The Foot in Diabetes PDF
Preview The Foot in Diabetes
The Foot in Diabetes The Foot in Diabetes Fifth Edition Edited by Andrew J. M. Boulton Division of Diabetes, Endocrinology and Gastroenterology University of Manchester, Manchester, UK; Manchester Royal Infirmary, Manchester, UK; Diabetes Research Institute, University of Miami, Miami, FL, USA Gerry Rayman Diabetes Centre, Ipswich Hospital, Ipswich, UK; University of East Anglia, Norwich, UK; University of Suffolk, Ipswich, UK Dane K. Wukich Department of Orthopaedic Surgery University of Texas Southwestern Medical Center Dallas, TX, USA This edition first published 2020 © 2020 John Wiley & Sons Ltd Edition History John Wiley & Sons (1e, 1987) John Wiley & Sons (2e, 1994) John Wiley & Sons (3e, 2000) John Wiley & Sons (4e, 2006) All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of Andrew J.M. Boulton, Gerry Rayman, and Dane K. Wukich to be identified as the authors of the editorial material in this work has been asserted in accordance with law. Registered Offices John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Office 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com. Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats. 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You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Library of Congress Cataloging‐in‐Publication Data Names: Boulton, A. J. M. (Andrew James Michael), editor. | Rayman, Gerry, editor. | Wukich, Dane K, editor. Title: The foot in diabetes / edited by Andrew J. M. Boulton, Gerry Rayman, Dane K. Wukich. Other titles: Foot in diabetes (Boulton) | Diabetes in practice. Description: Fifth edition. | Hoboken, NJ : Wiley-Blackwell, 2020. | Series: Diabetes in practice | Includes bibliographical references and index. Identifiers: LCCN 2019053492 (print) | LCCN 2019053493 (ebook) | ISBN 9781119445814 (hardback) | ISBN 9781119445883 (adobe pdf) | ISBN 9781119445838 (epub) Subjects: MESH: Diabetic Foot–therapy | Diabetic Foot–etiology Classification: LCC RD563 (print) | LCC RD563 (ebook) | NLM WK 835 | DDC 617.5/85–dc23 LC record available at https://lccn.loc.gov/2019053492 LC ebook record available at https://lccn.loc.gov/2019053493 Cover Design: Wiley Cover Images: Wound of diabetic foot © ittipon/Shutterstock, X-ray image © ChooChin/Shutterstock, Diabetic ulcer © Janthiwa Sutthiboriban/Shutterstock, Diabetic ulcer on left foot © Janthiwa Sutthiboriban/Shutterstock, Eczema from diabetes © srisakorn wonglakorn/Shutterstock Set in 9.5/12.5pt STIX Two Text by SPi Global, Pondicherry, India 10 9 8 7 6 5 4 3 2 1 v Contents List of Contributors xv Preface xix Introduction xxi 1 Epidemiology and Economic Impact of Foot Ulcers 1 Edward J. Boyko and Matilde Monteiro-Soares 1.1 Introduction 1 1.2 Diabetic Foot Ulcer (DFU) Definition 1 1.3 DFU Classification 2 1.4 DFU Incidence and Prevalence 3 1.5 DFU Recurrence 5 1.6 Risk Factors for Diabetic Foot Ulcers and Lower Extremity Amputation 6 1.7 Diabetic Foot Ulcer Outcomes 7 1.8 Economic Considerations 9 References 10 2 Cost of Diabetic Foot Disease in England 17 Marion Kerr 2.1 Introduction 17 2.2 Human Costs 17 2.3 Financial Costs 20 2.4 Why Measure Costs? 