***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Little prospect i ve research exists on risk factors for diabetic foot ulcer that considers the independent effects of multiple potential etiologic agents . We prospect ively studied the effects of diabetes characteristics , foot deformity , behavioral factors , and neurovascular function on foot ulcer risk among 749 diabetic veterans with 1,483 lower limbs . RESEARCH DESIGN AND METHODS Eligible subjects included all diabetic enrollees of a general internal medicine clinic without foot ulcer , of whom 83 % agreed to participate . Baseline assessment included history and lower-limb physical examination , tests for sensory and autonomic neuropathy , and measurements of macro- and microvascular perfusion in the foot .  Subjects were followed for the occurrence of a full thickness skin defect on the foot that took > 14 days to heal , with a mean follow-up of 3.7 years . RESULTS Using stepwise Cox regression analysis , the following factors were independently related to foot ulcer risk : foot insensitivity to the 5.07 monofilament ( relative risk [ 95 % CI ] ) 2.2 ( 1.5 - 3.1 ) , past history of amputation 2.8 ( 1.8 - 4.3 ) or foot ulcer 1.6 ( 1.2 - 2.3 ) , insulin use 1.6 ( 1.1 - 2.2 ) , Charcot deformity 3.5 ( 1.2 - 9.9 ) , 15 mmHg higher dorsal foot transcutaneous PO2 0.8 ( 0.7 - 0.9 ) , 20 kg higher body weight 1.2 ( 1.1 - 1.4 ) , 0.3 higher ankle-arm index 0.8 ( 0.7 - 1.0 ) , poor vision 1.9 ( 1.4 - 2.6 ) , and 13 mmHg orthostatic blood pressure fall 1.2 ( 1.1 - 1.5 ) . Higher ulcer risk was associated with hammer/claw toe deformity and history of laser photocoagulation in certain subgroups . Unrelated to foot ulcer risk in multivariate models were diabetes duration and type , race , smoking status , diabetes education , joint mobility , hallux blood pressure , and other foot deformities . CONCLUSIONS Certain foot deformities , reduced skin oxygenation and foot perfusion , poor vision , greater body mass , and both sensory and autonomic neuropathy independently influence foot ulcer risk , thereby providing support for a multifactorial etiology for diabetic foot ulceration OBJECTIVE The purpose of this study was to compare the effectiveness of a removable cast walker ( RCW ) rendered irremovable ( iTCC ) with the total contact cast ( TCC ) in the treatment of diabetic neuropathic plantar foot ulcers . RESEARCH DESIGN AND METHODS In a prospect i ve , r and omized , controlled trial , 41 consecutive diabetic patients with chronic , nonischemic , neuropathic plantar foot ulcers were r and omly assigned to one of two groups : a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material ( i.e. , an iTCC ) or a st and ard TCC . Primary outcome measures were the proportion of patients with ulcers that healed at < /=12 weeks , healing rates , complication rates , cast placement/removal times , and costs . RESULTS The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74 % , respectively ( 94 and 93 % , respectively , when patients who were lost to follow-up were excluded ) . Survival analysis ( healing rates ) was statistically equivalent in the two groups , as were complication rates , but with a trend toward benefit in the iTCC group . The iTCC took significantly less time to place and remove than the TCC with 39 % and 36 % reductions , respectively . There was also an overall lower cost associated with the use of the iTCC compared with the TCC . CONCLUSIONS The iTCC may be equally efficacious , faster to place , easier to use , and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers OBJECTIVE To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation . RESEARCH DESIGN AND METHODS Eighty-five patients who fit diabetic foot risk category 2 or 3 ( neuropathy and foot deformity or previous history of ulceration or partial foot amputation ) were r and omized into a st and ard therapy group ( n = 41 ) or an enhanced therapy group ( n = 44 ) . St and ard therapy consisted of therapeutic footwear , diabetic foot education , and regular foot evaluation by a podiatrist . Enhanced therapy included the addition of a h and held infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening . Elevated temperatures ( > 4 degrees F compared with the opposite foot ) were considered to be " at risk " of ulceration due to inflammation at the site of measurement . When foot temperatures were elevated , subjects