetic foot - a common complication of undiagnosed or uncontrolled diabetes. Complications of diabetes affecting the extremities, especially the feet, are a risk factor for gangrene, partly because painless wounds can go unnoticed.
Surgery - an operation involving the ligation of an artery, as treatment of an aneurysm for example, can shut off blood supply in such a way as to cause gangrene. Mechanical constriction - for example, gangrene can be revealed when pressure splints are removed.
Severe burns, scalds and cold - heat, chemical agents (especially carbolic acid, but also caustic potash, and nitric or sulphuric acid), and cold (including frostbite) can all lead to dry gangrene. Raynaud's disease - this condition, in which spasm of blood vessels causes impaired circulation to the ends of fingers and toes, especially in cold weather, is implicated in some cases of gangrene. Eating large quantities of coarse rye bread - long-term intake of ergot, a fungus that can infect rye is implicated in gangrene development as ergotism involves vasoconstriction. Injury - deep, crushing or penetrating wounds that are sustained in conditions that allow bacterial infection to take hold can lead to gangrene.
Mechanical constriction - rarely, blood flow restriction caused by pressure from bandages, bone fractures, tumors, and so on, can lead to gangrene. Embolic gangrene - the sudden occlusion of an artery due to an embolism can lead to dry gangrene, but this can also increase the risk of infection and thus lead to wet gangrene. Any case of dry gangrene can progress to wet gangrene if there is an opportunity for bacterial infection. In addition to the features seen in more common types of gangrene, there are certain signs and symptoms peculiar to gas gangrene, a less common form of wet gangrene. Produce a foul-smelling brown-red or bloody fluid when the tissue affected tissue is drained or leaks (a serosanguineous discharge). Initial suspicion of gangrene calls for physical examination by a doctor, who will also take medical history, asking questions about symptoms and potential exposure to infection or trauma. If gangrene is suspected, further diagnostic tests will be used to determine the type and extent of the necrosis, and to detect or rule out gas gangrene. Olfactory tests - to detect the unique, foul smell that can indicate gangrene, especially gas gangrene. To reduce the risk of serious complication and death, gangrene requires emergency treatment. In all cases of dry gangrene caused by chronic disease, prevention is far better than cure - simply because cure is not possible after, for example, diabetic gangrene has set in, when amputation of an extremity becomes necessary.5 The same attention to prevention is also important in avoiding the acute risks of gangrene, such as from injury or extreme cold. Hyperbaric oxygen therapy6,9-11 is used in other tissue infections and, in particular, diabetic foot ulcers that have become infected and failed to heal. The idea behind this treatment is that a hyperbaric chamber of high-pressure oxygen creates a bactericidal and bacteriostatic effect and improves oxygen supply to the wounds by encouraging the formation of new blood vessels (angiogenesis), and causing greater dissolution of oxygen in plasma. In certain settings, such as hospitals, healthcare professionals should practise measures that minimise the risk of infections such as gas gangrene. Frostbite can lead to gangrene, as can Reynaud's, a disease that usually affects the finger tips and tends to be worse in winter. Routinely administering, for abdominal surgery, intravenous antibiotics - before, during, and after the operation. Please use one of the following formats to cite this article in your essay, paper or report:MLAMacGill, Markus. For any corrections of factual information, or to contact our editorial team, please see our contact page. Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.
Learn about pneumococcal disease - an infection caused by a common type of bacteria known as pneumococcus. Lyme disease is caused by the Borrelia burgdorferi bacterium and is transmitted to humans and animals through the bite of infected ticks.
HMP Communications LLC (HMP) is the authoritative source for comprehensive information and education servicing health care professionals. Cold feet, many culpritsIf your toes are always cold, one reason could be poor blood flow - a circulatory problem sometimes linked to smoking, high blood pressure or heart disease.
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Diabetes occurs when the hormone – Insulin is not produced in sufficient quantities or is defective. When people with Diabetes have excess of glucose in their blood for a long duration of time it tends to make them prone to serious complications, including foot problems. Our body hosts a number of bacteria’s and fungi, some of these are good while the the others at times multiply in numbers and start infecting our hair, skin and nail. When you are healthy fungal nail infection won’t affect your nail and when it does attack it is easily visible and painful. When a toe finger is bent for a long duration of time the muscles shorten and inturn makes the toe finger bend forward.


