High risk diabetic foot : treatment and prevention

277 Pages·2010·2.932 MB·English

by  Lawrence A Lavery, Edgar J G Peters, Ruth L Bush

High Risk Diabetic Foot: L High Risk
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Treatment and Prevention e
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About the book About the editors P
e Diabetic Foot
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As the number of people diagnosed with diabetes LAWrenCe A. LAVery, D.P.M, M.P.H, is a Professor in the
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continues to rise, the various complications Department of Plastic Surgery and Orthopaedic Surgery at s
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related to the disease become of more pressing the University of Texas Southwestern Medical Center in Dallas,

concern to the medical community. The diabetic Texas. A Podiatrist with over twenty years of experience, Dr. B
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foot is among these possible complications. Lavery is the Medical Director of the Comprehensive Wound s
h
Diabetes can lead to nerve damage and poor Care Center at the University of Texas. He is the Past Chair of Treatment and Prevention
circulation in the extremities, which then the Foot Care Council for the American Diabetes Association
leaves the diabetic patient susceptible to and serves on the Infectious Diseases Committee for the
infections and deformities of the foot. Written International Working Group on the Diabetic Foot. H
from the perspective of the Podiatrist, Vascular
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Surgeon, and Infectious Disease Specialist, this EDGar J. G. PEtErs, M.D., Ph.D., is an Internist and Infectious g
comprehensive text is an essential resource for Disease Specialist with the University Medical Center, Utrecht in h
Physicians dealing with the management of the netherlands. After receiving his medical degree from Vrije
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complex diabetic foot problems. University Medical Centre in amsterdam, Dr. Peters worked at
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Dr. Karel Bakker’s foot clinic. His extensive research includes his s
Adopting a multi-discipline approach, High Risk Ph.D. thesis on risk assessment of diabetic foot complications. k
Diabetic Foot addresses: He is actively involved in the development of guidelines for D
• the vascular diseases that can lead to diabetic diagnosing and treating diabetic foot infections, both as a i
foot secretary of the International Working Group on the Diabetic a
Foot and within the Infectious Disease Society of America. b
• the neuropathic impact of diabetes on the
patient’s extremities e
rUTH L. BUSH, M.D., M.P.H, Associate Professor of Surgery at t
• possible infections and deformities, like the the Texas A&M College of Medicine, is a Vascular Surgeon ic
Charcot Foot practicing at the Scott & White Hospital in Temple, Texas. At the

• various therapy options from pharmaceutical Scott & White Hospital, she is Director of the Vein Care Center. F
options, to orthopedic devices, to surgical She is also Chief of Vascular Surgery at the Olin e. Teague VA o
options Medical Center. Since earning her medical degree from the o
University of north Carolina School of Medicine, Dr. Bush has t
• amputation issues, such as prevention and
authored over 100 peer-reviewed publications. She is a Fellow
rehabilitation T
of the American College of Surgeons and is on the Board of r
e
• the growing importance of foot clinics Directors for the Society for Vascular Surgery.
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P
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Lawrence A. Lavery
Edgar J. G. Peters
Telephone House, 69-77 Paul Street, London eC2A 4LQ, UK
52 Vanderbilt avenue, New York, NY 10017, Usa
Ruth L. Bush
www.informahealthcare.com
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High Risk Diabetic Foot
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High Risk Diabetic Foot
Treatment and Prevention
Edited by
Lawrence A. Lavery
University of Texas
Southwestern Medical Center
Dallas, Texas, U.S.A.
Edgar J. G. Peters
University Medical Center Utrecht
Utrecht, The Netherlands
Ruth L. Bush
Texas A&M College of Medicine
Scott & White Memorial Hospital
Temple, Texas, U.S.A.
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First published in 2010 by Informa Healthcare, Telephone House, 69-77 Paul Street, London
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Preface
The global burden of diabetes and diabetes related complications is growing
rapidly. In many ways it is a “perfect storm” that reflects the combined effects
of aging, obesity and change of lifestyles around the world. Lower extremity
complicationsareanobviouspartofthediabetesepidemic.Ithasbeenestimated
that every 30 seconds a leg is lost due to diabetes somewhere in the world.
Theseamputationsbythemselveshavebeenshowntoleadtoincreasedriskof
furthercomplicationssuchasadditionalamputations,chronicwounds,hospital
admissionsanddeath.
Thoughfearedbypatientsanddoctorsalike,amputationsarenottheonly
lowerextremitycomplicationofdiabetes.Amputationsareusuallyprecededby
ulcersandwoundswithalowtendencytoheal.Thesechronicwoundscanbea
sourceofinfectionandfurtherdecay.Thereareseveralfactorsassociatedwiththe
developmentoftheseskinlesionssuchas:peripheralvasculardisease,numbness
of the foot caused by peripheral symmetric polyneuropathy, foot deformities
and ill fitting shoes. Patients at risk for foot complications can be identified by
screening for these risk factors. In this book, we will try to shed light on the
complexinteractionoftheseriskfactorsandontheirsequelae.
Itwasnotlongagothatrecommendationsabouttheevaluationandtreat-
mentofdiabeticfootcomplicationsweresolelybasedonexpertopinionorsmall
case series. Much of the work in this text references the level of medical evi-
dencethatiscurrentlyavailable.TheauthorsappliedthesystemusedbytheUK
NationalHealthServicetogradethelevelofevidencefactoredintorecommen-
dationsfortreatmentsorinterventions.Theserecommendationswillbepresent
throughoutthebookandcanbesummarizedby:
(cid:1)
Level A: Systematic reviews, consistent randomised controlled clinical trial,
cohortstudy,clinicaldecisionrulevalidatedindifferentpopulations.
(cid:1)
LevelB:Consistentretrospectivecohort,exploratorycohort,ecologicalstudy,
outcomesresearch,case-controlStudy;orextrapolationsfromlevelAstudies.
(cid:1)
LevelC:Case-seriesstudyorextrapolationsfromlevelBstudies
(cid:1)
LevelD:Expertopinionwithoutexplicitcriticalappraisal,orbasedonphysi-
ology,benchresearchorfirstprinciples.
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vi PREFACE
This book provides guidelines for the recognition, diagnosis and treatment of
thehigh-riskdiabeticfoot.Thediabeticfootispreferablytreatedbyamultidis-
ciplinaryteamofcaregivers.Thisbookisspecificallywrittenforthesecaregives,
which include physicians, surgeons, nurses, podiatrists, physiotherapists, radi-
ologists,healthcaremanagersandpotentiallymanymorespecialists.Ultimately,
wehopethatthisbookwillhelpreducethenumberofamputationsindiabetic
patients.
LawrenceA.Lavery
EdgarJ.G.Peters
RuthL.Bush
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Contents
Preface....v
Contributors....ix
1. Peripheralarterialdisease 1
ChristopherJ.MarroccoandRuthL.Bush
2. Clinicalandvascularlaboratoryassessmentofperipheral
vasculardisease 9
DanielT.Ginat,WaelE.A.Saad,andMarkG.Davies
3. Endovasculartreatmentofinfrainguinalarterialdisease 28
JasonMaggi,RajeshMalik,andFirasF.Mussa
4. Openarterialreconstructionofthediabeticfoot 35
JosephJ.NaoumandEricK.Peden
5. Diabeticneuropathyandthelowerextremity 49
NicolaasC.SchaperandHansH.Savelberg
6. Painfuldiabeticneuropathy 65
LeeC.RogersandRayazA.Malik
7. Advancedtherapiestotreatdiabetic
footulcers 80
LawrenceA.LaveryandGeorgeT.Liu
8. Theinfecteddiabeticfoot 92
EdgarJ.G.Peters
9. Offloadingthediabeticfoot 127
SiccoA.Bus
10. Surgicalapproachtothediabeticfootulcer 155
NathanA.HuntandDouglasP.Murdoch
11. Charcotarthropathy 173
JavierLaFontaine
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viii CONTENTS
12. Amputation 192
I.M.Nordon,R.J.Hinchliffe,andK.G.Jones
13. Preventingfootcomplications 216
LawrenceA.LaveryandAgborNdip
14. Impactofspecializedfootclinics 227
KristienVanAcker
Index....257
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Contributors
SiccoA.Bus DepartmentofRehabilitation,AcademicMedicalCenter,
UniversityofAmsterdam,Amsterdam,TheNetherlandsDiabeticFootUnit,
DepartmentofSurgery,ZiekenhuisgroepTwente,locationAlmelo,
TheNetherlands
RuthL.Bush TexasA&MCollegeofMedicine,Scott&WhiteMemorial
Hospital,Temple,Texas,U.S.A.
MarkG.Davies DepartmentofSurgery,UniversityofRochesterMedical
Center,Rochester,NewYork,U.S.A.
DanielT.Ginat DepartmentofImagingScience,UniversityofRochester
MedicalCenter,Rochester,NewYork,U.S.A.
R.J.Hinchliffe St.GeorgesVascularInstitute,St.George’sHospital,London,
U.K.
NathanA.Hunt* Scott&WhiteMemorialHospitalandClinic,Temple,Texas,
U.S.A.
K.G.Jones St.GeorgesVascularInstitute,St.George’sHospital,London,U.K.
JavierLaFontaine TexasA&MHealthScienceCenter,Scott&White
MemorialHospital,Temple,Texas,U.S.A.
LawrenceA.Lavery DepartmentofPlasticSurgeryandDepartmentof
OrthopaedicSurgery,UniversityofTexasSouthwesternMedicalCenter,Dallas,
Texas,U.S.A.
GeorgeT.Liu DepartmentofOrthaopaedics,UniversityofTexas
SouthwesternMedicalCenter,Dallas,Texas,U.S.A.
JasonMaggi DepartmentofSurgery,NewYorkUniversitySchoolof
Medicine,NewYork,NewYork,U.S.A.
RajeshMalik DivisionofVascularSurgery,MountSinaiSchoolofMedicine,
NewYork,NewYork,U.S.A.
RayazA.Malik DivisionofCardiovascularMedicine,CentralManchester
FoundationTrust,andUniversityofManchester,Manchester,UK
*Currentaffiliation:OrthopaedicCenteroftheRockies,FortCollins,Colorado,U.S.A.
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