, Volume 41, Issue 3, pp 384–397 | Cite as

Diagnostics and treatment of the diabetic foot

  • Jan ApelqvistEmail author


Every 30 s, a lower limb is amputated due to diabetes. Of all amputations in diabetic patients 85% are preceded by a foot ulcer which subsequently deteriorates to a severe infection or gangrene. There is a complexity of factors related to healing of foot ulcers including strategies for treatment of decreased perfusion, oedema, pain, infection, metabolic disturbances, malnutrition, non-weight bearing, wound treatment, foot surgery, and management of intercurrent disease. Patients with diabetic foot ulcer and decreased perfusion do often not have rest pain or claudication and as a consequence non-invasive vascular testing is recommended for early recognition of ulcers in need of revascularisation to achieve healing. A diabetic foot infection is a potentially limb-threatening condition. Infection is diagnosed by the presence or increased rate of signs inflammation. Often these signs are less marked than expected. Imaging studies can diagnose or better define deep, soft tissue purulent collections and are frequently needed to detect pathological findings in bone. The initial antimicrobial treatment as well as duration of treatment is empiric. There is a substantial delay in wound healing in diabetic foot ulcer which has been related to various abnormalities. Several new treatments related to these abnormalities have been explored in wound healing with various successes. An essential part of the strategy to achieve healing is an effective offloading. Many interventions with advanced wound management have failed due to not recognizing the need for effective offloading. A multidisciplinary approach to wounds and foot ulcer has been successfully implemented in different centres with a substantial decrease in amputation rate.


Diabetic foot Foot ulcer Infection Ischemia Treatment Revascularisation 


  1. 1.
    A.J. Boulton, L. Vileikyte, G. Ragnarson-Tennvall, J. Apelqvist, The global burden of diabetic foot disease. Lancet 366(9498), 1719–1724 (2005)PubMedCrossRefGoogle Scholar
  2. 2.
    International Working Group on the Diabetic Foot, International consensus on the diabetic foot and practical guidelines on the management and the prevention of the diabetic foot. Amsterdam, the Netherlands (2011). Available on CD-ROM at or (
  3. 3.
    J. Apelqvist, K. Bakker, W.H. van Houtum, International Working Group on the Diabetic Foot (IWGDF) Editorial Board, Practical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007) prepared by the International Working Group on the Diabetic Foot. Diabetes Metab. Res. Rev. 24(Suppl 1), S181–S187 (2008)PubMedCrossRefGoogle Scholar
  4. 4.
    S. Tesfaye, A.J.M. Boulton, P.J. Dyck, R. Freeman, M. Horowitz, P. Kempler et al., Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33(10), 2285–2293 (2010)PubMedCrossRefGoogle Scholar
  5. 5.
    E.J. Boyko, J.H. Ahtoni, V. Stensel, R.C. Forsberg, D.R. Davignon, D.G. Smith, A prospecticve study for risk factors for diabetic ulcer. The Seattle Diabetic Foot Study. Diabetes Care 22, 1036–1042 (1999)PubMedCrossRefGoogle Scholar
  6. 6.
    C.A. Abbott, A.L. Carrington, H. Ashe, S. Bath, L.C. Every, J. Griffiths et al., The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet. Med. 19, 377–384 (2002)PubMedCrossRefGoogle Scholar
  7. 7.
    N. Singh, D.G. Amstrong, B.A. Lipsky, Preventing foot ulcers in patients with diabetes. JAMA 293, 217–228 (2005)PubMedCrossRefGoogle Scholar
  8. 8.
    E.J. Boyko, J.H. Ahroni, V. Cohen, K.M. Nelson, P.J. Heagerty, Prediction of diabetic ulcer occurrence using commonly available clinical information. The Seattle Diabetic Foot Study. Diabetes Care 29, 1202–1207 (2006)PubMedCrossRefGoogle Scholar
  9. 9.
    A.J. Boulton, The diabetic foot: grand overview, epidemiology and pathogenesis. Diabetes Metab. Res. Rev. 24(Suppl 1), S3–S6 (2008)PubMedCrossRefGoogle Scholar
  10. 10.
    J. Apelqvist, J. Larsson, What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab. Res. Rev. 16(Suppl 1), S75–S83 (2000)PubMedCrossRefGoogle Scholar
  11. 11.
    W. Jeffcoate, F. Game, P. Cavanagh, The role of proinflammatory cytokines in the cause of neuropathic osteoartropathy (acute Charcot foot) in diabetes. Lancet 366, 2058–2061 (2005)PubMedCrossRefGoogle Scholar
  12. 12.
    E. Trepman, A. Nihal, M. Pinzur, Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int. 26, 46–63 (2005)PubMedGoogle Scholar
  13. 13.
    L. Prompers, N. Schaper, J. Apelqvist, M. Edmonds, E. Jude, D. Mauricio et al., Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study. Diabetologia 51(5), 747–755 (2008)PubMedCrossRefGoogle Scholar
  14. 14.
    L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K. Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G. Ragnarson Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Urbancic, K. Van Acker, J. van Baal, F. van Merode, High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia 50, 18–25 (2007)PubMedCrossRefGoogle Scholar
  15. 15.
    L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K. Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G.R. Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Urbancic, K. Van Acker, J. Van Baal, F. Van Merode, N. Schaper, Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale study, a prospective cohort study. Diabet. Med. 25, 700–707 (2008)PubMedCrossRefGoogle Scholar
  16. 16.
    M.A. Gershater, M. Löndahl, P. Nyberg, J. Larsson, J. Thörne, M. Eneroth, J. Apelqvist, Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia 52(3), 398–407 (2009)PubMedCrossRefGoogle Scholar
  17. 17.
    N.C. Schaper, M.H. Nabuurs-Franssen, S.P. Huijberts, Peripheral vascular disease and type 2 diabetes mellitus. Diabetes Metab. Res. Rev. 16(Suppl 1), S11–S15 (2000)PubMedCrossRefGoogle Scholar
  18. 18.
    F.W. LoGerfo, J.D. Coffman, Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care. N. Engl. J. Med. 311, 1615–1619 (1984)PubMedCrossRefGoogle Scholar
  19. 19.
    G. Jörneskog, K. Brismar, B. Fagrell, Pronounced skin capillary ischemia in the feet of diabetic patients with bad metabolic control. Diabetologia 41(4), 410–415 (1998)PubMedCrossRefGoogle Scholar
  20. 20.
    N.C. Schaper, M. Huijberts, K. Pickwell, Neurovascular control and neurogenic inflammation in diabetes. Diabetes Metab. Res. Rev. 24(suppl 1), S40–S44 (2008)PubMedCrossRefGoogle Scholar
  21. 21.
