Skip to main content

The Diabetic Foot

  • Chapter
Obesity and Diabetes

Part of the book series: Contemporary Diabetes ((CDI))

  • 2283 Accesses

Abstract

Foot pathology remains the leading diabetic complication requiring hospitalization (1). Because the incidence of diabetes in the general population is expected to rise, the prevalence of diabetic foot complications will follow. The resulting cost to society can be measured in direct costs attributed to treatment, as well as indirect costs in lost productivity. The total cost of diabetic foot complications in the United States has been estimated to approach $4 billion annually, as extrapolated from the costs of ulcer care and amputations (2). However the costs are measured, diabetic foot problems represent a major public health challenge of growing proportions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Gibbons G, Eliopolos G. Infection of the diabetic foot. In: Kozak G, Hoar CJ, Rowbotham J, Wheelock F, Gibbons G, Campbell DR, eds. Management of Diabetic Foot Problems. Saunders, Philadelphia, 1984, pp. 97–102.

    Google Scholar 

  2. Harrington C, Zagari MJ, Corea J, Klitenic J. A cost analysis of diabetic lower-extremity ulcers. Diabetes Care 2002;25:630–631.

    Article  Google Scholar 

  3. Shera AS, Jawad F, Maqsood A, Jamal S, Azfar M, Ahmed U. Prevalence of chronic complications and associated factors in type 2 diabetes. J Pak Med Assoc 2004;54(2):54–59.

    PubMed  CAS  Google Scholar 

  4. Vela SA, Lavery LA, Armstrong DG, Anaim AA. The effect of increased weight on peak pressures: implications for obesity and diabetic foot pathology. J Foot Ankle Surg 1998;37:416–420.

    PubMed  CAS  Google Scholar 

  5. Cavanagh PR, Sims DS Jr, Sanders LJ. Body mass is a poor predictor of peak plantar pressure in diabetic men. Diabetes Care 1991;14(8):750–755.

    Article  PubMed  CAS  Google Scholar 

  6. Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999;22:157–162.

    Article  PubMed  CAS  Google Scholar 

  7. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care 1990;13:513–521.

    Article  PubMed  CAS  Google Scholar 

  8. Young MJ, Breddy JL, Veves A, Boulton AJM. The prediction of diaetic neuropathic foot ulceration using vibration perception thresholds: a prospective study. Diabetes Care 1994;17:557–560.

    Article  PubMed  CAS  Google Scholar 

  9. Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy: results of the Seattle prospective diabetic foot study. Diabetes Care 1997;96:223–228.

    Google Scholar 

  10. Ward JD, Simms JM, Knight G, Boulton AJM, Sandler DA. Venous distension in the diabetic neuropathic foot. J R Soc Med 1983;76:1011–1014.

    PubMed  CAS  Google Scholar 

  11. Tegner R. The effect of skin temperature on vibratory sensitivity in polyneuropathy. J Neurol Neurosurg Psychiatry 1985;48:176–178.

    PubMed  CAS  Google Scholar 

  12. Boulton AJ, Hardisty CA, Betts RP, et al. Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care 1983;1:26–33.

    Article  Google Scholar 

  13. Kumar S, Fernando DJ, Veves A, Knowles EA, Young MJ, Boulton AJ. Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Diabetes Res Clin Pract 1991;13:63–67.

    Article  PubMed  CAS  Google Scholar 

  14. Stokes IA, Furis IB, Hutton WC. The neuropathic ulcer and loads on the foot in diabetic patients. Acta Orthop Scand 1975;46:839–847.

    Article  PubMed  CAS  Google Scholar 

  15. Ctercteko G, Dhanendran M, Hutton WC, et al. Vertical forces acting on the feet of diabetic patients with neuropathic ulceration. Br J Surg 1981;68:608–614.

    Article  PubMed  CAS  Google Scholar 

  16. Veves A, Fernando DJ, Walewski P, et al. A study of plantar pressures in a diabetic clinic population. Foot 1991;2:89–92.

    Article  Google Scholar 

  17. Fernando DJ, Masson EA, Veves A, Boulton AJ. Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care 1991;14(1):8–11.