They are caused by the staphylococcus aureus bacteria which often enter the skin through wounds and cuts. Unfortunately diabetes can wreck havoc on the immune system and lead to a number of health problems including certain skin complications as well.
With high sugar levels the efficiency of the immune system is greatly affected and it can lead to slower healing of wounds and cuts. When there is any break in the skin like cuts or open wounds then it can become infected with bacteria. For larger and painful boils filled with pus you will need to drain the pus and take antibiotics to prevent any bacterial infection.
Remember that for taking any medicine for boils it is best to consult a healthcare provider first. Follow-up laboratory and imaging tests, and sometimes exploratory surgery may also be used to diagnose gangrene.
Doctors working in hospitals, especially those involved in abdominal surgery, also take steps to prevent gangrene. In such cases, the circulation of blood to the feet worsens, and there is a higher likelihood of any foot wounds going unnoticed by the patient. This can also occur in younger people with arteriosclerosis (arterial narrowing) caused by, for example, a combination of syphilis and alcohol dependency.
If treatment involves wet or oily dressings and there are septic conditions, wet gangrene can develop.
In gas gangrene the infected area of skin can quickly extend, with some changes visible in just a matter of minutes. As such, it is important that anyone with suspected symptoms of gangrene seeks immediate medical attention. With treatment, there is a success rate of up to 60%7 (an improvement on the 50% rate achieved on battlefields for the soldiers serving in the World Wars1). However, the precise mechanism behind the effects of hyperbaric oxygen therapy remains unknown.
Chicago, Illinois, US: Encyclop?dia Britannica, published online by Encyclop?dia Britannica, Inc, accessed November 2014.
As our understanding of the Charcot disease process has evolved in regard to the disease’s pathophysiology, the optimal intervention period and identifying limitations with traditional internal fixation methods, external fixation seems to be the next step in Charcot treatment.
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It is an area that has undergone scientific research (along with other wound types).There have also been clinical trials done using manuka honey on leg ulcers with positive results.
It is intended for general information purposes only and does not address individual circumstances. If you have existing boils with pus then drain out the pus by covering the boils with warm cloth, apply antiseptic and cover the boils with bandage.
If you have boils and there are clothes that rub against them then make sure that you wear loose fitting clothes that do not rub against wound. This is because certain immune suppressing medicines used for boils treatment can complicate the problem further. This is because of diabetic neuropathy, which is a loss of sensation resulting from nerve damage caused by diabetes. However, as with anything new that takes center stage, there will always be undefined uses that invite controversy and debate. The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments.
Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. Bone mineral density during total contact cast immobilization for a patient with neuropathic (Charcot) arthropathy.
Calcaneal bone mineral density in patients with Charcot neuropathic osteoarthropathy: differences between Type 1 and Type 2 diabetes. Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle. Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus.
Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage. Staging of Charcot neuroarthropathy along the medial column of the foot in the diabetic patient.
Arthrodesis as an early alternative to nonoperative management of charcot arthropathy of the diabetic foot. Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. Cardiovascular risk factors predicting the development of distal symmetrical polyneuropathy in people with type 1 diabetes: A 9-year follow-up study. Addressing psychosocial aspects of care for patients with diabetes undergoing limb salvage surgery. The management of acute Charcot fracture-dislocations with the Taylor’s spatial external fixation system.
It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health.
A doctor can look for any underlying problems - or let you know that you simply have cold feet.
Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. People suffering from boils should try to avoid sharing clothes and towels among family members. Out of this group, surgeons treated 64 percent of patients successfully with exostectomies and only 36 percent necessitated arthrodesis. When Streptococcus pyogenes infects wounds it can start infection, destroy skin grafts, and clump together into a biofilm, or barrier, which means antibiotics become ineffective. Usually, these cases of significant bone loss require bone grafting for structural support and long screws and large plates to span the defect. It is known that people with this bacteria often find that their wound doesn't heal properly, with the biofilm making them especially difficult to treat with antimicrobials because the film offers a layer of extra protection. However, pain that's not due to sky-high heels may come from a stress fracture, a small crack in a bone. In cases of longstanding deformities, single-stage corrections may be limited by chronic soft tissue contractures and peripheral scarring of the neurovacsular bundle, leading to complications of inadequate deformity correction, wound dehiscence and local ischemic tissue loss. One possible cause: exercise that was too intense, particularly high-impact sport like football and distance running. Complications with wound healing, poor screw purchase, hardware failure, nonunion and recurrence of deformity are potential sequelae of open arthrodesis with internal fixation in Charcot reconstruction. As in other wound care uses, it is important to use a proper medical grade manuka honey that has been appropriately filtered (finer levels of pollen and other bits removed) and sterilised.
