Amputation Prevention and Rehabilitation in Diabetes

  • John M. Embil
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 498)

Abstract

Diabetes is a multi-system disease which can lead to complications such as peripheral neuropathy and peripheral vascular disease. These two complications can synergistically lead to the formation of ulcerations in the feet and lower extremities of persons with diabetes (PWD). Should an ulceration develop, it may be a self limited process healing spontaneously or it may lead to more serious complications such as infection of the skin, soft tissue, bone, sepsis, and possibly amputation of toes, foot, or lower extremity. For the year 1991, 57% of all amputations involving lower extremities in Manitoba were in PWD. Lower extremity amputations were 10 times higher amongst PWD than those without diabetes. In 1991, the prevalence of diabetes in adult Manitobans was as follows: First Nations individuals - 12% males, 20% females, non-First Nations individuals - 7% male, 6.4% females. The Manitoba Health Services Commission records for 1993-1994 show 16% of lower extremity amputations in Manitoba were amongst First Nations individuals, and 84% in non-First Nations individuals.1

Keywords

Neuropathy Gallium Metronidazole Amoxicillin Osteomyelitis 

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References

  1. 1.
    Blanchard J. Manitoba Epidemiology of Lower Extremity Complications in diabetes (personal communication). September 1997.Google Scholar
  2. 2.
    Grayson ML, Silvers J, Tumidge J. Home intravenous antibiotic therapy: A safe and effective alternative to inpatient therapy. Med J Aust 1995; 162: 249–253.PubMedGoogle Scholar
  3. 3.
    Milkovich G. Cost and benefits. Hosp Pract 1993 (supplement) 39–43.Google Scholar
  4. 4.
    Eisenberg JN, Kitz DS. Savings from outpatient antibiotic therapy for osteomyelitis: Economic analysis of a therapeutic strategy. JAMA 1986; 225: 1584–1588.CrossRefGoogle Scholar
  5. 5.
    Lipsky BA, Pecoraro RE, Larson SA, et al. Outpatient management of uncomplicated lower-extremity infections in diabetic patients. Arch Intern Med 1990; 150: 790–797.PubMedCrossRefGoogle Scholar
  6. 6.
    Lipsky BA. Osteomyelitis of the foot in diabetic patients. Clin Infect Dis 1997; 25: 1318–1326.PubMedCrossRefGoogle Scholar
  7. 7.
    Pittet D, Wyssa B, Herter-Clavel C, et al. Outcome of diabetic foot infection treated conservatively. A retrospective cohort study with long-term follow-up. Arch Intern Med 1999; 159: 851–856.PubMedCrossRefGoogle Scholar
  8. 8.
    Embil JM, Rose G, Duerksen F, et al. Oral antimicrobial therapy (OAT) for osteomyelitis of the foot in diabetic patients. Submitted Clin Infect Dis 1999.Google Scholar
  9. 9.
    Wilson KH, Kauffman CA. Oral antibiotic therapy for osteomyelitis of the foot in diabetic patients. South Med J 1985; 78: 223–224.PubMedCrossRefGoogle Scholar
  10. 10.
    Venkatesan P, Lawn S, MacFarlane RM, et al. Conservative management of osteomyelitis in the feet of diabetic patients. Diabetic Med 1997; 14: 487–490.PubMedCrossRefGoogle Scholar
  11. 11.
    Peterson LR, Lissack LM, Canter K, et al. Therapy of lower extremity infections with ciprofloxacin in patients with diabetes mellitus, peripheral vascular disease or both. Am J Med 1989; 86: 801–808.PubMedCrossRefGoogle Scholar
  12. 12.
    MacGregor RR, Graziani AL. Oral administration of antibiotics: A rational alternative to the parenteral route. Clin Infect Dis 1997; 24: 457–467.PubMedCrossRefGoogle Scholar
  13. 13.
    Orchard TJ, Strandness DE Jr on behalf of the participants. Assessment of peripheral vascular disease in diabetes. Report and recommendation of an International Work Shop sponsored by the American Heart Association and the American Diabetes Association 18–20 September 1992. NewOrleans, Louisiana. Circulation 1993; 88: 819–828.CrossRefGoogle Scholar
  14. 14.
    Bawer MG, Kaiser GC, William VL. Blood flow in the diabetic leg. Circulation 1971; 43: 391–394.CrossRefGoogle Scholar
  15. 15.
    Takolander R, Rauwerda JA. The use of non-invasive vascular assessment in diabetic patients with foot lesions. Diabetic Med 1996; 13: 539–542.Google Scholar
  16. 16.
    Newman LG, Waller J, Palestro CJ et al. Unsuspected osteomyelitis in diabetic foot ulcers: Diagnosing and monitoring by leukocyte scanning with indium In’ oxyquinonlone. JAMA 1991; 226: 1246–1251.CrossRefGoogle Scholar
  17. 17.
    Grayson ML, Gibbons GW, Balogh K, et al. Probing to bone in infected pedal ulcers. JAMA 1995; 273: 721–723.PubMedCrossRefGoogle Scholar
  18. 18.
    Keenan AM, Tindel NL, Alavi A. Diagnosing pedal osteomyelitis in diabetic patients using current scintigraphic techniques. Arch Intern Med 1989; 149: 2262–2266.PubMedCrossRefGoogle Scholar
  19. 19.
    Schauwecker DS. Osteomyelitis: diagnosis with In-111-labled leukocytes. Radiology 1989; 171: 141–146.PubMedGoogle Scholar
  20. 20.
    Shults DW, Hunter GC, McIntyre KE, et al. Value of radiographs and bone scans in determining the need for therapy in diabetic patients with foot ulcers. Am J Surg 1989; 158: 525–530.PubMedCrossRefGoogle Scholar
  21. 21.
    Norden CW. Lessons learned from animal models of osteomyelitis. Rev Infect Dis 1988; 10: 103–109.CrossRefGoogle Scholar
  22. 22.
    Bamberger DM, Duas GP, Gerding DM. Osteomyelitis in the feet of diabetic patients. Am J Med 1987; 83: 653–659.PubMedCrossRefGoogle Scholar
  23. 23.
    Fitzgerald RH. Antibiotic distribution in normal and osteomyelitic bone. Orthop Clin North Am 1984; 15: 537–446.PubMedGoogle Scholar
  24. 24.
    Gentry LO, Rodrigues GG. Oral ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis. Antimicrob Agents Chemother 1990; 34: 40–43.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • John M. Embil
    • 1
  1. 1.Departments of Internal MedicineInternal Medicine, Infectious Dieseases And Medical Microbiology Health Sciences CentreWinnipeg

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