    M.S. Ruiter, J.M. van Golde, N.C. Schaper, C.D. Stehouwer, M.S. Huijberts, Diabetes impairs arteriogenesis in the peripheral circulation: review of molecular mechanisms. Clin. Sci. (Lond.) 119(6), 225–238 (2010)CrossRefGoogle Scholar
  22. 22.
    C. Gazzaruso, A. Coppola, M. Montalcini, E. Baffero, A. Garzaniti, G.G. Pelissero, S. Collaviti, A. Grugnetti, P. Gallotti, A. Pujia, S.B. Solerte, A. Giustina, Lipoprotein(a) and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus. Endocrine 41, 89–95 (2012)PubMedCrossRefGoogle Scholar
  23. 23.
    L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K. Bakker et al., Optimal organization of health care in diabetic foot disease: introduction to the Eurodiale study. Int. J. Low Extrem. Wounds 6(1), 11–17 (2007)PubMedCrossRefGoogle Scholar
  24. 24.
    S. Krishnan, F. Nash, N. Baker, D. Fowler, G. Rayman, Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care 31, 99–101 (2008)PubMedCrossRefGoogle Scholar
  25. 25.
    W.H. van Houtum, J.A. Rauwerda, D. Ruwaard, N.C. Schaper, K. Bakker, Reduction in diabetes-related lower-extremity amputations in the Netherlands: 1991–2000. Diabetes Care 27, 1042–1046 (2004)PubMedCrossRefGoogle Scholar
  26. 26.
    J. Larsson, J. Apelqvist, C.D. Agardh, A. Stenström, Decreasing incidence of major amputation in diabetic patients: a consequence of a multidisciplinary foot care team approach? Diabet. Med. 12, 770–776 (1995)PubMedCrossRefGoogle Scholar
  27. 27.
    K. Aydin, M. Isildak, J. Karakaya, A. Gurlek, Change in amputation predictors in diabetic foot disease: effect of multidisciplinary approach. Endocrine 38, 87–92 (2010)PubMedCrossRefGoogle Scholar
  28. 28.
    M. Luther, I. Kantonen, M. Lepantalo, FINNVASC Study Group, Arterial intervention and reduction in amputation for chronic critical leg ischaemia. Br. J. Surg. 87, 454–458 (2000)PubMedCrossRefGoogle Scholar
  29. 29.
    H. Zayed, M. Halawa, L. Maillardet, P.S. Sidhu, M. Edmonds, H. Rashid, Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach. Int. J. Clin. Pract. 63(6), 855 (2009)PubMedCrossRefGoogle Scholar
  30. 30.
    A.J.M. Boulton, The diabetic foot: from art to science. Diabetologia 47(8), 1343–1353 (2004)PubMedCrossRefGoogle Scholar
  31. 31.
    International Working Group on the Diabetic Foot (IWGDF) Editorial Board, The diabetic foot. Diabetes Metab. Res. Rev. 24(Suppl 1), S1–S193 (2008)Google Scholar
  32. 32.
    P.R. Cavanagh, B.A. Lipsky, A.W. Bradbury, G. Botek, Treatment for diabetic foot ulcers. Lancet 366(9498), 1725–1735 (2005)PubMedCrossRefGoogle Scholar
  33. 33.
    J. Kalish, A. Hamdan, Management of diabetic foot problems. J. Vasc. Surg. 51(2), 476–486 (2010)PubMedCrossRefGoogle Scholar
  34. 34.
    J. Apelqvist, The foot in perspective. Diabetes Metab. Res. Rev. 24(Suppl 1), S110–S115 (2008)PubMedCrossRefGoogle Scholar
  35. 35.
    D. Steed, C. Attinger, T. Colaizzi, M. Crossland, M. Franz, L. Harkless et al., Guidelines for the treatment of diabetic ulcers. Wound Repair Regen. 14, 680–692 (2006)PubMedCrossRefGoogle Scholar
  36. 36.
    S. Vuorisalo, M. Venermo, M. Lepäntalo, Treatment of diabetic foot ulcers. J. Cardiovasc. Surg. 50(3), 275–291 (2009)Google Scholar
  37. 37.
    R. Fontaine, M. Kim, R. Kieny, Surgical treatment of peripheral circulation disorders. Helv. Chir. Acta 21, 499–533 (1954)PubMedGoogle Scholar
  38. 38.
    P.R.F. Bell, D. Charlesworth, R.G. DePalma, H.H.G. Eastcott, B. Eklöf, J.D. Gruss, C.W. Jamieson, P.J. Morris, A.N. Nicolaides, R.B. Rutherford, The definition of critical iscaemia of a limb. Br. J. Surg. 69, 22 (1982)Google Scholar
  39. 39.
    Suggested standards for reports dealing with lower extremity ischemia, Prepared by the Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J. Vasc. Surg. 4(1), 80–94 (1986)Google Scholar
  40. 40.
    Second European consensus document on chronic critical leg ischaemia. Eur. J. Vasc. Surg. 6(suppl A), 1–32 (1992)Google Scholar
  41. 41.
    R.B. Rutherford, J.D. Baker, C. Ernst, K.W. Johnston, J.M. Porter, S. Ahn, D.N. Jones, Recommended standards for reports dealing with lower extremity ischemia: revised version. J. Vasc. Surg. 26(3), 517–538 (1997)PubMedCrossRefGoogle Scholar
  42. 42.
    L. Norgren, W.R. Hiatt, J.A. Dormandy, on behalf of the TASC II Working Group, Inter-society consensus for the management of peripheral arterial disease (TASC II). J. Vasc. Surg. 45(Suppl), S5–S67 (2007)PubMedCrossRefGoogle Scholar
  43. 43.
    Management of peripheral arterial disease (PAD), Transatlantic inter-society consensus (TASC). Eur. J. Vasc. Endovasc. Surg. 19(Suppl A), S1–S250 (2000)Google Scholar
  44. 44.
    N.C. Schaper, Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab. Res. Rev. 20(Suppl 1), 90–95 (2004)CrossRefGoogle Scholar
  45. 45.
    D.G. Armstrong, L.A. Lavery, L.B. Harkless, Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 21(5), 855–859 (1998)PubMedCrossRefGoogle Scholar
  46. 46.
    S. Beckert, M. Witte, C. Wicke et al., A new wound-based severity score for diabetic foot ulcers. Diabetes Care 29(5), 988–992 (2006)PubMedCrossRefGoogle Scholar
  47. 47.
    N.C. Schaper, G. Andros, J. Apelqvist, K. Bakker, J. Lammer, M. Lepantalo, J.L. Mills, J. Reekers, C.P. Shearman, R.E. Zierler, R.J. Hinchliffe, Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes Metab. Res. Rev. 28(Suppl 1), 218–224 (2012)Google Scholar
  48. 48.