22 2.5 Establishing Healthcare Priorities 22 2.6 Conclusions 25 References 26 3 Epidemiology of Amputation and the Influence of Ethnicity 31 Caroline A. Abbott 3.1 Why Study the Epidemiology of LEA? 31 3.2 LEA Incidence Study Design: The Risk of Bias 32 3.3 LEA Risk Assessment Study Design 32 3.4 Risk Factors for LEA 33 3.5 Incidence Rates of LEA 34 3.6 International and Regional Differences 34 3.7 Time Trends in LEA Rates 34 vi Contents 3.8 Ethnic Differences in Diabetes-Related LEA 35 3.9 Ethnic Differences in Diabetes-Related LEA Risk 35 3.10 Indian Asians 38 References 38 4a The Diabetic Foot Worldwide: India 43 M. Viswanathan 4a.1 Introduction 43 4a.2 Epidemiology of Diabetes in India 43 4a.3 Socio Economic Burden Due to Diabetes 43 4a.4 Common Risk Factors for Amputation in India 43 4a.5 Diagnosing High Risk Feet in Developing Countries 44 4a.6 Comparison in Risk Factors between India and the Western World 44 4a.7 DFI as a Cause for Declining Kidney Function 44 4a.8 Helping People with Amputation Cope Up with the Disability 44 References 45 4b The Diabetic Foot Worldwide: Pakistan 47 Abdul Basit 4b.1 Introduction 47 4b.2 Concept of Multidisciplinary Diabetic Foot Care Team (MDFCT) 47 4b.3 Nationwide Diabetic Foot Programme (Step by Step-[SbS]) 48 4b.4 Footwear for Every Diabetic (FED) 48 4b.5 Further Steps Ahead of SbS 49 References 49 4c The Diabetic Foot Worldwide: Sub-Saharan Africa 51 Zulfiqarali G. Abbas 4c.1 Introduction 51 4c.2 Pathophysiology of Foot Ulcers 52 4c.3 Peripheral Neuropathy (PN) 52 4c.4 Peripheral Arterial Diseases (PAD) 53 4c.5 Foot Ulceration in SSA 54 4c.6 Foot Infection 55 4c.7 Amputation 56 4c.8 Mortality 56 4c.9 Prevention 56 4c.10 Conclusions 58 References 58 4d Burden of Diabetic Foot Disease in Brazil 61 Hermelinda C. Pedrosa and Luciana R. Bahia References 64 4e Diabetic Foot in Romania and Eastern Europe 67 Norina Alinta Gâvan and C. I. Bondor 4e.1 Introduction 67 4e.2 The Aim 67 Contents vii 4e.3 Diabetic Foot in Romania 67 4e.4 Diabetic Foot in Eastern Europe 70 4e.5 Conclusions 71 References 71 4f Diabetic Foot Worldwide: Pacific Region 75 Shigeo Kono References 76 4g The Diabetic Foot Worldwide: Middle East 79 Samir H. Assaad-Khalil 4g.1 The Burden of Diabetic Foot Disease (DFD) in the Middle East (ME) 79 4g.2 Specific Regional Barriers to Healthy Feet and Foot Care 80 4g.3 Misconceptions 81 4g.4 Footwear 81 4g.5 Foot Care, Education and Awareness 81 References 82 4h The Diabetic Foot Worldwide: Australasia 85 Peter A. Lazzarini 4h.1 Introduction 85 4h.2 Australia 85 4h.3 New Zealand 86 4h.4 Pacific Islands 86 4h.5 Conclusion 87 References 87 5 Diabetic Neuropathy 89 Dinesh Selvarajah, Gordon Sloan, and Solomon Tesfaye 5.1 Epidemiology 89 5.2 Classification 89 5.3 Symmetrical Neuropathies 91 5.4 Asymmetrical Neuropathies 95 5.5 Pathogenesis of Distal Symmetrical Neuropathy 97 5.6 Management of Diabetic Neuropathy 98 References 101 6 The Pathway to Ulceration: Aetiopathogenesis and Screening 105 Andrew J.M. Boulton 6.1 Introduction 105 6.2 Peripheral Arterial Disease (PAD) 106 6.3 Diabetic Neuropathy 107 6.4 Neuropathy: The Major Contributory Factor in Ulceration 109 6.5 Other Risk Factors for Foot Ulceration 109 6.6 Assessment of Foot Ulcer Risk 111 6.7 The Pathway