Abstract
Diabetic foot problems are eminently preventable and yet represent one of the commonest causes of hospital inpatient admission in Western countries. Realizing the global importance of diabetic foot disease, the International Diabetes Federation focused on the diabetic foot throughout the year 2005, during which there was a worldwide campaign to “put feet first” and highlight the all too common problem of amputation among patients with diabetes throughout the world. To coincide with World Diabetes Day in 2005, The Lancet launched an issue almost exclusively dedicated to the diabetic foot: this was the first time that any major nonspecialist journal had focused on this worldwide problem; however, major challenges remain in getting across important messages relating to the diabetic foot. The late sequelae of diabetic peripheral neuropathy include foot ulceration, Charcot neuroarthropathy, and amputation: likewise, peripheral vascular disease is a major etiological factor in diabetic foot lesions. Today, in many countries, it is neuro-ischemic ulcers which are most commonly seen and which present a major challenge in management. The importance of routine diabetic foot care in very high-risk patients is emphasized by a recent observational study from Arizona where the state decided, as a cost-saving measure, to remove routine podiatry from high-risk diabetic patients. This led to an annual saving of $351,000, but the cost of this action measured by increased hospitalization, length of stay, and amputations was $16.7 million per annum.
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References
Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, 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. 2002;19:377–84.
American Diabetes Association. Microvascular complications and foot care. Diabetes Care. 2015;38:S58–66.
Armstrong DG, Lavery LA. Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet. 2005;366:1704–10.
Armstrong DG, Lavery LA, Kimbriel HR, Nixon BP, Boulton AJM. Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure off-loading regimen. Diabetes Care. 2003;26:2595–7.
Armstrong DG, Lavery LA, Wu S, Boulton AJ. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomised controlled trial. Diabetes Care. 2005;28:551–4.
Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and their recurrence. N Engl J Med 2017;376:2367–2375.
Bakker K, Apelqvist J, Lipsky BA, Van Netten JJ, et al. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence based global consensus. Diabetes Metab Res Rev. 2016;32:2–6.
Boulton AJM. Management of diabetic peripheral neuropathy. Clin Diabetes. 2005;23:9–15.
Boulton AJM, Malik RA, Arezzo JL, Sosenko JM. Diabetic somatic neuropathies: technical review. Diabetes Care. 2004;27:1458–86.
Boulton AJM, Vileikyte L, Ragnaarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719–24.
Boulton AJM, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31:1679–85.
Bowling FL, Abbott CA, Harris WE, et al. A pocket-sized disposable device for testing the integrity of sensation in the outpatient setting. Diabet Med. 2012;29:1550–2.
Cavanagh P, Attinger C, Abbas Z, Bal A, Rojas N, Xu ZR. The cost of treating diabetic foot ulcers in 5 different countries. Diabetes Metab Res Rev. 2012;28:107–11.
Citron DM, Goldstein EJ, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007;45:2819–28.
Cruciani M, Lipsky BA, Mengoli C, de Lalla F. Granulocyte-colony stimulating factors as adjunctive therapy for diabetic foot infections. Cochrane Database Syst Rev. 2013;10:CD006810.
Department of Health. Six years on delivering the national service framework in diabetes. (2010). http://nationalarchives.gov.uk
Diabetes UK. Cost of diabetes report. 2014. Available from http://www.diabetes.org.uk/Documents/CostofDiabetes
Dunville JC, Hinchliffe RA, Cullum N, et al. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev. 2013;10:CD010318.
Game FL, Apelqvist J, Attinger C, et al. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32:154–68.
Gonzalez JS, Vileikyte L, Ulbrecht JS, Rubin RR, Garrow AP, Delgado C, Cavanagh PR, Boulton AJM, Peyrot M. Depression predicts first but not recurrent diabetic foot ulcers. Diabetologia. 2010;53:2241–8.
Health and Social Care Information Centre. National Diabetes In-patient Audit 2012. 2013. https://catalogue.ic.nhs.uk/publications/clinical/diabetes/nati-diab-inp-audi-12/nati-diab-inp-audi-12-nat-rep.pdf
Holman N, Young RJ, Jeffocate WJ. Variation in the recorded incidence of amputation of the lower limb in England. Diabetologia. 2012;55:1919–25.
International Diabetes Federation guidelines for type 2 diabetes. www.idf.org/sites/default/files/IDF-Guideline-for-Type-2-Diabetes.pdf
Inzucchi SE, Bergenstal R, Buse J, Diamant M, Ferrannini E, Nauck M, Mathews D. Management of hyperglycaemia in type 2 diabetes, a patient centred approach: update to a position statement of the American Diabetes Association and the European Association for the study of diabetes. Diabetes Care. 2015;38:140–9.
Jeffcoate WJ, Bus SA, Game FL, et al. Reporting standards of studies and papers on the prevention and management of foot ulcers in diabetes: required details and markers of good quality. Lancet Diabetes Endocrinol. 2016;4:781–8.
Jeffocate WJ, Young RJ. National diabetic foot audit of England and Wales yields its first dividends. Diabet Med. 2016;33:1464–5.
Katz IA, Harlan A, Miranda-Palma B, Prieto-Sanchez L, et al. A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care. 2005;28:555–9.
Kerr M, Rayman G, Jeffcoate WJ. Cost of diabetic foot disease to the National Health Service in England. Diabet Med. 2014;(12):1498–504.
Krishnan S, Nash F, Baker N, Fowler D, Rayman G. Reduction in diabetic amputations over 11 years in a defined UK population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care. 2008;31:99–101.
Lavery LA, Higgins KR, Lanctot DR, et al. Preventing diabetic foot ulcer recurrence in high risk patients. Use of temperature monitoring as a self-assessment tool. Diabetes Care. 2007;30:114–20.
Lavery LA, Lavery DC, Hunt NA, LaFontaine J, Ndip A, Boulton AJM. Amputations and foot-related hospitalizations disproportionately affect dialysis patients. Int Wound J. 2015;12(5):523–6.
Leese GP, Stang D, McKnight JA, The Scottish Diabetes Foot Action Group. A national strategic approach to diabetic foot disease in Scotland: changing a culture. Br J Diabetes Vasc Dis. 2011;11(2):69–73.
Lipsky BA, Berendt AR, Cornia PB, et al. Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54:e132–73.
Löndahl M, Katzman P, Nilsson A, et al. Hyperbaric oxygen facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care. 2010;33:998–1003.
Nabuurs-Franssen MH, Sleegers R, Huijberts MS, Wijnen W, Sanders AP, Walenkamp G, et al. Total contact casting of the diabetic foot in daily practice a prospective follow up study. Diabetes Care. 2005;28:243–7.
National Institute for Clinical Excellence 2004. Clinical guidelines for type 2 diabetes: prevention and management of foot problems (CG10). http://www.nice.org.uk/guidance/cg10/resources/cg10-type-2-diabetes-footcare-information-for-the-public2
Ndip A, Rutter MK, Vileikyte L, et al. Dialysis is an independent risk factor for foot ulceration in patients with diabetes and chronic kidney disease. Diabetes Care. 2010;33:1811–6.
Oyibo S, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ. A comparison of two diabetic foot ulcer classification systems. Diabetes Care. 2001;24:84–8.
Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care. 1990;13:513–21.
Peters EJ, Lipsky BA, Aragon-Sanchez J, et al. Interventions in the management of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32:145–53.
Piaggesi A, Macchiarini S, Rizzo L, Palumbo F, Tedeschi A, Nobili LA, Del Prato S. An off the shelf instant contact casting device for the management of diabetic foot ulcers: a randomised prospective trial versus traditional fiberglass cast. Diabetes Care. 2007;30:586–90.
Pop-Busui R, Boulton AJ, Feldman EL, Brill V, Freeman R, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40:136–54.