    S.R. McGee, E.J. Boyko, Physical examination and chronic lower-extremity ischemia: a critical review. Arch. Intern. Med. 158(12), 1357 (1998)PubMedCrossRefGoogle Scholar
  49. 49.
    N.C. Schaper, G. Andros, J. Apelqvist, K. Bakker, J. Lammer, M. Lepantalo, J.L. Mills, J. Reekers, C.P. Shearman, R.E. Zierler, R.J. Hinchliffe, Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot. Diabetes Metab. Res. Rev. 28(Suppl 1), 236–237 (2012)Google Scholar
  50. 50.
    M. Lundin, J.P. Wiksten, T. Peräkylä, O. Lindfors, H. Savolainen, J. Skyttä et al., Distal pulse palpation: is it reliable? World J. Surg. 23, 252–255 (1999)PubMedCrossRefGoogle Scholar
  51. 51.
    J. Apelqvist, J. Larsson, C.-D. Agardh, The importance of peripheral pulses, peripheral oedema and local pain for the outcome of diabetic foot ulcers. Diabet. Med. 7, 590–594 (1990)PubMedCrossRefGoogle Scholar
  52. 52.
    G. Andros, R.W. Harris, L.B. Dulawa, R.W. Oblath, S.X. Salles-Cunha, The need for arteriography in diabetic patients with gangrene and palpable foot pulses. Arch. Surg. 119(11), 1260–1263 (1984)PubMedCrossRefGoogle Scholar
  53. 53.
    E.J. Boyko, J.H. Ahroni, D. Davignon, V. Stensel, R.L. Prigeon, D.G. Smith, Diagnostic utility of the history and physical examination for peripheral vascular disease among patients with diabetes mellitus. J. Clin. Epidemiol. 50(6), 659–668 (1997)PubMedCrossRefGoogle Scholar
  54. 54.
    A.M. O’Hare, R. Katz, M.G. Shilipak, M. Cushman, A.B. Newman, Mortality and cardiovascular risk across ankle-arm index spectrum: results from the Cardiovascular Health Study. Circulation 113, 388–393 (2006)PubMedCrossRefGoogle Scholar
  55. 55.
    V. Aboyans, E. Ho, J.O. Denenberg, L.A. Ho, L. Natarajan, M.H. Criqui, The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects. J. Vasc. Surg. 48, 1197–1203 (2008)PubMedCrossRefGoogle Scholar
  56. 56.
    J. Apelqvist, J. Castenfors, J. Larsson, A. Stenstrom, C.D. Agardh, Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer. Diabetes Care 12, 373–378 (1989)PubMedCrossRefGoogle Scholar
  57. 57.
    P. Holstein, The distal blood pressure predicts healing of amputations on the feet. Acta Orthop. Scand. 55, 227–233 (1984)PubMedCrossRefGoogle Scholar
  58. 58.
    J.L. Ballard, C.C. Eke, T.J. Bunt, J.D. Killeen, A prospective evaluation of transcutaneous oxygen measurements in the management of diabetic foot problems. J. Vasc. Surg. 22, 485–490 (1995)PubMedCrossRefGoogle Scholar
  59. 59.
    E. Faglia, G. Clerici, M. Caminiti, A. Quarantiello, V. Curci, A. Morabito, Predictive values of transcutaneous oxygen tension for above-the-ankle amputation in diabetic patients with critical limb ischemia. Eur. J. Vasc. Endovasc. Surg. 33, 731–736 (2007)PubMedCrossRefGoogle Scholar
  60. 60.
    E. Lukkari-Rautiarinen, M. Lepäntalo, J. Pietilä, Reproducibility of skin blood flow, perfusion pressure and oxygen tension measurements in advanced lower limb ischaemia. Eur. J. Vasc. Surg. 3, 345–350 (1989)PubMedCrossRefGoogle Scholar
  61. 61.
    M.S. Pinzur, R. Stuck, R. Sage, H. Osterman, Transcutaneous oxygen tension in the dysvascular foot with infection. Foot Ankle 14, 254–256 (1993)PubMedGoogle Scholar
  62. 62.
    E.J. Boyko, J.H. Ahroni, V.L. Stensel, D.G. Smith, D.R. Davignon, R.E. Pecoraro, Predictors of transcutaneous oxygen tension in the lower limbs of diabetic subjects. Diabet. Med. 13, 549–554 (1996)PubMedCrossRefGoogle Scholar
  63. 63.
    W.B. Kannel, D.L. McGee, Update on some epidemiologic features of intermittent claudication: the Framingham Study. J. Am. Geriatr. Soc. 33(1), 13–18 (1985)PubMedGoogle Scholar
  64. 64.
    W.A. Marston, S.W. Davies, B. Armstrong, M.A. Farber, R.C. Mendes, J.J. Fulton et al., Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization. J. Vasc. Surg. 44(1), 108–114 (2006)PubMedCrossRefGoogle Scholar
  65. 65.
    A. Karthikesalingam, P.J. Holt, P. Moxey, K.G. Jones, M.M. Thompson, R.J. Hinchliffe, A systematic review of scoring systems for diabetic foot ulcers. Diabet. Med. 27(5), 544–549 (2010)PubMedCrossRefGoogle Scholar
  66. 66.
    J.K. Raines, R.C. Darling, J. Buth, D.C. Brewster, W.G. Austen, Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities. Surgery 79, 21–29 (1976)PubMedGoogle Scholar
  67. 67.
    R. Takolander, J.A. Rauwerda, The use of noninvasive vascular assessment in diabetic patients with foot lesions. Diabet. Med. 13(suppl 1), S39–S42 (1995)Google Scholar
  68. 68.
    G.L. Moneta, R.A. Yeager, R.W. Lee, J.M. Porter, Noninvasive localization of arterial occlusive disease: a comparison of segmental Doppler pressures and arterial duplex mapping. J. Vasc. Surg. 17, 578–582 (1993)PubMedCrossRefGoogle Scholar
  69. 69.
    F.T. Padberg, T.L. Back, P.N. Thompson, R.W. Hobson II, Transcutaneous oxygen (TcPO2) estimates probability of healing in the ischemic extremity. J. Surg. Res. 60, 365–369 (1996)PubMedCrossRefGoogle Scholar
  70. 70.
    L. Graziani, A. Silvestro, V. Bertone, E. Manara, R. Andreini, A. Sigala, R. Mingardi, R. De Giglio, Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur. J. Vasc. Endovasc. Surg. 33(4), 453–460 (2007)PubMedCrossRefGoogle Scholar
  71. 71.
    K.A. Arsenault, J. McDonald, P.J. Devereaux, K. Thorlund, J.G. Tittley, R.P. Whitlock, The use of transcutaneous oximetry to predict complications of chronic wound healing: a systematic review and meta-analysis. Wound Repair Regen. 19, 657–663 (2011)PubMedCrossRefGoogle Scholar
  72. 72.
