SFDI biomarkers provide a quantitative ulcer risk metric and can be used to predict diabetic foot ulcer onset.

AIMS: Annually, up to 4% of people with diabetes present with a chronic foot ulcer. Quantitative real-time testing to identify patients at risk for ulceration can guide preventative care. Here, we assess whether a non-invasive optical imaging technique, Spatial Frequency Domain Imaging (SFDI), can identify patients at the highest risk for ulceration and predict ulcer onset. METHODS: We imaged 252 subjects with diabetes at Kaiser Permanente, Southern California. SFDI derived tissue biomarkers of microcirculation were compared between subjects with and without a history of ulceration, and subjects who did or did not develop ulcers after 1 year. RESULTS: Feet of subjects at the highest risk (i.e. history of ulceration) had significantly lower hemoglobin in the papillary dermis (HbT1), along with higher oxygenation (StO2) due to poor extraction. These subjects also had more homogeneous hemoglobin spread in the reticular dermis (HbT2) and tissue scattering (related to skin structure). Prediction based on HbT1 and tissue scattering identified new ulcerations and performed with sensitivity/specificity of 68.8%/64.8% and 75.0%/69.1%, respectively. CONCLUSION: These results show that SFDI hemoglobin distribution and oxygenation biomarkers provide a quantitative basis for ulcer risk stratification and ulcer onset prediction.

Minimal invasive percutaneous bipolar radiofrequency for plantar fasciotomy: a retrospective study.

The purpose of this study was to present the results of a relatively new, minimally invasive surgical technique for the treatment of chronic plantar fasciitis in 14 patients, 2 of whom underwent the treatment bilaterally one foot at time on separate occasions. This was a retrospective, multicenter, nonrandomized study. All of the patients had failed conservative therapy and had symptoms for at least 6 months. The mean follow-up duration was 15.25 months (range, 6-33 months). The postoperative mean American Orthopaedic Foot & Ankle Society hindfoot score was 82.06 (range, 56-100). None of the patients developed complex regional pain syndrome, and all but 2 (14.29% of patients, 12.5% of feet) of the patients were able to return to regular shoe gear by 2-4 weeks postoperative, and only 1 (7.14% of patients, 6.25% of feet) patient was considered a treatment failure. Based on our experience with minimally invasive percutaneous bipolar radiofrequency plantar fasciotomy, we believe the technique to be a relatively easy intervention that is effective and requires less healing time in comparison with traditional open surgical procedures.