Abstract
Diabetes is reaching epidemic proportions and carries the risk of multiple complications. Diseases of the foot are among the most feared complications of diabetes. Physician education plays a significant role in preventing, diagnosing, monitoring, and treating the diseases of the foot. This chapter is designed to provide an overview of both education about and the care of diabetic feet. It contains tables and illustrations meant to allow readers to “take home” important information they can share with patients and colleagues.
As this is the third printing of this text and chapter, we feel obliged to preface this update by stating that researchers found a 52% drop in the incidence of diabetic foot infection in the USA from 1996 to 2010. The findings of a study published in the American Journal of Infection Control also revealed that lower-extremity amputation from diabetic foot infection dropped from 33.2% in 1996 to 17.1% in 2010 (Duhon BM, et al., Am J Infect Control. 2015. doi:10.1016/j.ajic.2015.09.012).
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References
Duhon BM, et al. Prevent care in people with diabetes – NCBI. Am J Infect Control. 2015, doi:10.1016/j.ajic.2015.09.012.
Brenner MA, editor. Management of the diabetic foot. New York: Williams and Wilkins; 1987 (chapter 6).
Bailey TS, Yu HM, Rayfield EJ. Patterns of foot examination in a diabetes clinic. Am J Med. 1985;78:371–4.
Mayfield J. Foot examinations reduce the risk of diabetic amputations. J Fam Pract. 1998;49:499–504.
American Diabetes Association. Foot care in patients with diabetes mellitus. Diabetes Care. 1998;21:54–8.
Reiber GE, Raugi GJ. A model for foot care in people with diabetes. Lancet. 2005;366:1676–7, 1719–24.
Barshes NR, Sigireddi M., Wrobel JS., et al. The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diab Foot Ankle. 2013;4. doi:10.3402/dfa.v4i0.21847.
Rice B, Desai U, Kate A. Burden of diabetic foot ulcers for medicare and private insurers. Diabetes Care. 2013;Online DC-132176.
Rogers L, Lavery L, Armstrong D. The right to bear legs – an amendmentto healthcare: how preventing amputations can save billions for the US Health-care System. J Am Pod Med Assoc. 2008;98(2):166–8. doi:10.2337/dc13-2176.
Rivo M. It’s time to start practicing population-based health care. Fam Pract Manag. 1998;5(6):37–46.
Boulton AJ, Vileikyte L, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719–24.
Miller J, Carter C, Shih J, Armstrong D, et al. How to do a three minute diabetic foot exam. J Fam Pract. 2014;63(11):646–9, 653–6.
Ragnarson TG, Apelqvist J. Health and economic consequences of diabetic foot lesions. Clin Infect Dis. 2004;39 Suppl 2:S132–9.
Armstrong DG, Lavery LA, Stern S, et al. Is prophylactic diabetes foot surgery dangerous? J Foot Ankle Surg. 1996;35:585–90.
Kim P, Attinger C, Evans K. Role of the podiatrist in diabetic limb salvage. J Vasc Surg. 2012;56(4):1168–72.
LEAPP. Diabetes Care. 1998;21:23–5.
Baek D, Steinberg J. Prophylactic foot surgery in patients with diabetes: is it worth the risk? Podiatr Today. 2008;21(8):238–42.
Krelin S, Heisler M, Piette J, et al. The effect of chronic pain on diabetes patients’ self-management. Diabetes Care. 2005;28(1):65–70.
Van Schie J, Boulton A. Biomechanics of the diabetic foot (Chapter 10). In: The diabetic foot, The road to foot ulceration. New York: Humana Press; 2003. p. 185.
Shavelson D. Chapter 7: The biomechanics of the diabetic foot. In: Global perspective on diabetic foot ulcerations. InTech Pub. 2011; ISBN:978-953-307-727-7.
Kapandji IF. Chapter V: The plantar vault. In: The physiology of the joints: lower limb, The Physiology of the Joints. Elsevier: Churchill and Livingstone. vol. 2. 1988.