    J.L. Mills Sr, Open bypass and endoluminal therapy: complementary techniques for revascularization in diabetic patients with critical limb ischaemia. Diabetes Metab. Res. Rev. 24(Suppl 1), S34–S39 (2008)PubMedCrossRefGoogle Scholar
  73. 73.
    F. Pomposelli, Arterial imaging in patients with lower extremity ischemia and diabetes mellitus. J. Vasc. Surg. 52(3 Suppl), 81S–91S (2010)PubMedCrossRefGoogle Scholar
  74. 74.
    R. Collins, J. Burch, G. Cranny, R. Aguiar-Ibáñez, D. Craig, K. Wright, E. Berry, M. Gough, J. Kleijnen, M. Westwood, Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review. BMJ 334(7606), 1257 (2007)PubMedCrossRefGoogle Scholar
  75. 75.
    R. Met, S. Bipat, D.A. Legemate, J.A. Reekers, M.J. Koelemay, Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA 301, 415–424 (2009)PubMedCrossRefGoogle Scholar
  76. 76.
    M.H. Heijenbrok-Kal, M.C. Kock, M.G. Hunink, Lower extremity arterial disease: multidetector CT angiography meta-analysis. Radiology 245, 433–439 (2007)PubMedCrossRefGoogle Scholar
  77. 77.
    D.J. Dinter, K.W. Neff, G. Visciani, R. Lachmann, C. Weiss, S.O. Schoenberg, H.J. Michaely, Peripheral bolus-chase MR angiography: analysis of risk factors for nondiagnostic image quality of the calf vessels—a combined retrospective and prospective study. AJR Am. J. Roentgenol. 193, 234–240 (2009)PubMedCrossRefGoogle Scholar
  78. 78.
    G. Andreisek, T. Pfammatter, K. Goepfert, D. Nanz, P. Hervo, R. Koppensteiner, D. Weishaupt, Peripheral arteries in diabetic patients: standard bolus-chase and time-resolved MR angiography. Radiology 242, 610–620 (2007)PubMedCrossRefGoogle Scholar
  79. 79.
    N. Diehm, A. Shang, A. Silvestro, D.D. Do, F. Dick, J. Schmidli, F. Mahler, I. Baumgartner, Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty. Eur. J. Vasc. Endovasc. Surg. 31(1), 59–63 (2006)PubMedCrossRefGoogle Scholar
  80. 80.
    A. Ndip, L. Lavery, A.J.M. Boulton, Diabetic foot disease in people with advanced nephropathy and those on renal dialysis. Curr. Diabetes Rep. 10, 283–290 (2010)CrossRefGoogle Scholar
  81. 81.
    M. Heikkinen, M. Salmenperä, A. Lepäntalo, M. Lepäntalo, Diabetes care for patients with peripheral arterial disease. Eur. J. Vasc. Endovasc. Surg. 33, 583–591 (2007)PubMedCrossRefGoogle Scholar
  82. 82.
    M.R. Prince, H. Zhang, M. Morris, J.L. MacGregor, M.E. Grossman, J. Silberzweig, R.L. DeLapaz, H.J. Lee, C.M. Magro, A.M. Valeri, Incidence of nephrogenic systemic fibrosis at two large medical centers. Radiology 248(3), 807–816 (2008)PubMedCrossRefGoogle Scholar
  83. 83.
    C. Rydahl, H.S. Thomsen, P. Marckmann, High prevalence of nephrogenic systemic fibrosis in chronic renal failure patients exposed to gadodiamide, a gadolinium-containing magnetic resonance contrast agent. Invest. Radiol. 43(2), 141–144 (2008)PubMedCrossRefGoogle Scholar
  84. 84.
    R. Wertman, E. Altun, D.R. Martin, D.G. Mitchell, J.R. Leyendecker, R.B. O’Malley, D.J. Parsons, E.R. Fuller 3rd, R.C. Semelka, Risk of nephrogenic systemic fibrosis: evaluation of gadolinium chelate contrast agents at four American universities. Radiology 248(3), 799–806 (2008)PubMedCrossRefGoogle Scholar
  85. 85.
    J. Apelqvist, T. Elgzyri, J. Larsson, M. Löndahl, P. Nyberg, J. Thörne, Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. J. Vasc. Surg. 53(6), 1582–1588 (2011)PubMedCrossRefGoogle Scholar
  86. 86.
    E. Faglia, G. Clerici, J. Clerissi, L. Gabrielli, S. Losa, M. Mantero, M. Caminiti, V. Curci, A. Quarantiello, T. Lupattelli, A. Morabito, Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care 32(5), 822–827 (2009)PubMedCrossRefGoogle Scholar
  87. 87.
    L. Uccioli, R. Gandini, L. Giurato, S. Fabiano, E. Pampana, V. Spallone, E. Vainieri, G. Simonetti, Long-term outcomes of diabetic patients with critical limb ischaemia followed in a tertiary referral diabetic foot clinic. Diabetes Care 33(5), 977–982 (2010)PubMedCrossRefGoogle Scholar
  88. 88.
    Hinchliffe et al., A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab. Res. Rev. 28(Suppl 1), 179–217 (2012)Google Scholar
  89. 89.
    E. Faglia, G. Clerici, J. Clerissi, M. Mantero, M. Caminiti, A. Quarantiello et al., When is a technically successful peripheral angioplasty effective in preventing above-the-ankle amputation in diabetic patients with critical limb ischaemia? Diabet. Med. 24, 823–829 (2007)PubMedCrossRefGoogle Scholar
  90. 90.
    F. Sigala, Ch. Menenakos, P. Sigalas, Ch. Baunach, S. Langer, E. Papalambros et al., Transluminal angioplasty of isolated crural arterial lesions in diabetics with critical limb ischemia. VASA 34, 186–191 (2005)PubMedCrossRefGoogle Scholar
  91. 91.
    T. Zeller, S. Sixt, A. Rastan, New techniques for endovascular treatment of peripheral artery disease with focus on chronic critical limb ischemia. VASA 38, 3–12 (2009)PubMedCrossRefGoogle Scholar
  92. 92.
    H.H. Dosluoglu, G.S. Cherr, P. Lall, L.M. Harris, M.L. Dryjski, Peroneal artery-only runoff following endovascular revascularizations is effective for limb salvage in patients with tissue loss. J. Vasc. Surg. 48, 137–143 (2008)PubMedCrossRefGoogle Scholar
  93. 93.
    E. Faglia, L. Dalla Paola, G. Clerici, J. Clerissi, L. Graziani, M. Fusaro, L. Gabrielli, S. Losa, A. Stella, M. Gargiulo, M. Mantero, M. Caminiti, S. Ninkovic, V. Curci, A. Morabito, Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur. J. Vasc. Endovasc. Surg. 29(6), 620–627 (2005)PubMedCrossRefGoogle Scholar
  94. 94.
