Abstract
Diabetic foot ulcers continue to pose a serious threat to patients with diabetes. The presence of an ulcer significantly increases the risk of amputation. Although treatment of an ulcer depends on the combination of medical and surgical management, many ulcers will heal with conservative care. Local care of the diabetic foot requires that the practitioner have the ability not only to treat ulcerations but also to recognize these problems early on so as to prevent their worsening. This knowledge is paramount for healing diabetic ulcers and preventing infection and subsequent amputation. The goal of healing the diabetic foot in the outpatient setting focuses on maintaining an intact skin envelope. If this fails, infection may develop and amputation may ensue. It is the goal of the practitioner to recognize the at-risk diabetic foot as well as address those problems that may give rise to infection and amputation (1,2).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Thomson FJ, Veves A, Ashe H, et al. A team approach to diabetic foot care the Manchester experience. Foot 1991;1:75–82.
Edmonds ME, Blundell MP, Morris HE, et al. Improved survival of the diabetic foot: the role of the specialist foot clinic. Q J Med 1986;232:763–771.
Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle 1981; 2:64.
Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg 1996;35:528–531.
Olmos PR, Cataland S, O’Dorisio TM, et al. The Semmes–Weinstein monofilament as a potential predictor of foot ulceration in patients with noninsulin–dependent diabetes. Am J Med Sci 1995;309:76–82.
Veves A, Masson EA, Fernando DJS, Boulton AIM. Use of experimental padded hosiery to reduce foot pressures in diabetic neuropathy. Diabetes Care 1989;12:653–655.
Veves A, Masson EA, Fernando DJS, Boulton AIM. Studies of experimental hosiery in diabetic neuropathic patients with high foot pressures. Diabet Med 1990;7:324–326.
Young MJ, Cavanagh PR, Thomas G, et al. The effect of callus removal on dynamic plantar pressures in diabetic patients. Diabet Med 1992;9:55–57.
Joseph WS, Axler DA. Microbiology and antimicrobial therapy of diabetic foot infections. Clin Podiatr Med Surg 1990;7:467–481.
Caputo OM, Cavanagh PR, Ulbrecht JS, Gibbons OW, Karchmer AW. Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994;331:854–860.
Eaglestein W, Falanga V. Chronic wounds. Surg Clin North Am 1997;77:689–700.
Steed DL, Diabetic Ulcer Study Group. Clinical evaluation of recombinant human platelet–derived growth factor for the treatment of lower extremity diabetic ulcers. J Vasc Surg 1995;21:71–81.
Steed DL, Donohoe D, Webster MW, Lindsley L. Diabetic Ulcer Study Group. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. JAm Coll Surg 1996;183:61–64.
Young MJ, Veves A, Boulton AJM. The diabetic foot: aetiopathogenesis and management. Diabetes Metab Rev 1993;9:109–127.
Pollard JP, LeQuesne LP. Methods of healing diabetic forefoot ulcers. BMJ 1983;286: 436–437.
Burden AC, Jones OR, Jones R, Blandford RL. Use of the Scotchcast boot in treating diabetic foot ulcers. BMJ 1983;286:1555–1557.
Coleman WC, Brand PW, Birke JA. The total contact cast: a therapy for plantar ulcerations on insensitive feet. J Am Podiatr Assoc 1984;74:548–552.
Mueller MJ, Diamond JE, Sinacore DR. Total contact casting in treatment of diabetic plantar ulcers. Diabetes Care 1989;12:384–388.
Ritz G, Kushner D, Friedman S. A successful technique for the treatment of diabetic neurotrophic ulcers. J Am Podiatr Med Assoc 1992;82:479–481.
Giurini J. Diabetic ulcers. J Am Podiatr Med Assoc 1992;82:594.
Kucan JO, Robson MC, Heggers JP, Ko F. Comparison of silver sulfadiazine, povidoneiodine and physiologic saline in the treatment of chronic pressure ulcers. J Am Geriatr Soc 1981;29:232–235.
Lineweaver W, Howard R, Soucy D, et al. Topical antimicrobial activity. Arch Surg 1985; 120:267–270.