to Ulceration 116 viii Contents 6.8 Mechanical Factors and Neuropathic Foot Ulceration 118 6.9 The Patient with Sensory Loss 120 References 120 7 Biomechanics of the Diabetic Foot for the Uninitiated 125 S.A. Bus and J.S. Ulbrecht 7.1 Introduction 125 7.2 The Concept of Pressure and its Measurement 125 7.3 The Role of Elevated Plantar Pressure in Foot Ulceration 126 7.4 Mechanisms of Elevated Plantar Pressure 128 7.5 Foot Biomechanics in Treating a Plantar Foot Ulcer 130 7.6 Biomechanical Issues in Preventing a Foot Ulcer 132 7.7 Summary 133 References 134 8 Psychological and Behavioural Aspects of Diabetic Foot Ulceration 139 Loretta Vileikyte and Ryan T. Crews 8.1 The Role of Psychological and Behavioural Factors in DFU Development 139 8.2 The Role of Psychological and Behavioural Factors in DFU Healing 142 8.3 The Impact of DFUs on Patients’ Health Status and QoL 146 8.4 Measuring QoL in DFU Patients: Generic, DFU-Specific or Combined Approach? 147 References 148 9 What Role for the Plain Radiograph of the Diabetic Foot? 153 Richard William Whitehouse 9.1 Introduction 153 9.2 Pathologies 157 9.3 Summary 166 References 167 10 Advanced Cross-Sectional Radiology-Ultrasound, Computed Tomography and Magnetic Resonance Imaging of the Diabetic Foot 169 Aparna Komarraju and Avneesh Chhabra 10.1 Introduction 169 10.2 Pathophysiology of Diabetic Foot Disease 170 References 183 11 Gait and Exercise Training in Diabetic Peripheral Neuropathy 187 Neil D. Reeves 11.1 Introduction 187 11.2 Gait Characteristics of People with Diabetes 187 11.3 Muscle Forces and the Biomechanics of Gait in Diabetes 188 11.4 Biomechanical Strategies to Alter Gait in Diabetic Peripheral Neuropathy 190 Contents ix 11.5 Falls and Diabetic Peripheral Neuropathy 193 11.6 Biomechanical Factors Leading to Increased Fall Risk 193 11.7 Diabetic Peripheral Neuropathy and Balance during Gait 194 11.8 Exercise and Diabetic Peripheral Neuropathy 196 11.9 Effects of Exercise in Patients with Diabetic Peripheral Neuropathy on Gait and Balance 197 11.10 The Case for Resistance Exercise Training 198 References 198 12 Smart Technology for the Diabetic Foot in Remission 201 Bijan Najafi and David G. Armstrong 12.1 Background 201 12.2 Technologies to Guide the Prescription of Footwear-Related Offloading Treatments 203 12.3 Technologies to Facilitate Triaging those at High Risk of DFU 204 12.4 Technologies to Manage Dose of Physical Activities in People with Diabetes and Insensate Foot 211 12.5 Using Technology to Improve Patient Education for Effective Prevention of Diabetic Foot Ulcers 214 12.6 Mobile Health (mHealth) to Manage Diabetic Foot Ulcers 215 12.7 Internet of Things and Remote Management of Diabetic Foot Ulcers 216 12.8 Technologies to Facilitate Delivering of Therapy at Home and Reduce Risk of DFU 217 12.9 Conclusion 218 References 219 13 How to Assess the Quality of Clinical Trials for Diabetic Foot Ulcer Therapies 225 Fran Game and William Jeffcoate 13.1 Introduction 225 13.2 Hierarchy of Evidence 226 13.3 Items to Be Considered in Assessing Trials of Diabetic Foot Ulcer Therapies 227 13.4 The Population 227 13.5 The Person and Limb 228 13.6 The Ulcer 229 13.7 The Therapy 230 13.8 Outcomes 230 13.9 Adverse