Fellner D. Tracing the origins of the vault theory of biomechanics-a historical perspective. present podiatry etalk. 30 Nov 2013. https://podiatry.com/etalk/index.php?topicid=14461#-1. Dec 5, 3022:103–28.
Gottlieb D. Comprehending Dr Shavelson’s functional foot typing system. Present Podiatry e-talk. 2 Jan 2012. https://www.podiatry.com/etalk/index.php?topicid=8450#-1
Peacock D. The peacock press. Podiatry Management Magazine. 2015;137–44.
Shavelson D. Aching feet-aching back…Is there a link? Rad the Mag. Fall 2008. http://www.homecareforyou.com/publication/read/article.asp?id=296&cat=27
Shavelson DA. Closer look at neoteric biomechanics. Podiatr Today. 2007;234–41.
Root ML, Orien WP, Weed JH. Normal and abnormal function of the foot. In: Clinical biomechanics, vol. 2. Los Angeles: Clinical Biomechanics Corp; 1977.
Inman VT. In: Mann RA, Inman VT, editors. The joints of the ankle. New York: Williams and Wilkins; 1976.
Donatelli R. The biomechanics of the foot and ankle. Philadelphia: FA Davis Comp; 1990.
Kevin KA. Biomechanics of the normal and abnormal foot. J Am Podiatr Med Assoc. 2000;90:88–92.
Levine P, Shavelson D, Poretsky L. The pre-charcot foot-anew clinical entity to prevent charcot joint disease. Pract Diabetol. 2006;25(3):24–28.
Boulton A, Armstrong D, Albert A, Frykberg R. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31(8):1679–85.
Armstrong, Nalini, et al. Preventing Foot Ulcers in Patients with Diabetes. JAMA. 2005;293(2):217–228.
Caputo GM. The nylon monofilament test for sensation. N Engl J Med. 1994;331:854–9.
Frykberg R, editor. The high risk foot in diabetes. New York: Churchill Livingstone; 1991.
Armstrong D, Lavery L, Harkless L. Who is at risk for diabetic foot ulceration? Clin Podiatr Med Surg. 1998;15:11–9.
Armstrong DG, Harkless LB, et al. Validation of a diabetic wound classification system: the importance of depth, infection and ischaemia. J Am Podiatr Med Assoc. 1998;79:144–53.
Alex R, Ratnarai B, Winston B, et al. Risk factors for foot ulcers in patients with diabetes mellitus. Indian J Community Med. 2010;35(1):183–5.
Frykberg R. Team approach toward lower extremity amputation prevention in diabetes. J Am Podiatr Med Assoc. 1997;87:5–12.
Shoiaiefard A, Khorgami Z, Larijani B. Independent risk factors for amputation in diabetic foot. Int J Diab Dev Ctries. 2008;28(2):32–7.
Kim P. Biomechanics of the diabetic foot: consideration in limb salvage. Adv Wound Care. 2013;2(3):107–11.
Ulbrecht J, Hurley T, Cavanagh P. Prevention of recurrent foot ulcers with plantar pressure–based in-shoe orthoses. Diabetes Care. 2014;23:465–74.
Brunner J. Does your patient need diabetic therapeutic footwear? (Where benefit, evidence, and bureaucracy collide). Clin Diabetes. 2015;33(2):51–3.
Day MR, Harkless LB. Factors associated with pedal ulceration in patients with diabetes mellitus. J Am Podiatr Med Assoc. 1997;87:365–9.
Young MJ, Breddy JL, Veves A, et al. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. Diabetes Care. 1994;17:557–62.
Fisher K, Armstrong D. Your annual comprehensive foot exam. Diabetes Self-Management. 2015. http://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/your-annual-comprehensive-foot-exam/
Gemechu F, Seemant F, Curley C. Diabetic foot infections. Am Fam Physician. 2013;88(3):177–84.
Alexiado K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;20:1–15.
Game F. Obesity and the diabetic foot. Diabesity Pract. 2013;2(3):112–7.
Wiebe C. Diabetics with sight problems prefer self-exam of feet. Medscape Medical News’. 2014. http://www.medscape.com/viewarticle/831898
The Medicare Therapeutic Shoe Bill. Department of health and human services, medical carriers manual, Section 2134, p2-85.1–2-86. Washington, DC: US Gov’t Printing Office; 1994.