External circular fixation can provide mechanical stability to structurally deficient bone and maintain skeletal alignment where internal fixation options for direct stabilization are limited. Red, white and blue toesRaynaud's disease can cause your toes to turn white, then bluish, and then red and then return to their natural tone.
A Closer Look At The Ex-Fix Controversy There has been evidence to suggest that external fixation methods can provide advantages in Charcot reconstruction when internal fixation is unsuccessful. However, much of the controversy surrounding external fixation stems from the lack of consensus regarding treatment goals and indications for use. It is also properly approved, with a medical devices license, and is the actual product used in several studies using medical grade honey.
Stress or changes in temperature can trigger vasospasms, which usually don’t lead to other health concerns.
Manuka Honey Dressings - these are ready to use dressings, with natural fibers impregnated with the medical grade manuka honey, and are sterilised.
Raynaud's may also be related to rheumatoid arthritis, Sjogren's disease or thyroid problems.
As logical as this may seem to some surgeons, this widespread use has not been accompanied with meaningful statistical evidence to justify the role of ex-fix in Charcot foot reconstruction yet there is continued nationwide promotion of its use. Heel painThe most common cause of heel pain is plantar fasciitis, inflammation where this long ligament attaches to the heel bone. The lack of uniform outcome measures makes it difficult to interpret the existing literature and generate meaningful comparisons as to whether surgical reconstruction is superior to total contact casting, and whether external fixation is superior to internal fixation.
Arthritis, excessive exercise and poorly fitting shoes also can cause heel pain, as can tendonitis. Less common causes include a bone spur on the bottom of the heel, a bone infection, tumour or fracture.
The cost of external fixation may range from $6,000 to $30,000 per patient for initial application.
Dragging your feetSometimes the first sign of a problem is a change in the way you walk - a wider gait or slight foot dragging. Additionally, experts have quoted a 100 percent complication rate with external fixation in Charcot reconstruction.
The cause may be the slow loss of normal sensation in your feet, brought on by peripheral nerve damage. Therefore, with a device which requires frequent postoperative follow-up, has high complication rates and is cost prohibitive, the indications of external fixation need to be clear. For external fixation in Charcot reconstruction, the risk to benefit ratio for unconventional applications may be disproportionately high in comparison to that of internal fixation. Nerve damage also can be due to infection, vitamin deficiency, alcoholism, and nervous system disease. By using this device on the diabetic foot, you must ask: Are you saving the limb or putting it at risk? The question is not who is a candidate for external fixation but who is not a candidate for internal fixation. Lung disease is the most common underlying cause, but it also can be caused by heart disease, liver and digestive disorders or certain infections.


Swollen feetThis is usually a temporary nuisance caused by standing too long or long haul travel - especially if you are pregnant. In the presence of infected bone, the introduction of internal fixation may serve as a source for infection involving unaffected areas of adjacent bone.
With staged procedures involving wound debridement, one must often excise infected bone and provide long-term parental antibiotic therapy prior to introducing internal fixation for final reconstruction. In addition, structural defects may require a large bone graft with long reconstruction or locking plates and screws to achieve direct stabilization. This method often requires wide surgical exposure, stripping the periosseous blood supply to the bone and increasing the probability for nonunion.
External fixation may provide indirect stabilization of the skeletal defect spanning the area of bone resection or to protect bone graft through percutaneous methods that limit soft tissues exposure. Burning feetA burning sensation in the feet is common among people with diabetes with peripheral nerve damage. It can also be caused by a vitamin B deficiency, athlete’s foot, chronic kidney disease, poor circulation in the legs and feet (peripheral arterial disease) or hypothyroidism.
