• Dirk Hochlenert
  • Gerald Engels
  • Stephan Morbach
  • Stefanie Schliwa
  • Frances L. Game


This chapter outlines the definition, causes, implications, classifications, epidemiology, economy and perspectives of DFS. The intention is to open up a holistic view of the disease, the people suffering from it and its importance for society.


  1. 1.
    Armstrong DG, Mills JL. Toward a change in syntax in diabetic foot care: prevention equals remission. J Am Podiatr Med Assoc. 2013;103(2):161–2.CrossRefPubMedGoogle Scholar
  2. 2.
    Risse A. Phänomenologische und psychopathologische Aspekte in der Diabetologie. Berlin: Walter de Gruyter; 1997.Google Scholar
  3. 3.
    Armstrong DG, Lavery LA, Holtz-Neiderer K, Mohler MJ, Wendel CS, Nixon BP, Boulton AJ. Variability in activity may precede diabetic foot ulceration. Diabetes Care. 2004;27(8):1980–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Rosen RC, Davids MS, Bohanske LM, Lemont H. Hemorrhage into plantar callus and diabetes mellitus. Cutis. 1985;35(4):339–41.PubMedGoogle Scholar
  5. 5.
    Busch K, Chantelau E. Effectiveness of a new brand of stock ‘diabetic’ shoes to protect against diabetic foot ulcer relapse. A prospective cohort study. Diabet Med. 2003;20(8):665–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Armstrong DG, Ingelfinger JR, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75. Scholar
  7. 7.
    Chantelau E. Alternativen zur Fußamputation bei diabetischer Podopathie. Was ist gesichert? Dtsch Arztebl. 2002;99(30):A2052–6.Google Scholar
  8. 8.
    Plank J, Haas W, Rakovac I, Gorzer E, Sommer R, Siebenhofer A, Pieber TR. Evaluation of the impact of chiropodist care in the secondary prevention of foot ulcerations in diabetic subjects. Diabetes Care. 2003;26(6):1691–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, Hartemann A, et al. The Charcot foot in diabetes. Diabetes Care. 2011;34(9):2123–9. Scholar
  10. 10.
    Tanudjaja T, Chantelau E. Recurrent diabetic foot lesions—a study of disease activity in high risc patients. In: The diabetic foot, second international symposium Noordwijkerhout 1995; 1995.Google Scholar
  11. 11.
    Waaijman R, de Haart M, Arts ML, Wever D, Verlouw AJ, Nollet F, Bus SA. Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients. Diabetes Care. 2014.
  12. 12.
    Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2(2):64–122.CrossRefPubMedGoogle Scholar
  13. 13.
    Wagner FW Jr. The diabetic foot. Orthopedics. 1987;10(1):163–72.PubMedGoogle Scholar
  14. 14.
    Armstrong DG. The University of Texas diabetic foot classification system. Ostomy Wound Manage. 1996;42(8):60–1.PubMedGoogle Scholar
  15. 15.
    Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998;21(5):855–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev. 2004;20(Suppl 1):S90–5. Scholar
  17. 17.
    Arlt B, Protze J. [Diabetic foot]. Langenbecks Arch Chir Suppl Kongressbd. 1997;114:528–32.Google Scholar
  18. 18.
    Ince P, Abbas ZG, Lutale JK, Basit A, Ali SM, Chohan F, Morbach S, Mollenberg J, Game FL, Jeffcoate WJ. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31(5):964–7. Scholar
  19. 19.
    Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–49. Scholar
  20. 20.
    IDF. IDF diabetes Atlas eight edition 2017. 2017. Accessed 18 Feb 2018.
  21. 21.
    LeMaster JW, Reiber GE, Rayman A. Epidemiology and economic impact of foot ulcers. In: Boulton AJ, Cavenagh PR, Rayman A, editors. The foot in diabetes. 4th ed. Chichester: Wiley; 2006.Google Scholar
  22. 22.
    Hochlenert D. Qualitätsbericht Netzwerk Diabetischer Fuß Köln und Umgebung 2006; 2007.Google Scholar
  23. 23.
    Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg. 1998;176(2A Suppl):5S–10S.CrossRefPubMedGoogle Scholar
  24. 24.
    Hochlenert D. Qualitätsbericht der Netzwerke Diabetischer Fuß Nordrhein, Hamburg und Berlin. 2017.
  25. 25.
    NHS. National Diabetes Foot Care Audit—2014-2016. 2017. Accessed 23 Mar 2018.
  26. 26.
    Apelqvist J. The diabetic foot syndrome today: a pandemic uprise. In: Piaggesi A, Apelqvist J, editors. The diabetic foot syndrome (frontiers in diabetes). Basel: S. Karger AG; 2018.Google Scholar
  27. 27.
    Kroger K, Berg C, Santosa F, Malyar N, Reinecke H. Lower limb amputation in Germany. Dtsch Arztebl Int. 2017;114(7):130–6. Scholar
  28. 28.
    Lombardo FL, Maggini M, De Bellis A, Seghieri G, Anichini R. Lower extremity amputations in persons with and without diabetes in Italy: 2001-2010. PLoS One. 2014;9(1):e86405. Scholar
  29. 29.
    Rumenapf G, Morbach S. Amputation statistics-how to interpret them? Dtsch Arztebl Int. 2017;114(8):128–9. Scholar
  30. 30.
    Pickwell KM, Siersma VD, Kars M, Holstein PE, Schaper NC, Consortium on behalf of the Eurodiale. Diabetic foot disease: impact of ulcer location on ulcer healing. Diabetes Metab Res Rev. 2013;29(5):377–83. Scholar