were instructed to reduce their activity and contact the study nurse . Study subjects were followed for 6 months . RESULTS The enhanced therapy group had significantly fewer diabetic foot complications ( enhanced therapy group 2 % vs. st and ard therapy group 20 % , P = 0.01 , odds ratio 10.3 , 95 % CI 1.2 - 85.3 ) . There were seven ulcers and two Charcot fractures among st and ard therapy patients and one ulcer in the enhanced therapy group . CONCLUSIONS These results suggest that at-home patient self-monitoring with daily foot temperatures may be an effective adjunctive tool to prevent foot complications in individuals at high risk for lower-extremity ulceration and amputation BACKGROUND Limited ankle dorsiflexion has been implicated as a contributing factor to plantar ulceration of the forefoot in diabetes mellitus . The purpose of this study was to compare outcomes for patients with diabetes mellitus and a neuropathic plantar ulcer treated with a total-contact cast with and without an Achilles tendon lengthening . Our primary hypothesis was that the Achilles tendon lengthening would lead to a lower rate of ulcer recurrence . METHODS Sixty-four subjects were r and omized into two treatment groups , immobilization in a total-contact cast alone or combined with percutaneous Achilles tendon lengthening , with measurements made before and after treatment , at the seven-month follow-up examination , and at the final follow-up evaluation ( a mean [ and st and ard deviation ] of 2.1 + /- 0.7 years after initial healing ) . There were thirty-three subjects in the total-contact cast group and thirty-one subjects in the Achilles tendon lengthening group . There were no significant differences in age , body-mass index , or duration of diabetes between the groups . Outcome measures were time to healing of the ulcer , ulcer recurrence rate , range of dorsiflexion of the ankle , peak torque ( strength ) of the plantar flexor muscles , and peak plantar pressures on the forefoot . RESULTS Twenty-nine ( 88 % ) of thirty-three ulcers in the total-contact cast group and all thirty ulcers ( 100 % ) in the Achilles tendon lengthening group healed after a mean duration ( and st and ard deviation ) of 41 + /- 28 days and 58 + /- 47 days , respectively ( p > 0.05 ) . ( One patient in the Achilles tendon lengthening group died before treatment was completed . ) In the first seven months of follow-up , sixteen ( 59 % ) of the twenty-seven patients in the total-contact cast group who were available for follow-up and four ( 15 % ) of the twenty-seven patients in the Achilles tendon lengthening group who were available for follow-up had an ulcer recurrence ( p = 0.001 ) . At the time of the two-year follow-up , twenty-one ( 81 % ) of the twenty-six patients in the total-contact cast group and ten ( 38 % ) of the twenty-six patients in the Achilles tendon lengthening group had ulcer recurrence ( p = 0.002 ) . Compared with the group treated with the total-contact cast , the group treated with Achilles tendon lengthening had increased dorsiflexion and it remained increased at seven months ( p < 0.001 ) . Plantar flexor peak torque also decreased after Achilles tendon lengthening ( p < 0.004 ) , but it returned to baseline after seven months . Peak plantar pressures on the forefoot during barefoot walking were reduced ( p < 0.0002 ) following Achilles tendon lengthening yet returned to baseline values within seven months after treatment . CONCLUSIONS All ulcers healed in the Achilles tendon lengthening group , and the risk for ulcer recurrence was 75 % less at seven months and 52 % less at two years than that in the total-contact cast group . Achilles tendon lengthening should be considered an effective strategy to reduce recurrence of neuropathic ulceration of the plantar aspect of the forefoot in patients with diabetes mellitus and limited ankle dorsiflexion ( < /=5 degrees ) OBJECTIVE To compare the efficacy , safety , and compliance of a nonremovable fiberglass cast boot and off-loading shoes in the treatment of  diabetic plantar ulcers .  