Advertisement

The Diabetic Foot

  • Crystal L. Ramanujam
  • John J. Stapleton
  • Thomas Zgonis
Chapter

Abstract

With the rising prevalence of diabetes mellitus, the impact of foot complications has been recognized worldwide. The potentially devastating effects of this disease have led to substantial personal, social, medical, and economic costs, therefore fueling the search for effective preventative measures and definitive treatment strategies. The main diabetic foot complications include neuropathic ulcerations, infections, amputations, and Charcot deformities. Understanding the pathways to these clinical manifestations provides a foundation for appropriate medical management and surgical intervention when indicated. Many complications are preventable with proper and frequent diabetic foot screenings, patient education in the overall management of diabetes mellitus and its related multi-organ manifestations, and directing high-risk patients into comprehensive treatment programs. Once a diabetic foot complication has ensued, early and aggressive treatment efforts under a multidisciplinary medical and surgical team approach should be targeted at maintaining the patient’s function and preserving their quality of life.

Keywords

Peripheral Vascular Disease Necrotizing Fasciitis Diabetic Peripheral Neuropathy Surgical Debridement Negative Pressure Wound Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217–28.PubMedCrossRefGoogle Scholar
  2. 2.
    New JP, McDowell D, Burns E, Young RJ. Problem of amputations in patients with newly diagnosed diabetes mellitus. Diabet Med. 1998;15:760–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Veves A, Giurini JM, LoGerfo FW. The diabetic foot. Medical and surgical management. Totowa, NJ: Humana; 2002.CrossRefGoogle Scholar
  4. 4.
    Apelqvist J, Castenfors J, Larsson J. Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers. Diabet Med. 1989;6:526–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Ramsey SD, Newton K, Blough D, McCulloch DK, Sandhu N, Reiber GE, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22:382–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Reiber GE. The epidemiology of diabetic foot problems. Diabet Med. 1996;13:S6–11.PubMedGoogle Scholar
  7. 7.
    Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med. 1992;117:97–105.PubMedCrossRefGoogle Scholar
  8. 8.
    Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. Executive summary: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54:1679–84.PubMedCrossRefGoogle Scholar
  9. 9.
    Clemens MW, Attinger CE. Angiosomes and wound care in the diabetic foot. Foot Ankle Clin. 2010;15:439–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Ramanujam CL, Zgonis T. Antibiotic-loaded cement beads for Charcot ankle osteomyelitis. Foot Ankle Spec. 2010;3:274–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Robinson AH, Pasapula C, Brodsky JW. Surgical aspects of the diabetic foot. J Bone Joint Surg Br. 2009;91:1–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Ranachowska C, Lass P, Korzon-Burakowska A, Dobosz M. Diagnostic imaging of the diabetic foot. Nucl Med Rev Cent East Eur. 2010;13:18–22.PubMedGoogle Scholar
  13. 13.
    Yu GV, Hudson JR. Evaluation and treatment of stage 0 Charcot’s neuroarthropathy of the foot and ankle. J Am Podiatr Med Assoc. 2002;92:210–20.PubMedGoogle Scholar
  14. 14.
    Sohn MW, Stuck RM, Pinzur M, Lee TA, Budiman-Mak E. Lower-extremity amputation risk after charcot arthropathy and diabetic foot ulcer. Diabetes Care. 2010;33:98–100.PubMedCrossRefGoogle Scholar
  15. 15.
    Stapleton JJ, Zgonis T. Surgical reconstruction of the diabetic charcot foot: internal, external or combined fixation? Clin Podiatr Med Surg. 2012;29:425–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Zgonis T, Roukis TS, Stapleton JJ, Cromack DT. Combined lateral column arthrodesis, medial plantar artery flap, and circular external fixation for Charcot midfoot collapse with chronic plantar ulceration. Adv Skin Wound Care. 2008;21:521–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Crystal L. Ramanujam
    • 1
  • John J. Stapleton
    • 2
    • 3
  • Thomas Zgonis
    • 1
  1. 1.Division of Podiatric Medicine and Surgery, Department of Orthopaedic SurgeryUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  2. 2.Division of Podiatric SurgeryLehigh Valley HospitalAllentownUSA
  3. 3.Penn State College of MedicineHersheyUSA

Personalised recommendations