  31. 31.
    Apelqvist J, Larsson J, Agardh CD. Long-term prognosis for diabetic patients with foot ulcers. J Intern Med. 1993;233(6):485–91.CrossRefPubMedGoogle Scholar
  32. 32.
    Siersma V, Thorsen H, Holstein PE, Kars M, Apelqvist J, Jude EB, Piaggesi A, et al. Importance of factors determining the low health-related quality of life in people presenting with a diabetic foot ulcer: the Eurodiale study. Diabet Med. 2013.
  33. 33.
    Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia. 2008;51(5):747–55. Scholar
  34. 34.
    Icks A, Scheer M, Morbach S, Genz J, Haastert B, Giani G, Glaeske G, Hoffmann F. Time-dependent impact of diabetes on mortality in patients after major lower extremity amputation: survival in a population-based 5-year cohort in Germany. Diabetes Care. 2011;34(6):1350–4. Scholar
  35. 35.
    Chammas NK, Hill RL, Edmonds ME. Increased mortality in diabetic foot ulcer patients: the significance of ulcer type. J Diabetes Res. 2016;2016:2879809. Scholar
  36. 36.
    Young MJ, McCardle JE, Randall LE, Barclay JI. Improved survival of diabetic foot ulcer patients 1995-2008: possible impact of aggressive cardiovascular risk management. Diabetes Care. 2008;31(11):2143–7. Scholar
  37. 37.
    Game F. Choosing life or limb. Improving survival in the multi-complex diabetic foot patient. Diabetes Metab Res Rev. 2012;28(Suppl 1):97–100. Scholar
  38. 38.
    Pickwell K, Siersma V, Kars M, Apelqvist J, Bakker K, Edmonds M, Holstein P, et al. Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: an observational study. Diabetes Metab Res Rev. 2017;33(3).
  39. 39.
    Siersma V, Thorsen H, Holstein PE, Kars M, Apelqvist J, Jude EB, Piaggesi A, et al. Health-related quality of life predicts major amputation and death, but not healing, in people with diabetes presenting with foot ulcers: the Eurodiale study. Diabetes Care. 2014;37(3):694–700. Scholar
  40. 40.
    Kerr M. Improving footcare for people with diabetes and saving money: an economic study in England. Insight Health Economics. 2017. Accessed 17 Mar 2018.
  41. 41.
    Hauner H. [Epidemiology and costs of diabetes mellitus in Germany]. Dtsch Med Wochenschr. 2005;130 Suppl 2:S64–65.
  42. 42.
    Koster I, Huppertz E, Hauner H, Schubert I. Direct costs of diabetes mellitus in Germany—CoDiM 2000-2007. Exp Clin Endocrinol Diabetes. 2011;119(6):377–85. Scholar
  43. 43.
    Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M, Holstein P, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008;51(10):1826–34. Scholar
  44. 44.
    Bakker K, Dooren J. [A specialized outpatient foot clinic for diabetic patients decreases the number of amputations and is cost saving]. Ned Tijdschr Geneeskd. 1994;138(11):565–9.Google Scholar
  45. 45.
    Hochlenert D. Gesundheitspreis NRW 2012: Netzwerk Diabetischer Fuß Nordrhein (ID-Nr.: 236671). 2012.
  46. 46.
    Schaper NC. Lessons from Eurodiale. Diabetes Metab Res Rev. 2012;28(Suppl 1):21–6. Scholar
  47. 47.
    Sanders LJ, Robbins JM, Edmonds ME. History of the team approach to amputation prevention: pioneers and milestones. J Vasc Surg. 2010;52(3 Suppl):3S–16S. Scholar
  48. 48.
    Kersken J, Gröne C, Lobmann R, Müller E. Die Fußbehandlungseinrichtung der Deutschen Diabetes-Gesellschaft. Diabetologe. 2009;5(2):111–20. Scholar
  49. 49.
    Lobmann R, Müller E, Kersken J, Bergmann K, Brunk-Loch S, Gröne C, Lindloh C, Mertens B, Spraul M. The diabetic foot in Germany: analysis of quality in specialised diabetic footcare centres. Diabetic Foot J. 2007;10(2):68–72.Google Scholar
  50. 50.
    Morbach S, Kersken J, Lobmann R, Nobels F, Doggen K, Van Acker K. The German and Belgian accreditation models for diabetic foot services. Diabetes Metab Res Rev. 2016;32(Suppl 1):318–25. Scholar
  51. 51.
    Hochlenert D, Engels G. Low major amputation rate and low recurrence in networks for treatment of the DFS. In: Abstract Book, X. Diabetic Foot Study Group Meeting Seminaris See Hotel, Berlin-Potsdam, Germany 28–30 Sept 2012; 2012.Google Scholar
  52. 52.
    Risse A, Hochlenert D. Integrierte Versorgung—Neue (?) Versorgungsformen am Beispiel des diabetischen Fußsyndroms. Diabetologe. 2010;2:100–7. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dirk Hochlenert
    • 1
  • Gerald Engels
    • 2
  • Stephan Morbach
    • 3
  • Stefanie Schliwa
    • 4
  • Frances L. Game
    • 5
  1. 1.Amb. Zentrum für DiabetologieEndoskopie & Wundheilung GemeinschaftspraxisKölnGermany
  2. 2.Department of Wound SurgerySt. Vinzenz Hospital and MVZ St. MarienKölnGermany
  3. 3.Department of Diabetes and AngiologyMarienkrankenhaus GmbHSoestGermany
  4. 4.Institute of Anatomy, Anatomy and Cell BiologyUniversity of BonnBonnGermany
  5. 5.Department of Diabetes and EndocrinologyDerby Hospitals NHS Foundation TrustDerbyUK

Personalised recommendations