    Article  PubMed  CAS  Google Scholar 

  18. Grant WP, Sullivan R, Soenshine DE, et al. Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. J Foot Ankle Surg 1997;36:272–278.

    Article  PubMed  CAS  Google Scholar 

  19. Vlassara H, Brownlee M, Cerami A. Nonenzymatic glycosylation: rose in the pathogenesis of diabetic complications. Clin Chem 1986;32:B37–B41.

    PubMed  CAS  Google Scholar 

  20. Armstrong DG, Stacpoole-Shea S, Nguyen HC, Harkless LB. Lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot. J Bone Joint Surg 1999;81A:535–538.

    Google Scholar 

  21. Schilling JA. Wound healing. Physiol Rev 1968;48:374–423.

    PubMed  CAS  Google Scholar 

  22. Jude EB, Boulton AJ, Ferguson MW, Appleton I. The role of nitric oxide synthase isoforms and arginase in the pathogenesis of diabetic foot ulcers: possible modulatory effects by transforming growth factor beta 1. Diabetologia 1999;42:748–757.

    Article  PubMed  CAS  Google Scholar 

  23. Loots MA, Lamme EN, Zeegelaar J, Mekkes JR, Bos JD, Middelkoop E. Differences in cellular infiltrate and extracellular matrix of chronic diabetic and venous ulcers versus acute wounds. J Invest Dermatol 1998;111:850–857.

    Article  PubMed  CAS  Google Scholar 

  24. Cooper DM, Yu EZ, Hennesey P, et al. Determination of endogenous cytokines in chronic wounds. Ann Surg 1994;219:688–692.

    Article  PubMed  CAS  Google Scholar 

  25. Clark RAF. Mechanisms of cutaneous wound repair. In: (Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austin KF, eds.), Dermatology in General Medicine. McGraw-Hill, New York, 1993, pp. 473–483.

    Google Scholar 

  26. Armstrong DG, Nguyen HC, Lavery LA, et al. Offloading the diabetic foot wound: a randomized clinical trial. Diabetes Care 2001;24:1019–1022.

    Article  PubMed  CAS  Google Scholar 

  27. Mueller MJ, Diamond JE, Sinacore DR, et al. Total contact casting in treatment of diabetic plantar ulcers. Diabetes Care 1989;12:364–387.

    Article  Google Scholar 

  28. Lavery LA, Vela SA, Lavery DC, et al. Reducting dynamic foot pressures in high-risk diabetics with foot ulcerations: a comparison of treatments. Diabetes Care 1996;19:818–821.

    Article  PubMed  CAS  Google Scholar 

  29. Birke JA, Fred B, Krieger LA, Sliman K. The effectiveness of an accommodative dressing in offloading pressure over areas of previous metatarsal head ulceration. Wounds 2003;15:33–39.

    Google Scholar 

  30. Bonakdar-Pour A, Gaines VD. The radiology of osteomyelitis. Orthop Clin North Am 1983;14:21–37.

    PubMed  CAS  Google Scholar 

  31. Lipsky BA, Pecoraro RE, Wheat LJ. The diabetic foot: soft tissue and bone infection. Infect Dis Clin North Am 1990;4:409–432.

    PubMed  CAS  Google Scholar 

  32. Lipsky BA, Pecoraro RE, Larson SA, Hanley ME, Ahroni JH. Outpatient management of uncomplicated lower-extremity infections in diabetic patients. Arch Intern Med 1990;150:790–797.

    Article  PubMed  CAS  Google Scholar 

  33. Jones EW, Edwards R, Finch R, Jaffcoate WJ. A microbiologic study of diabetic foot lesions. Diabet Med 1984;2:213–215.

    Article  Google Scholar 

  34. Field FK, Kerstein MD. Overview of wound healing in a moist environment. Am J Surg 1994;167(1A):2S–6S.

    Article  PubMed  CAS  Google Scholar 

  35. Cooper DM, Yu EZ, Hennesey P, et al. Determination of endogenous cytokines in chronic wounds. Ann Surg 1994;219:688–692.