Shavelson D. Foundational wellness biomechanics: 2011. Abstract http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=69768. 21 Sept 2011.
Armstrong D, Lavery L, Nixon B, Boulton A. Techniques for debriding and off-loading the diabetic foot wound. Clinical Inf Dis (Suppl). 2004;39:592–9.
McNeely MJ, Boyko EJ, Ahroni JH, et al. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. Diabetes Care. 1995;18:216–9.
Bakotic B. Epidermal nerve fiber density testing-an overview. Pod Manage. 2010;141–52.
Bril V. Treatments for diabetic neuropathy. J Peripher Nerv Syst. 2012;17(s2):22–7.
Shavelson D. Chapter 8: Local anesthetics and injectable cortisone. In: Delauro T, editor. Clinics in podiatric medicine and surgery. Philadelphia: W.B. Saunders; 1993.
Hounsom L, et al. GLA is effective against multiple indices of experimental diabetic neuropathy. Diabetologia. 1998;41:839–43.
Mayo Clinic Reports. Alpha Lipoic Acid (ALA) improves symptoms of diabetic neuropathy. Diabetes Care. 2003;5:456–59.
Head KA. Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev. 2006:32–37.
Sessions J, Nickerson D. Biologic basis of nerve decompression surgery for focal entrapments in diabetic peripheral neuropathy. J Diabetes Sci Technol. 2014;8(2):412–8.
Malhotra R, Chan C, Nather A. Osteomyelitis in the diabetic foot. Diabet Foot Ankle. 2014;5. doi:10.3402/dfa.v5.24445.
Marcinko DE. Antibiotic-impregnated polymethyl methacrylate beads. In: Habershaw GM, editor. Infections of the foot: diagnosis and management. St Louis: Mosby-Year Book; 1998. p. 174–6.
Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Repair Regen. 1994;2(3):165–70.
Ucciloi L, Izzo V, Meloni M, et al. Non-healing foot ulcers in diabetic patients: general and local interfering conditions and management options with advanced wound dressings. J Wound Care. 2015;24(4 Suppl):343–56.
Motzkau M, Tautenhahn J, Lehnert H, Lobmann R. Expression of matrix-metalloproteases in the fluid of chronic diabetic foot wounds treated with a protease absorbent dressing. Exp Clin Endocrinol Diabetes. 2011;119(5):286–90.
Nain PS, Uppal SK, Garg R, et al. Role of negative pressure wound therapy in healing of diabetic foot ulcers. J Surg Tech Case Rep. 2011;3(1):17–22.
Thomas A, Thayer W. Debridement of chronic wounds: a review of past & present treatment strategies. Todays Wound Clinic. 2014;8(5).
Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer: a randomized study. Diabetes Care. 1996;19:1338–42.
Snyder RJ, Simonson DA. Cadaveric allograft as adjunct therapy for non-healing wounds. J Foot Ankle Surg. 1999;38:93–101.
Einhorn DA. The State of Diabetes Complications in America. The American Association of Clinical Endocrinologists 16th Annual Meeting and Clinical Congress, Seattle; 2007.
Todd WF, Armstrong DG, Liswood PJ. Evaluation and treatment of the infected foot in a community teaching hospital. J Am Podiatr Med Assoc. 1996;86:421–6.
Shavelson D. The unequal limb syndrome: biomechanical considerations. J Am Podiatr Med Assoc. 1983;1:18–23.
Boulton, A. Diabetic foot what can we learn from leprosy? Legacy of Dr Paul W. Brand. Diabetes Metab Res Rev. Supplement 1, pg 3–7.
Falanga V. How to use Apligraf to treat venous ulcers. Skin Aging. 1999;2:30–6.
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Shavelson, D., Steinberg, J., Bakotic, B.W. (2017). The Diabetic Foot. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Cham. https://doi.org/10.1007/978-3-319-18741-9_25
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DOI: https://doi.org/10.1007/978-3-319-18741-9_25
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