RESEARCH DESIGN AND METHODS Patients ( n = 93 ) with noninfected , nonischemic plantar ulcers were included in this prospect i ve nonr and omized study . Treatment used a nonremovable fiberglass cast boot for longer st and ing and deeper ulcers ( n = 42 ) and a half shoe or heel-relief shoe for other ulcers ( n = 51 ) . We evaluated off-loading therapy , compliance , and complications in both groups . RESULTS The healing rate was significantly higher with the cast boot than with the off-loading shoe ( 81 vs. 70 % , P = 0.017 ) , with healing times of 68.6 + /- 35.1 vs. 134.2 + /- 133.0 days , respectively , and hazard ratio 1.68 ( 95 % CI 1.04 - 2.70 ) ; complete compliance with treatment was 98 vs. 10 % ( P = 0.001 ) , respectively . Secondary osteomyelitis developed in 3 patients in the cast boot group and 13 patients in the off-loading shoe group ( P = 0.026 ) . CONCLUSIONS A nonremovable fiberglass cast boot was effective in healing diabetic plantar ulcers and in decreasing the risk of secondary osteomyelitis . The cast boot forced compliance with off-loading , thus promoting healing Abstract . Aims /hypothesis : The management of charcot neuroarthropathy , a severe disabling condition in diabetic patients with peripheral neuropathy , is currently inadequate with no specific pharmacological treatment available . We undertook a double-blind r and omised controlled trial to study the effect of pamidronate , a bisphosphonate , in the management of acute diabetic Charcot neuroarthropathy . Methods : Altogether 39 diabetic patients with active Charcot neuroarthropathy from four centres in Engl and were r and omised in a double-blind placebo-controlled trial . Patients received a single infusion of 90 mg of pamidronate or placebo ( saline )  . Foot temperatures , symptoms and markers of bone turnover ( bone specific alkaline phosphatase and deoxypyridinoline crosslinks ) were measured over the 12 months , in 10 visits . All patients also had st and ard treatment of the Charcot foot . Results : Mean age of the study group ( 59 % Type II ( non-insulin-dependent ) diabetes mellitus ) was 56.3 ± 10.2 years .  The mean temperature difference between active and control groups was 3.6 ± 1.7 ° C and 3.3 ± 1.4 ° C , respectively . There was a fall in temperature of the affected foot in both groups after 2 weeks with a further reduction in temperature in the active group at 4 weeks ( active and placebo vs baseline ; p = 0.001 ; p = 0.01 , respectively ) , but no difference was seen between groups . An improvement in symptoms was seen in the active group compared with the placebo group ( p < 0.001 ) . Reduction in bone turnover ( means ± SEM ) was greater in the active than in the control group . Urinary deoxypyridinoline in the pamidronate treated group fell to 4.4 ± 0.4 nmol/mmol creatinine at 4 weeks compared with 7.1 ± 1.0 in the placebo group ( p = 0.01 ) and bone-specific alkaline phosphatase fell to 14.1 ± 1.2 u/l compared with 18.6 ± 1.6 u/l after 4 weeks , respectively ( p = 0.03 ) . Conclusion /interpretation : The bisphosphonate , pamidronate , given as a single dose leads to a reduction in bone turnover , symptoms and disease activity in diabetic patients with active Charcot neuroarthropathy . [ Diabetologia ( 2001 ) 44 : 2032–2037 CONTEXT Many people with diabetes experience lower-limb ulcers . Footwear has been implicated as a primary cause of foot ulcers , yet research is limited on the efficacy of shoe and insert combinations to prevent reulceration . OBJECTIVE To determine whether extra-depth and -width therapeutic shoes used with 2 types of inserts reduce reulceration in diabetic individuals with a history of foot ulcer . DESIGN , 
    Output:
    
The trials evaluating bisphosphonates reported greater reduction in foot temperature and disease activity for intervention subjects compared with controls .
Another outcome of this review indicated additional beneficial effects of bisphosphonates in reducing pain and discomfort .
Bisphosphonates may be useful adjuncts to st and ard management of Charcot foot by improved healing demonstrated by a reduction in disease activity indicated by skin temperature and bone destruction .
Magnetic therapy may reduce deformity , joint destruction and improve mobility .
CONCLUSION There is a lack of evidence supporting the use of pharmacological or non-surgical interventions with reducing lesions , ulceration , rate of surgical intervention , hospital admissions and improving the quality of life of subjects with Charcot foot .
Bisphosphonates may improve the healing of Charcot foot by reducing skin temperature and disease activity of Charcot foot , when applied in addition to st and ard interventions to control the position and shape of the foot