    Article  PubMed  CAS  Google Scholar 

  36. Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (Becaplermin) in patients with chronic neuropathic diabetic ulcers. Diabetes Care 1998;21:822–827.

    Article  PubMed  CAS  Google Scholar 

  37. Muhart M, McFalls S, Kirsner RS, et al. Behavior of tissue-engineered skin. Arch Dermatol 1999;135:913–918.

    Article  PubMed  CAS  Google Scholar 

  38. Hansbrough JF, Dore C, Hansbrough WB: Clinical trials of a living dermal tissue replacement placed beneath meshed, split-thickness skin grafts on excised burn wounds. J Burn Care Rehabil 1992;13:519–529.

    Article  PubMed  CAS  Google Scholar 

  39. Cooper ML, Hansbrough JF, Spielvogel RL, et al. In vivo optimization of a living dermal substitute employing cultured human fibroblasts on a biodegradable polyglycolic acid or polyglactin mesh. Biomaterials 1991;12:243–248.

    Article  PubMed  CAS  Google Scholar 

  40. Gentzkow GD, Iwasaki SD, Hershon KS, et al. Use of Dermagraft, a cultured human dermis, to treat diabetic foot ulcers. Diabetes Care 1996;19:350–354.

    Article  PubMed  CAS  Google Scholar 

  41. Eaglstein WH, Iriondo M, Laszio K. A composite skin substitute (Graftskin) for surgical wounds: a clinical experience. Dermatol Surg 1995;21:839–843.

    Article  PubMed  CAS  Google Scholar 

  42. Brem H, Balledux J, Bloom T, Kerstein M, Hollier L. Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent. Arch Surg 2000;135:627–634.

    Article  PubMed  CAS  Google Scholar 

  43. Veves A, Falanga V, Armstrong DG, Sabolinski ML. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers. Diabetes Care 2001;24:290–295.

    Article  PubMed  CAS  Google Scholar 

  44. Charcot JM. Sur quelques arthropathies qui paraissent dependre d’une lesion du cerveau ou de la moelle epiniere. Arch Physiol Norm Pathol 1868;1:161–178.

    Google Scholar 

  45. Sanders LJ, Frykberg RG. Diabetic neuropathic osteoarthropathy: Charcot Foot. In: (Frykberg RG, ed.). The High Risk Foot in Diabetes Mellitus. Churchill Livingstone, New York, 1991, pp. 297–338.

    Google Scholar 

  46. Delano PJ. The pathogenesis of Charcot’s joint. AJR 1946;(56)2:189–200.

    Google Scholar 

  47. Edmonds ME, Roberts VC, Watkins PJ. Blood flow in the diabetic neuropathic foot. Diabetologia 1982;22:9–15.

    Article  PubMed  CAS  Google Scholar 

  48. Edelman SV, Kosofsky EM, Paul RA, et al. Neuro-osteoarthropathy (Charcot’s joint) in diabetes mellitus following revascularization surgery: three case reports and a review of the literature. Arch Intern Med 1987;147:1504–1508.

    Article  PubMed  CAS  Google Scholar 

  49. Sinha S, Munichoodappa C, Kozak GP. Neuroarthropathy (Charcot joints) in diabetes mellitus: clinical study of 101 cases. Medicine 1972;52:191–210.

    Article  Google Scholar 

  50. Giurini JM, Chrzan JS, Gibbons GW, Habershaw GH. Charcot’s disease in diabetic patients. Postgrad Med 1991;89:163–169.

    PubMed  CAS  Google Scholar 

  51. Frykberg RG. Charcot changes in the diabetic foot. In: Veves A, Giurini JM, LoGerfo FW, eds. The Diabetic Foot. Humana, Totowa, NJ, 2002, pp. 221–246.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Dinh, T.L., Veves, A. (2006). The Diabetic Foot. In: Mantzoros, C.S. (eds) Obesity and Diabetes. Contemporary Diabetes. Humana Press. https://doi.org/10.1007/978-1-59259-985-1_20

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-985-1_20

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-538-5

  • Online ISBN: 978-1-59259-985-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics