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symptoms, renal and retinal function, and co-morbitities. 18 - 25 Physical examination should determine the size, depth, colour and position of the DFU, neuropathy, ischaemia or neuro-ischaemia of the foot, bone exposed, necrosis, infection, and the
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adolescents and young adults (aged 10 to 40 years), with a male gender predominance. It is less infrequent in the distal extremities of upper and lower limbs. When superficially located, ES usually presents as firm, slowly growing painless nodules or plaque
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-wasting or hypertrophy should be noted. A complete neurological examination of both the upper and the lower limbs is needed. To detect any muscular imbalance, a full examination of all muscle groups should be performed for power and graded between 1 and 5 on
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° upper limit. 7 , 8 , 11 The distal metatarsal articular angle (DMAA) is measured between the distal articular surface and the perpendicular line to the longitudinal axis of the first metatarsal. It is considered non-pathological at up to 10° in
Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
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AO Research Institute Davos, Davos Switzerland
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pathologic, and a CT angiography is recommended ( 9 ). If the CT angiography reveals relevant vascular stenosis which negatively affects limb perfusion, a percutaneous transluminal angioplasty either stand-alone or combined with stent implantation should be