    L. Graziani, A. Piaggesi, Indications and clinical outcomes for below knee endovascular therapy: review article. Catheter. Cardiovasc. Interv. 75(3), 433–443 (2010)PubMedGoogle Scholar
  95. 95.
    M. Manzi, M. Fusaro, T. Ceccacci, G. Erente, L. Dalla Paola, E. Brocco, Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J. Cardiovasc. Surg. 50(3), 331–337 (2009)Google Scholar
  96. 96.
    D.M. Ihnat, J.L. Mills Sr, Current assessment of endovascular therapy for infrainguinal arterial occlusive disease in patients with diabetes. J. Vasc. Surg. 52(Suppl 3), 92S–95S (2010)PubMedCrossRefGoogle Scholar
  97. 97.
    V.A. Alexandrescu, G. Hubermont, Y. Philips, B. Guillaumie, C. Ngongang, P. Vandenbossche, K. Azdad, G. Ledent, J. Horion, Selective primary angioplasty following an angiosome model of reperfusion in the treatment of Wagner 1–4 diabetic foot lesions: practice in a multidisciplinary diabetic limb service. J. Endovasc. Ther. 15(5), 580–593 (2008)PubMedCrossRefGoogle Scholar
  98. 98.
    C. Setacci, G. De Donato, F. Setacci, E. Chisci, Ischemic foot: definition, etiology and angiosome concept. J. Cardiovasc. Surg. 51(2), 223–231 (2010)Google Scholar
  99. 99.
    R.F. Neville, C.E. Attinger, E.J. Bulan, I. Ducic, M. Thomassen, A.N. Sidawy, Revascularization of a specific angiosome for limb salvage: does the target artery matter? Ann. Vasc. Surg. 23(3), 367–373 (2009)PubMedCrossRefGoogle Scholar
  100. 100.
    C.E. Attinger, K.K. Evans, E. Bulan, P. Blume, P. Cooper, Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast. Reconstr. Surg. 117(7 Suppl), 261S–293S (2006)PubMedCrossRefGoogle Scholar
  101. 101.
    M.I. Söderström, E.M. Arvela, M. Korhonen, K.H. Halmesmäki, A.N. Albäck, F. Biancari, M.J. Lepäntalo, M.A. Venermo, Infrapopliteal percutaneous transluminal angioplasty versus bypass surgery as first-line strategies in critical leg ischemia: a propensity score analysis. Ann. Surg. 252(5), 765–773 (2010)PubMedCrossRefGoogle Scholar
  102. 102.
    R. Met, K.P. Van Lienden, M.J. Koelemay, S. Bipat, D.A. Legemate, J.A. Reekers, Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review. Cardiovasc. Interv. Radiol. 31, 687–697 (2008)CrossRefGoogle Scholar
  103. 103.
    F.B. Pomposelli, N. Kansal, A.D. Hamdan, A. Belfield, M. Sheahan, D.R. Campbell, J.J. Skillman, F.W. Logerfo, A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases. J. Vasc. Surg. 37, 307–315 (2003)PubMedCrossRefGoogle Scholar
  104. 104.
    M. Kalani, J. Apelqvist, M. Blombäck, K. Brismar, B. Eliasson, J.W. Eriksson et al., Effect of dalteparin on the healing of chronic foot ulcers in diabetic patients with peripheral arterial occlusive disease: a prospective, randomized, double-blind, placebo-controlled study. Diabetes Care 26(9), 2575–2580 (2003)PubMedCrossRefGoogle Scholar
  105. 105.
    M. Rullan, L. Cerda, G. Frontera, L. Masmiquel, J. Llobera, Treatment oc chronic diabetic foot ulcers with bemiparin a randomized, triple-blind, placebo controlled, clinical trial. Diabet. Med. 25(9), 1090–1095 (2008). Erratum in: Diabet. Med. 25(10), 1257 (2008)Google Scholar
  106. 106.
    M. Weck, H. Rietzsch, H. Lawall, U. Pichlmeier, P. Bramlage, S. Schellong, Intermittent intravenous urokinase for critical limb ischemia in diabetic foot ulceration. Thromb. Haemost. 100(3), 475–482 (2008)PubMedGoogle Scholar
  107. 107.
    R.J. Hinchliffe, G.D. Valk, J. Apelqvist, D.G. Armstrong, K. Bakker, F.L. Game et al., A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab. Res. Rev. 24(Suppl 1), S119–S144 (2008)PubMedCrossRefGoogle Scholar
  108. 108.
    Game et al., A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab. Res. Rev. 28(Suppl 1), 119–141 (2012)Google Scholar
  109. 109.
    M. Eneroth, J. Larsson, J. Apelqvist, Foot infections in diabetes mellitus—entity with different characteristics, treatment and prognosis. J. Diabetes Complicat. 13(5–6), 254–263 (1999)PubMedCrossRefGoogle Scholar
  110. 110.
    M. Eneroth, J. Apelqvist, Clinical characteristics and outcome in diabetic patients with deep foot infections. Foot Ankle 18, 716–722 (1997)PubMedGoogle Scholar
  111. 111.
    B.A. Lipsky, A.R. Berendt, J. Embil, F. de Lalla, Diagnosing and treating diabetic foot infections. Diabetes Metab. Res. Rev. 20(Suppl 1), S56–S64 (2004)PubMedCrossRefGoogle Scholar
  112. 112.
    L.A. Lavery, D. Armstrong, R. Wunderlich, M. Mohler, C. Wendel, B. Lipsky, Risk factors for foot infections in individuals with diabetes. Diabetes Care 29, 1288–1293 (2006)PubMedCrossRefGoogle Scholar
  113. 113.
    B.A. Lipsky, Y.P. Tabak, R.S. Johannes et al., Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost. Diabetologia 53, 914–923 (2010)PubMedCrossRefGoogle Scholar
  114. 114.
    A.R. Berendt, E.J. Peters, K. Bakker, J.M. Embil, M. Eneroth, R.J. Hinchliffe, W.J. Jeffcoate, B.A. Lipsky, E. Senneville, J. Teh, G.D. Valk, Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab. Res. Rev. 24(Suppl 1), S145–S161 (2008)PubMedCrossRefGoogle Scholar
  115. 115.
    S. Butalia, V.A. Palda, R.J. Sargeant, A.S. Detsky, O. Mourad, Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 299, 806–813 (2008)PubMedCrossRefGoogle Scholar
  116. 116.
    National Institute for Health and Clinical Excellence, Diabetic foot—inpatient management of people with diabetic foot ulcers and infection (2011), 6/4/2011
  117. 117.
    G. Pellizer, M. Strazzabosco et al., Deep tissue biopsy vs superficial swap culture monitoring in the microbiological assessment of limb-threatening diabetic foot infection. Diabet. Med. 18, 822–827 (2001)CrossRefGoogle Scholar
  118. 118.
    D.R. Graham, C. Lucasti, O. Malafaia, R.L. Nichols, P. Holtom, N.Q. Perez, A. McAdams, G.L. Woods, T.P. Ceesay, R. Gesser, Ertapenem once daily versus piperacillin-tazobactam 4 times per day for treatment of complicated skin and skin-structure infections in adults: results of a prospective, randomized, double-blind multicenter study. Clin. Infect. Dis. 34(11), 1460–1468 (2002)PubMedCrossRefGoogle Scholar
  119. 119.
    N. Saltoglu, A. Dalkiran, T. Tetiker, H. Bayram, Y. Tasova, C. Dalay, M. Sert, Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital. Clin. Microbiol. Infect. 16(8), 1252–1257 (2010)PubMedCrossRefGoogle Scholar
  120. 120.
    D.R. Graham, D.A. Talan, R.L. Nichols, C. Lucasti, M. Corrado, N. Morgan, C.L. Fowler, Once-daily, high-dose levofloxacin versus ticarcillin-clavulanate alone or followed by amoxicillin-clavulanate for complicated skin and skin-structure infections: a randomized, open-label trial. Clin. Infect. Dis. 35(4), 381–389 (2002)PubMedCrossRefGoogle Scholar
  121. 121.
    B.A. Lipsky, K.J. Holroyd, M. Zasloff, Topical versus systemic antimicrobial therapy for treating mildly infected diabetic foot ulcers: a randomized, controlled, double-blinded, multicenter trial of pexiganan cream. Clin. Infect. Dis. 47(12), 1537–1545 (2008)PubMedCrossRefGoogle Scholar
  122. 122.
    J.S. Tan, N.M. Friedman, C. Hazelton-Miller, J.P. Flanagan, T.M. File Jr, Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation? Clin. Infect. Dis. 23(2), 286–291 (1996)PubMedCrossRefGoogle Scholar
  123. 123.
    A.D. Tice, R.S. Turpin, C.T. Hoey, B.A. Lipsky, J. Wu, M.A. Abramson, Comparative costs of ertapenem and piperacillin-tazobactam in the treatment of diabetic foot infections. Am. J. Health Syst. Pharm. 64(10), 1080–1086 (2007)PubMedGoogle Scholar
  124. 124.
    B.A. Lipsky, D.G. Armstrong, D.M. Citron, A.D. Tice, D.E. Morgenstern, M.A. Abramson, Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial. Lancet 366(9498), 1695–1703 (2005)PubMedCrossRefGoogle Scholar
  125. 125.
    P.G. Clay, M.R. Graham, C.C. Lindsey, K.C. Lamp, C. Freeman, A. Glaros, Clinical efficacy, tolerability, and cost savings associated with the use of open-label metronidazole plus ceftriaxone once daily compared with ticarcillin/clavulanate every 6 hours as empiric treatment for diabetic lower-extremity infections in older males. Am. J. Geriatr. Pharmacother. 2(3), 181–189 (2004)PubMedCrossRefGoogle Scholar
  126. 126.
    R. Lobmann, A. Ambrosch, M. Seewald, M. Dietlein, K. Zink, K.H. Kullmann, H. Lehnert, Antibiotic therapy for diabetic foot infections: comparison of cephalosporines with chinolones. Diabetes Nutr. Metab. 17(3), 156–162 (2004)PubMedGoogle Scholar
  127. 127.
    R.W. Bradsher Jr, R.M. Snow, Ceftriaxone treatment of skin and soft tissue infections in a once daily regimen. Am. J. Med. 77(4), 63–67 (1984)PubMedGoogle Scholar
  128. 128.
    B.A. Lipsky, U. Stoutenburgh, Daptomycin for treating infected diabetic foot ulcers: evidence from a randomized, controlled trial comparing daptomycin with vancomycin or semi-synthetic penicillins for complicated skin and skin-structure infections. J. Antimicrob. Chemother. 55(2), 240–245 (2005)PubMedCrossRefGoogle Scholar
  129. 129.
    G. Siami, N. Christou, I. Eiseman, K.J. Tack, Clinafloxacin versus piperacillintazobactam in treatment of patients with severe skin and soft tissue infections. Antimicrob. Agents Chemother. 45(2), 525–531 (2001)PubMedCrossRefGoogle Scholar
  130. 130.
    L. Harkless, J. Boghossian, R. Pollak, W. Caputo, A. Dana, S. Gray, D. Wu, An open-label, randomized study comparing efficacy and safety of intravenous piperacillin/tazobactam and ampicillin/sulbactam for infected diabetic foot ulcers. Surg. Infect. (Larchmt.) 6(1), 27–40 (2005)CrossRefGoogle Scholar
  131. 131.
    G.J. Noel, K. Bush, P. Bagchi, J. Ianus, R.S. Strauss, A randomized, double-blind trial comparing ceftobiprole medocaril with vancomycin plus ceftazidime for the treatment of patients with complicated skin and skin-structure infections. Clin. Infect. Dis. 46(5), 647–655 (2008)PubMedCrossRefGoogle Scholar
  132. 132.
    R. Vick-Fragoso, G. Hernández-Oliva, J. Cruz-Alcázar, C.F. Amábile-Cuevas, P. Arvis, P. Reimnitz, J.R. Bogner, STIC Study Group, Efficacy and safety of sequential intravenous/oral moxifloxacin vs intravenous/oral amoxicillin/clavulanate for complicated skin and skin structure infections. Infection 37(5), 407–417 (2009)PubMedCrossRefGoogle Scholar
  133. 133.
    B.L. Erstad, J. McIntyre, Prospective, randomized comparison of ampicillin/sulbactam and cefoxitin for diabetic foot infections. Vasc. Surg. 31(4), 419–426 (1997)Google Scholar
  134. 134.
    B.A. Lipsky, P.D. Baker, G.C. Landon, R. Fernau, Antibiotic therapy for diabetic foot infections: comparison of two parenteral-to-oral regimens. Clin. Infect. Dis. 24(4), 643–648 (1997)PubMedCrossRefGoogle Scholar
  135. 135.
    B.A. Lipsky, K. Itani, C. Norden, Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillinsulbactam/amoxicillin-clavulanate. Clin. Infect. Dis. 38(1), 17–24 (2004)PubMedCrossRefGoogle Scholar
  136. 136.
    B.A. Lipsky, P. Giordano, S. Choudhri, J. Song, Treating diabetic foot infections with sequential intravenous to oral moxifloxacin compared with piperacillintazobactam/amoxicillin-clavulanate. J. Antimicrob. Chemother. 60(2), 370–376 (2007)PubMedCrossRefGoogle Scholar
  137. 137.
    M.L. Grayson, G.W. Gibbons, G.M. Habershaw, D.V. Freeman, F.B. Pomposelli, B.I. Rosenblum, E. Levin, A.W. Karchmer, Use of ampicillin/sulbactam versus imipenem/cilastatin in the treatment of limb-threatening foot infections in diabetic patients. Clin. Infect. Dis. 18(5), 683–693 (1994)PubMedCrossRefGoogle Scholar
  138. 138.
    Dutch Cochrane Centre (2011), 8/4/2011
  139. 139.
    A. Yönem, B. Cakir, S. Guler, O.O. Azal, A. Corakci, Effects of granulocyte-colony stimulating factor in the treatment of diabetic foot infection. Diabetes Obes. Metab. 3(5), 332–337 (2001)PubMedCrossRefGoogle Scholar
  140. 140.
    F. de Lalla, G. Pellizzer, M. Strazzabosco, Z. Martini, J.G. Du, L. Lora, P. Fabris, P. Benedetti, G. Erle, Randomized prospective controlled trial of recombinant granulocyte colony-stimulating factor as adjunctive therapy for limbthreatening diabetic foot infection. Antimicrob. Agents Chemother. 45(4), 1094–1098 (2001)PubMedCrossRefGoogle Scholar
  141. 141.
    T. Kästenbauer, B. Hornlein, G. Sokol, K. Irsigler, Evaluation of granulocytecolony stimulating factor (Filgrastim) in infected diabetic foot ulcers. Diabetologia 46(1), 27–30 (2003)PubMedGoogle Scholar
  142. 142.
    A. Gough, M. Clapperton, N. Rolando, A.V. Foster, J. Philpott-Howard, M.E. Edmonds, Randomised placebo-controlled trial of granulocyte-colony stimulating factor in diabetic foot infection. Lancet 350(9081), 855–859 (1997)PubMedCrossRefGoogle Scholar
  143. 143.
    M. Cruciani, B.A. Lipsky, C. Mengoli, F. de Lalla, Granulocyte-colony stimulating factors as adjunctive therapy for diabetic foot infections. Cochrane Database Syst. Rev. 8(3), CD006810 (2009)Google Scholar
  144. 144.
    E. Faglia, G. Clerici, M. Caminiti, A. Quarantiello, M. Gino, A. Morabito, The role of early surgical debridement and revascularization in patients with diabetes and deep foot space abscess: retrospective review of 106 patients with diabetes. J. Foot Ankle Surg. 45(4), 220–226 (2006)PubMedCrossRefGoogle Scholar
  145. 145.
    E. Senneville, A. Lombart, E. Beltrand, M. Valette, L. Legout, M. Cazaubiel, Y. Yazdanpanah, P. Fontaine, Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study. Diabetes Care 31(4), 637–642 (2008)PubMedCrossRefGoogle Scholar
  146. 146.
    K.Z. Vardakas, M. Horianopoulou, M.E. Falagas, Factors associated with treatment failure in patients diabetic foot infections: an analysis of data from randomised controlled trials. Diabetes Res. Clin. Pract. 80, 344–351 (2008)PubMedCrossRefGoogle Scholar
  147. 147.
    M.G. Sheahan, A.D. Hamdan, J.R. Veraldi, C.S. McArthur, J.J. Skillman, D.R. Campbell et al., Lower extremity minor amputations: the roles of diabetes mellitus and timing of revascularization. J. Vasc. Surg. 42, 476–480 (2005)PubMedCrossRefGoogle Scholar
  148. 148.
    P.A. Stone, M.R. Back, P.A. Armstrong, S.K. Flaherty, W.B. Keeling, B.L. Johnson, M.L. Shames, D.F. Bandyk, Midfoot amputations expand limb salvage rates for diabetic foot infections. Ann. Vasc. Surg. 19(6), 805–811 (2005)PubMedCrossRefGoogle Scholar
  149. 149.
    W.J. Jeffcoate, S.Y. Chipchase, P. Ince, F.L. Game, Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care 29, 1784–1787 (2006)PubMedCrossRefGoogle Scholar
  150. 150.
    M.J. Young, J.E. McCardle, L.E. Randall, J.I. Barclay, Improved survival of diabetic foot ulcer patients 1995–2008: possible impact of aggressive cardiovascular risk management. Diabetes Care 31, 2143–2147 (2008)PubMedCrossRefGoogle Scholar
  151. 151.
    J. Edwards, S. Stapley, Debridement of diabetic foot ulcers. Cochrane Database Syst. Rev. (1), CD003556 (2010). doi: 10.1002/14651858
  152. 152.
    F. Game, The advantages and disadvantages of non-surgical management of the diabetic foot. Diabetes Metab. Res. Rev. 24(Suppl 1), S72–S75 (2008)PubMedCrossRefGoogle Scholar
  153. 153.
    R. Sibbald, K. Woo, The biology of chronic foot ulcers in persons with diabetes. Diabetes Metab. Res. Rev. 24(Suppl 1), S25–S30 (2008)CrossRefGoogle Scholar
  154. 154.
    S.M. Bergin, P. Wraight, Silver based wound dressings and topical agents for treating diabetic foot ulcers. Cochrane Database Syst. Rev. (1), CD005082 (2006)Google Scholar
  155. 155.
    D.G. Armstrong, Diabetic Foot Study Consortium, Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 366, 1704–1710 (2005)PubMedCrossRefGoogle Scholar
  156. 156.
    M.T. Eginton, K.R. Brown, G.R. Seabrook, J.B. Towne, R.A. Cambria, A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds. Ann. Vasc. Surg. 17, 645–649 (2003)PubMedCrossRefGoogle Scholar
  157. 157.
    A. Etöz, Y. Özgenel, M. Özcan, The use of negative pressure wound therapy on diabetic foot ulcers: a preliminary controlled trial. Wounds 16, 264–269 (2004)Google Scholar
  158. 158.
    S.K. McCallon, C.A. Knight, J.P. Valiulus, M.W. Cunningham, J.M. McCulloch, L.P. Farinas, Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage. 46, 28–34 (2000)PubMedGoogle Scholar
  159. 159.
    P.A. Blume, J. Walters, W. Payne, J. Ayala, J. Lantis, Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers. Diabetes Care 31, 631–636 (2008)PubMedCrossRefGoogle Scholar
  160. 160.
    P. Vikatmaa, V. Juutilainen, P. Kuukasjärvi, A. Malmivaara, Negative pressure wound therapy: a systematic review on effectiveness and safety. Eur. J. Vasc. Endovasc. Surg. 36, 438–448 (2008)PubMedCrossRefGoogle Scholar
  161. 161.
    E. Faglia, F. Favales, A. Aldeghi, P. Calia, A. Quarantiello, G. Oriani et al., Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study. Diabetes Care 19, 1338–1343 (1996)PubMedCrossRefGoogle Scholar
  162. 162.
    A. Abidia, G. Laden, G. Kuhan, B.F. Johnson, A.R. Wilkinson, P.M. Renwick et al., The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomised-controlled trial. Eur. J. Vasc. Endovasc. Surg. 25, 513–518 (2003)PubMedCrossRefGoogle Scholar
  163. 163.
    N. Doctor, S. Pandya, A. Supe, Hyperbaric oxygen therapy in diabetic foot. J. Postgrad. Med. 38, 112–114 (1992)PubMedGoogle Scholar
  164. 164.
    G. Baroni, T. Porro, E. Faglia, G. Pizzi, A. Mastropasqua, G. Oriani et al., Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care 10, 81–86 (1987)PubMedCrossRefGoogle Scholar
  165. 165.
    W.A. Zamboni, H.P. Wong, L.L. Stephenson, M.A. Pfeifer, Evaluation of hyperbaric oxygen for diabetic wounds: a prospective study. Undersea Hyperb. Med. 24, 175–179 (1997)PubMedGoogle Scholar
  166. 166.
    M. Kalani, G. Jörneskog, N. Naderi, F. Lind, K. Brismar, Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up. J. Diabetes Complicat. 16, 153–158 (2002)PubMedCrossRefGoogle Scholar
  167. 167.
    M. Löndahl, P. Katzman, A. Nilsson, C. Hammarlund, Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care 33, 998–1003 (2010)PubMedCrossRefGoogle Scholar
  168. 168.
    T. Tan, E.J. Shaw, F. Siddiqui, P. Kandaswamy, P.W. Barry, Guideline Development Group, Inpatient management of diabetic foot problems: summary of NICE guidance. BMJ 342, 702–703 (2011)CrossRefGoogle Scholar
  169. 169.
    R. van Deursen, Footwear for the neuropathic patient: offloading and stability. Diabetes Metab. Res. Rev. 24(Suppl 1), S96–S100 (2008)PubMedCrossRefGoogle Scholar
  170. 170.
    S.A. Bus, G.D. Valk, R.W. van Deursen, D.G. Armstrong, C. Caravaggi, P. Hlavácek et al., The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab. Res. Rev. 24(Suppl 1), S162–S180 (2008)PubMedCrossRefGoogle Scholar
  171. 171.
    P.R. Cavanagh, S.A. Bus, Off-loading the diabetic foot for ulcer prevention and healing. J. Vasc. Surg. 52(3 Suppl), 37S–43S (2010)PubMedCrossRefGoogle Scholar
  172. 172.
    T.M. Owings, J. Apelqvist, A. Stenström, M. Becker, S. Bus, A. Kalpen, J.S. Ulbrecht, P. Cavanagh, Plantar pressures in diabetic foot ulcer patients who have remained healed. Diabet. Med. 26(11), 1141–1146 (2009)PubMedCrossRefGoogle Scholar
  173. 173.
    I.A. Katz, A. Harlan, B. Miranda-Palma, L. Prieto-Sanchez, D.G. Armstrong, J.H. Bowker et al., A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care 28, 555–559 (2005)PubMedCrossRefGoogle Scholar
  174. 174.
    D.G. Armstrong, L.A. Lavery, S. Wu, A.J. Boulton, Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care 28, 551–554 (2005)PubMedCrossRefGoogle Scholar
  175. 175.
    P.A. Blume, L.K. Paragas, B.E. Sumpio, C.E. Attinger, Single-stage surgical treatment of noninfected diabetic foot ulcers. Plast. Reconstr. Surg. 109, 601–609 (2002)PubMedCrossRefGoogle Scholar
  176. 176.
    C.E. Attinger, I. Ducic, P. Cooper, C.M. Zelen, The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients. Plast. Reconstr. Surg. 110, 1047–1054 (2002)PubMedCrossRefGoogle Scholar
  177. 177.
    A. Piaggesi, E. Schipani, F. Campi, M. Romanelli, F. Baccetti, C. Arvia et al., Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial. Diabet. Med. 15, 412–417 (1998)PubMedCrossRefGoogle Scholar
  178. 178.
    E.J. Fitzgerald O’Connor, M. Vesely, P.J. Holt, K.G. Jones, M.M. Thompson, R.J. Hinchliffe, A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes. Eur. J. Vasc. Endovasc. Surg. 41(3), 391–399 (2011)PubMedCrossRefGoogle Scholar
  179. 179.
    E. Tukiainen, M. Kallio, M. Lepantalo, Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork: long-term outcome. Ann. Surg. 244, 949–957 (2006)PubMedCrossRefGoogle Scholar
  180. 180.
    C. Randon, F. Vermassen, B. Jacobs, F. De Ryck, K. Van Landuyt, Y. Taes, Outcome of arterial reconstruction and free-flap coverage in diabetic foot ulcers: long-term results. World J. Surg. 34(1), 177–184 (2010)PubMedCrossRefGoogle Scholar
  181. 181.
    M.J. Mueller, D.R. Sinacore, M.K. Hastings, M.J. Strube, J.E. Johnson, Effect of Achilles tendon lengthening on neuropatic plantar ulcers. A randomized clinical trial. J. Bone Joint Surg. Am. 85A, 1436–1445 (2003)Google Scholar
  182. 182.
    N.L. Petrova, M.E. Edmonds, Charcot neuro-osteoarthropathy—current standards. Diabetes Metab. Res. Rev. 24(Suppl 1), S58–S61 (2008)PubMedCrossRefGoogle Scholar
  183. 183.
    H. Svensson, J. Larsson, J. Apelqvist, M. Eneroth, Minor amputations successful in patients with diabetes mellitus and severe foot ulcers threatening the survival of the foot. J. Wound Care 20, 261-2, 264, 266 (2011)Google Scholar
  184. 184.
    V. Dargis, O. Pantelejeva, A. Jonushaite, A. Boulton, I. Vileikyte, Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study. Diabetes Care 22(9), 1428–1431 (1999)PubMedCrossRefGoogle Scholar
  185. 185.
    C.J. McCabe, R.C. Stevenson, A.M. Dolan, Evaluation of diabetic foot screening and protection programme. Diabetes Med. 15, 80–84 (1998)CrossRefGoogle Scholar
  186. 186.
    J. Larsson, C.D. Agardh, J. Apelqvist, A. Stenström, Long term prognosis after amputation in diabetic patients. Clin. Orthop. Relat. Res. 350, 149–158 (1998)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of EndocrinologyUniversity Hospital of Skåne (SUS)MalmöSweden
  2. 2.Division for Clinical SciencesUniversity of LundLundSweden

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