Events 231 13.10 21 Point Checklist 231 References 233 x Contents 14a Bypass in Diabetic Peripheral Artery Disease 235 Neal R. Barshes and Joseph L. Mills 14a.1 Identifying Significant PAD Amongst Patients Presenting with Foot Ulcers 235 14a.2 Relative Benefits and Risks: Identifying Patients Who May Benefit from a Leg Bypass Operation 237 14a.3 Evaluating Relevant Vascular Anatomy for Planning a Bypass Operation 239 14a.4 The Operation and Early In-Hospital Recovery 241 14a.5 Follow-Up After a Leg Bypass Operation 243 References 243 14b Surgery or Endovascular Intervention in Diabetic Peripheral Vascular Disease 247 Edward Y. Woo and Misaki M. Kiguchi 14b.1 Introduction 247 14b.2 Background 247 14b.3 Diagnosis 248 14b.4 Management 250 14b.5 Endovascular Revascularization 250 14b.6 Results 253 14b.7 Complications 254 14b.8 Conclusion 254 References 255 15 Inpatient Diabetic Foot Care: A UK Perspective 259 Gerry Rayman 15.1 Introduction 259 15.2 The Burden of Inpatient Diabetes 260 15.3 The Burden of Inpatient Diabetic Foot Disease 260 15.4 Recommended Foot Care for Inpatients with Diabetes 261 15.5 Summary 262 References 263 16 Diagnosis and Management of Infection in the Diabetic Foot 265 Edgar J.G. Peters and Benjamin A. Lipsky 16.1 Introduction 265 16.2 Pathophysiology of Infections in Persons with Diabetes Mellitus 265 16.3 Risk Factors for DFI 266 16.4 Clinical Signs and Symptoms 266 16.5 Classification 267 16.6 Microbiology 268 16.7 Treatment 269 16.8 IWGDF Grade 4 (Severe) Infections 274 16.9 Osteomyelitis 275 References 280 Contents xi 17 Surgical Approach to Diabetic Foot Infections 287 Katherine M. Raspovic, Javier La Fontaine, and Lawrence Lavery 17.1 Introduction 287 17.2 Initial Evaluation 288 17.3 Initial Surgical Intervention 290 17.4 After Initial Surgical Intervention 293 17.5 Staged Surgical Intervention and Wound Closure 294 17.6 Surgical Offloading 296 17.7 Soft Tissue/Tendon Balancing and Definitive Osseous Surgical Reconstruction 296 17.8 Decision for Proximal Level Amputation 297 17.9 Conclusions 298 References 298 18 The Evidence Base for the Choice of Dressings in the Management of Diabetic Foot Ulcers 301 William J. Jeffcoate, Patricia E. Price, and Frances L. Game 18.1 The Problems 301 18.2 Quality of Evidence 302 18.3 The Definition of a Dressing 302 18.4 The Roles of the Dressing 303 18.5 Basic Aspects of Wound Care 304 18.6 Evidence for Potential Contributions of Dressings and Wound Applications to Improve Wound Healing 304 18.7 Other Therapies which May Modulate Healing of Chronic Wounds 306 18.8 Summary 307 References 308 19 Pathogenesis of Charcot Neuroarthropathy and Acute Management 311 N.L. Petrova and Michael E. Edmonds 19.1 Introduction 311 19.2 Pathogenesis of CN 311 19.3 Acute Management of CN 316 19.4 Conclusions 318 References 319 20 Surgical Reconstruction of the Charcot Foot 323 George Liu, Katherine Raspovic, and Dane Wukich 20.1 Introduction 323 20.2 Indications for Surgical Reconstruction 323 20.3 Radiographic Predictors for Ulceration 325 20.4 Timing of Surgery 326 20.5 Preoperative Medical Workup 327 20.6 Glycemic Control 327 20.7 Vitamin D 328 20.8 Renal Function 328
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