Prompers L, Huijberts M, Scaper N, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale study. Diabetologia. 2008;51:1826–34.
Rayman G, Vas PR, Baker N, et al. The Ipswich Touch Test: a simple and novel method to identify in patients with diabetes at risk of foot ulceration. Diabetes Care. 2011;34:1517–8.
Reiber GE, Vilikeyte L, Boyko E, del Aquila M, Smith DG, Lavery LA, Boulton AJM. Causal pathways for incident lower extremity ulcers in patients with diabetes from 2 settings. Diabetes Care. 1999;22:157–62.
Rogers LC, Frykberg RG, Boulton AJM. The Charcot foot in diabetes. Diabetes Care. 2011;34:2123–9.
Schaper NC, Andros G, Apelqvist J, et al. Diagnosis and management of peripheral arterial disease in diabetic patients with a foot ulcer. Diabetes Metab Res Rev. 2012;28:218–24.
Shen W, Wukich D. Orthopaedic surgery and the diabetic Charcot foot. Med Clin N Amer. 2013;97:873–82.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217–28.
Skrepnek GH, Mills JL, DG A. Foot-in-wallet disease: tripped up by “cost saving” reductions? Diabetes Care. 2014;37:e196–7.
Stoekenbroek RM, Santema TB, Koelemay MJ, et al. Is additional hyperbaric oxygen therapy cost-effective for treating ischemic diabetic ulcers? Protocol for the Dutch DAMOCLES multicentre randomized clinical trial. J Diabetes. 2015;7:125–32.
Tentolouris N, Achtsidis V, Marinou K, Katsilambros N. Evaluation of the self-administered indicator plaster neuropad for the diagnosis of neuropathy in diabetes. Diabetes Care. 2008;31:236–7.
Tentolouris N, Marinou K, Kokotis P, Karanti A, Diakoumopoulou E, Katsilambros N. Sudomotor dysfunction is associated with foot ulceration in diabetes. Diabet Med. 2009;26:302–5.
The diabetes control and complications research group. Effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.
Uckay I, Gariani K, Pataky Z, Lipsky BA. Diabetic foot infections: state-of-the-art. Diabetes Obes Metab. 2014;16:305–16.
Valk GD, de Sonnaville JJ, van Houtum WH, et al. The assessment of diabetic polyneuropathy in daily clinical practice: reproducibility and validity of Semmes Weinstein monofilaments examination and clinical neurological examination. Muscle Nerve. 1997;20:116–8.
van Schie CH, Abbott CA, Vileikyte L, Shaw JE, Hollis S, Boulton AJM. A comparative study of the Podotrack, a simple semi-quantitative plantar pressure measuring device, and the optical paedobarograph in the assessment of pressures under the diabetic foot. Diabet Med. 1999;16:144–59.
Vileikyte L. Psychosocial and behavioural aspects of diabetic foot lesions. Curr Diab Rep. 2008;8:119–25.
Vileikyte L, Rubin RR, Leventhal H. Psychological aspects of diabetic neuropathic foot complications: an overview. Diabetes Metab Res Rev. 2004;20:13–8.
Weck M, Slesaczeck T, Paetzold H, et al. Structured healthcare for subjects with diabetic foot ulcers results in major reduction of amputation rates. Cardiovasc Diabetol. 2013;12:45.
Young MJ, Breddy JL, Veves A, Boulton AJM. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care. 1994;17:557–600.
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Bowling, F.L., Boulton, A.J.M. (2019). Diabetic Foot. In: Bonora, E., DeFronzo, R. (eds) Diabetes Complications, Comorbidities and Related Disorders. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-27316-7_11-2
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DOI: https://doi.org/10.1007/978-3-319-27316-7_11-2
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Diabetic Foot- Published:
- 30 August 2019
DOI: https://doi.org/10.1007/978-3-319-27316-7_11-2
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Diabetic Foot- Published:
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DOI: https://doi.org/10.1007/978-3-319-27316-7_11-1