Sores that don’t healFoot sores that will not heal are a major warning sign of possible diabetes. With unintentional weightbearing, the patients’ excessive weight may exceed the mechanical limits of internal fixation devices, compromising the purchase of these devices to bone or causing implant failure.
Diabetes can impair sensation in the feet, circulation and normal wound healing, so even a blister can become a problem wound.
External fixation may provide stable reduction of the realignment arthrodesis, simultaneously allowing a shared loading of the fusion site without exceeding the mechanical limits of the fixator maintaining the correction. People with diabeties should wash and dry their feet and check them for any wounds every day. Both acute and chronic Charcot neuroarthropathy may result in severe and unstable limb deformities that are not structurally stable for weightbearing. Slow-healing of sores also can be caused by poor circulation from conditions such as peripheral artery disease. Additionally, one cannot reasonably offload these deformities with casting or bracing without exposing the limb to areas of focal high pressures, leading to ulceration. Pain in the big toeGout is a notorious cause of sudden pain in the big toe joint, along with redness and swelling (seen here). With joint fragmentation, bone resorption and severe deformity that one sees with acute Charcot, internal fixation may not adequately achieve direct stabilization to maintain alignment of open arthrodesis. External fixation may span areas of demineralized bone and maintain the alignment in arthrodesis.
If the joint is rigid, it may be hallux rigidus, a complication of arthritis where a bone spur develops.
In cases of correction of severe chronic Charcot, osseous correction may be limited by adapted soft tissue and neurovascular structures that may not tolerate acute, single stage correction without complications of soft tissue contracture, wound dehiscence or soft tissue necrosis.
One may gradually correct deformities with circular spatial frame or hinge axis methods that allow concomitant soft tissue lengthening and relaxation to occur. Pain in the smaller toesIf you feel like you're walking on a marble, or if pain burns in the ball of your foot and radiates to the toes, you may have Morton’s neuroma, a thickening of tissue around a nerve, usually between the third and fourth toes. Furthermore, complications associated with Charcot reconstruction with internal fixation, including limb loss, may not be considered reasonable risks in this lower risk patient group.
Itchy feetItchy, scaly skin may be athlete’s foot, a fungal infection that's particularly common in young men. A reaction to chemicals or skin care products - called contact dermatitis -- can cause itching, too, along with redness and dry patches.
In regard to clinical manifestations of acute Charcot neuroarthropathy in the absence of radiographic signs of joint destruction or deformity, which surgeons refer to as Stage 0 or pre-Charcot, various authors suggest it is best to use compression therapy and subsequent nonweightbearing cast immobilization.22,23,26 This conservative method, including total contact casting, is also widely advocated as the gold standard for Eichenholtz stage I Charcot. If the skin of your itchy feet is thick and scaly, it may be psoriasis, an over-reaction of the immune system.
In this stage, one may see radiographic signs of early joint fragmentation, destruction and debris formation without significant fracture displacement, joint dislocation or mechanical axis malalignments.
Claw toeThis foot deformity can be caused by shoes that are tight and pinch your toes or by a disease that damages nerves, such as diabetes, alcoholism or other neurological disorder.
Your toes will be bent upward as they extend from the ball of the foot, then downward from the middle joint, resembling a claw. However, further investigation is necessary to validate the efficacy of indirect stabilization in cases of Stage 0 and 1 without deformity. They may respond to stretching and exercises of the toes - or you may need special shoes or even surgery. Foot spasmsA sudden, sharp pain in the foot is the hallmark of a muscle spasm or cramp, which can last many minutes. Charcot rocker bottom foot deformity often leaves plantar osseous prominences, increasing the risk for tissue breakdown.
Simple plantar exostectomies are generally successful with a reported average 84 percent healing rate and 20 percent recurrence of skin breakdown.6,9,14,15,21 With the procedure’s satisfactory success rates, less technical difficulty and lower complication rates, one may consider exostectomies for stable uncomplicated Charcot deformities with plantar prominences. Other causes include poor circulation, dehydration or imbalances in potassium, magnesium, calcium or vitamin D levels in the body.
Proponents for arthrodesis may argue that recurrence of ulceration and progression of Charcot may be high with exostectomies as opposed to realignment arthrodesis. However, there is little uniform, long-term data to provide meaningful comparisons between the two treatment groups.
Dark spot on the footWe associate skin cancer with the sun, so we're not as likely to check our feet for unusual spots.
However, a melanoma, the most dangerous form of skin cancer, can develop even in areas that are not regularly exposed to the sun. Facilitating early protected weightbearing while maintaining alignment of the arthrodesis site can be an advantage of external fixation.
Ilizarov supported early weightbearing in lower extremity external fixation cases, observing that controlled weightbearing stimulus via “shared loading” promotes bone regeneration. Allowing early weightbearing to stimulate healing of the fusion site has been a common indication for external fixation. Thick, yellow nails also can be a sign of an underlying disease, including lymphoedema (swelling related to the lymphatic system), lung problems or rheumatoid arthritis.
However, a patient capable of non-weightbearing with crutches is likely capable of performing touch toe weightbearing for shared loading of the arthrodesis with internal fixation and in a contact cast.
Spoon-shaped toenailsSometimes an injury to the nail or frequent exposure to petroleum-based solvents can create a concave, spoon-like shape. If a patient’s postoperative regimen for arthrodesis involves non-weightbearing and the patient is able to safely maintain non-weightbearing, external fixation may be unconventional in this circumstance and one may not be able to justify the disproportionate cost of external fixation over the lower cost of internal fixation.
Understanding The Importance Of Appropriate Patient Selection Poor rehabilitation and health status. White nailsInjury to the nail or illness anywhere in the body can cause white areas in the nails.
The rationale of limb salvage for some surgeons is the association between increased energy expenditure with loss of limb length and a 66 percent increased incidence of contralateral limb loss within five years.28-30 Though one may attribute the relationship of contralateral limb loss after the index amputation to increased mechanical stress on the remaining limb leading to ulceration and infection, surgeons must also consider the event of limb loss as a marker of the disease state of diabetes. If part or all of a nail separates from the nail bed (shown here), it can appear white - and may be due to an injury, nail infection or psoriasis.If the nail is intact and most of it is white, it can sometimes be a sign of a more serious condition including liver disease, congestive heart failure or diabetes.
The development of Charcot is not a result of a local phenomenon but is a reflection of the overall disease state of diabetes. Pitting of the nailsPitting, or punctured-looking depressions in the surface of the nail, is caused by a disruption in the growth of the nail at the nail plate. One should not consider amputation as a failure but as a reasonable treatment option for Charcot limb deformities in patients who have accumulated risk factors for poor outcomes for limb salvage. Although one can generally reduce complications with experience, bear in mind that even experts have quoted a 100 percent complication rate when it comes to external fixation with Charcot reconstruction. Common complications of pin tract infections include cellulitis, osteomyelitis, external fixation component failure, unscheduled trips to the operating room for half pin or fine wire exchange, frame loosening requiring adjustments and stress fractures of the tibia.
External fixation product training seminars can demonstrate the basic methods of frame application but these seminars cannot prepare surgeons to deal with the more difficult aspect of external fixation — outpatient management. Ensuring successful outcomes of external fixation require weekly pin tract care and surgeon availability. If occurrence of a tibial pin tract infection is sufficient to influence a surgeon to abandon the frame, then one should reconsider the utilization of the external fixator for Charcot reconstruction. Reports of depression, destructive behavior, social isolation and sleeping disorders have been associated with external fixation use. Social support systems or groups can provide a practical exchange of information that helps patients cope with common issues regarding external fixation treatment. Without patient acceptance of external fixation, compliance issues and early abandonment of external fixation may compromise the outcomes for success. In other words, one can successfully manage a majority of Charcot with conservative therapy and external fixation is not a substitute for cases in which internal fixation works well.
There are promising retrospective analyses, early prospective studies and anecdotal evidence, which deserve further attention.
However, we must continue to critically investigate the best indications of external fixation use, moving from an “in my hands” approach to prospective comparative trials. At this point, the indications for Charcot reconstruction with external fixation seem to be few and far between. Liu is a Clinical Associate Professor in the Department of Orthopaedics at the University of Texas Health Science Center at San Antonio, Tx.
He received his fellowship training in trauma and reconstruction at the University Hospitals of Dresden, Germany and Catania, Italy. Liu currently practices at the Austin Diagnostic Clinic multispecialty group in Austin, Tx. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.




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