Gudas CJ. Prophylactic surgery in the diabetic foot. Clin Podiatr Med Surg 1987;4:445–458.
Tillo TH, Oiurini JM, Habershaw OM, Chrzan JS, Rowbotham JL. Review of metatarsal osteotomies for the treatment of neuropathic ulcerations. J Am Podiatr Med Assoc 1990;80: 211–217.
Jacobs RL. Hoffman procedure in the ulcerated diabetic neuropathic foot. Foot Ankle 1982; 3:142–149.
Giurini JM, Basile P, Chrzan JS, Habershaw GM, Rosenblum BI. Panmetatarsal head resection: a viable alternative to the transmetatarsal amputation. JAm Podiatr Med Assoc 1993; 83:101–107.
Giurini JM, Rosenblum HI. The role of foot surgery in patients with diabetes. Clin Podiatr Med Surg 1995;12:119–127.
Rosenblum BI, Giurini JM, Chrzan JS, Habershaw GM. Preventing loss of the great toe with the hallux interphalangeal joint arthroplasty. J Foot Ankle Surg 1994;33:557–560.
Newman LG, Waller J, Palestro CJ, et al. Unsuspected osteomyelitis in diabetic foot ulcers: diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline. JAMA 1991;266:1246–1251.
Keenan AM, Tindel NL, Alavi A. Diagnosis of pedal osteomyelitis in diabetic patients using current scintigraphic techniques. Arch Intern Med 1989;149:2262–2266.
Grayson ML, Gibbons GW, Halogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients. JAMA 1995; 273:721–723.
Hetherington VJ. Technetium and combined gallium and technetium scans in the neurotrophic foot. J Am Podiatr Assoc 1982;72:458–463.
Morrison WB, Schweitzer ME, Wapner KL, et al. Osteomyelitis in feet of diabetics: clinical accuracy, surgical utility, and cost–effectiveness of MR imaging. Radiology 1995;196: 557–564.
Yuh WTC, Corson ILL, Baraniewski HM, et al. Osteomyelitis of the foot in diabetic patients: evaluation with plain film, Tc–MDP bone scintigraphy, and MR imaging. AJR 1989;152: 795–800.
Gibbons GW. The diabetic foot: amputations and drainage of infection. J Vasc Surg 1987;5: 791–793.
Wheat LJ, Allen SD, Henry M, et al. Diabetic foot infections: bacteriologic analysis. Arch Intern Med 1986;146:1935–1940.
Taylor LM, Porter JM. The clinical course of diabetic patients who require emergent foot surgery because of infection or ischemia. J Vasc Surg 1987;6:454–459.
LoGerfo FW, Gibbons GW, Pomposelli FH Jr, et al. Trends in the care of the diabetic foot: Expanded role of arterial reconstruction. Arch Surg 1992;127:617–621.
Attinger CE. Use of soft tissue techniques for the salvage of the diabetic foot, in Medical and Surgical Management of the Diabetic Foot (Kominsky SJ, ed.), Mosby–Year Book, Boston, 1994.
Gibbons OW, Marcaccio EJ Jr, Burgess AM, et al. Improved quality of diabetic foot care, 1984 vs 1990: reduced length of stay and costs, insufficient reimbursement. Arch Surg 1993; 128:576–581.
Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. N Engl J Med 1994;331:854–860.
Edmonds M, Foster A, Oreenhill M, et al. Acute septic vasculitis not diabetic micro angiopathy leads to digital necrosis in the neuropathic foot. Diabet Med 1992;9(Suppl):P85.
Klamer TW, Towne JB, Bandyk DF, Bonner MJ. The influence of sepsis and ischemia on the natural history of the diabetic foot. Am Surg 1987;53:490–494
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2002 Springer Science+Business Media New York
About this chapter
Cite this chapter
Basile, P., Rosenblum, B.I. (2002). Local Care of the Diabetic Foot. In: Veves, A., Giurini, J.M., LoGerfo, F.W. (eds) The Diabetic Foot. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-168-8_14
Download citation
DOI: https://doi.org/10.1007/978-1-59259-168-8_14
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-61737-253-7
Online ISBN: 978-1-59259-168-8
eBook Packages: Springer Book Archive