Skip to main content
SpringerLink
Log in

Diabetic Foot Ulceration and Management

  • Chapter
  • First Online:
Diabetes and Peripheral Vascular Disease

Part of the book series: Contemporary Diabetes ((CDI))

Abstract

Despite the advancements in medical and surgical care during the past few decades, foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes. The prevalence of foot ulcers in these patients is as high as 25%. Superimposed infection is a frequent (40–80%) and costly complication of these ulcers. The pathophysiologic mechanisms underlying diabetic foot disease are multifactorial and include neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. It is, therefore, not surprising that the management of the diabetic foot is a complex clinical problem requiring a multidisciplinary approach to achieve limb salvage. The fundamentals of good clinical care include adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs. Even when properly managed some of the foot ulcers do not heal and arrest in a state of chronic inflammation. These wound can frequently benefit from various adjuvant therapies, such as recombinant platelet derived growth factor and other growth factors. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Knox RC, Dutch W, Blume P, Sumpio BE. Diabetic foot disease. Int J Angiol. 2000;9(1):1–6.

    Article  PubMed  Google Scholar 

  2. Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg. 1998;176(2A):5S–10.

    Article  PubMed  CAS  Google Scholar 

  3. Boulton AJ. The diabetic foot: a global view. Diabetes Metab Res Rev. 2000;16 Suppl 1:S2–5.

    Article  PubMed  Google Scholar 

  4. Weiss JS, Sumpio BE. Review of prevalence and outcome of vascular disease in patients with diabetes mellitus. Eur J Vasc Endovasc Surg. 2006;31(2):143–50.

    Article  PubMed  CAS  Google Scholar 

  5. Stockl K, Vanderplas A, Tafesse E, Chang E. Costs of lower extremity ulcers among patients with diabetes. Diabetes Care. 2004;27:2129–34.

    Article  PubMed  Google Scholar 

  6. Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29:1288–93.

    Article  PubMed  Google Scholar 

  7. Ellison DA, Hayes L, Lane C, Tracey A, McCollum CN. Evaluating the cost and efficacy of leg ulcer care provided in two large UK health authorities. J Wound Care. 2002;11(2):47–51.

    PubMed  CAS  Google Scholar 

  8. Lloyd A, Sawyer W, Hopkinson P. Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin. Value Health. 2001;4:392–400.

    Article  PubMed  CAS  Google Scholar 

  9. Ragnarson TG, Apelqvist J. Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000;14:235–41.

    Article  Google Scholar 

  10. Goodridge D, Trepman E, Embil JM. Health-related quality of life in diabetic patients with foot ulcers. Literature review. J Wound Ostomy Continence Nurs. 2005;32:368–77.

    Article  PubMed  Google Scholar 

  11. Phillips TJ. Chronic cutaneous ulcers: etiology and epidemiology. J Invest Dermatol. 1994;102(6):38S–41.

    Article  PubMed  CAS  Google Scholar 

  12. Ashford RL, McGee P, Kinmond K. Perception of quality of life by patients with diabetic foot ulcers. Diab Foot. 2000;3:150–5.

    Google Scholar 

  13. Browse NL. The etiology of venous ulceration. World J Surg. 1986;10(6):938–43.

    Article  PubMed  CAS  Google Scholar 

  14. Goldman M, Fronek A. The Alexander House Group: Consensus paper on venous leg ulcers. J Dermatol Surg Oncol. 1992;18:592.

    Google Scholar 

  15. Phillips T, Stanton B, Provan A. A study of the impact of leg ulcers on quality of life: financial, social, and psychological implications. J Am Acad Dermatol. 1994;31:49–53.

    Article  PubMed  CAS  Google Scholar 

  16. Hutton W, Stokes I. The mechanics of the foot. In: Klenerman L, editor. The foot and its disorders. Oxford: Blackwell; 1991. p. 11.

    Google Scholar 

  17. Murray H, Boulton A. The pathophysiology of diabetic foot ulceration. Clin Podiatr Med Surg. 1995;12:1.

    PubMed  CAS  Google Scholar 

  18. Sumpio BE, Armstrong DG, Lavery LA, Andros G. The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. J Vasc Surg. 2010;51(6):1504–6.

    Article  PubMed  Google Scholar 

  19. Sumpio BE, Aruny J, Blume PA. The multidisciplinary approach to limb salvage. Acta Chir Belg. 2004;104(6):647–53.

    PubMed  CAS  Google Scholar 

  20. American Diabetes Association. Preventive foot care in people with diabetes [position statement]. Diabetes Care. 2003;26 Suppl 1:78.

    Google Scholar 

  21. O’Brien IA, Corrall RJ. Epidemiology of diabetes and its complications. N Engl J Med. 1988;318(24):1619–20.

    Article  PubMed  Google Scholar 

  22. Kamal K, Powell RJ, Sumpio BE. The pathobiology of diabetes mellitus: implications for surgeons. J Am Coll Surg. 1996;183(3):271–89.

    PubMed  CAS  Google Scholar 

  23. Laing P. The development and complications of diabetic foot ulcers. Am J Surg. 1998;176(2A):11S–9.

    Article  PubMed  CAS  Google Scholar 

  24. Levin ME. Diabetes and peripheral neuropathy. Diabetes Care. 1998;21(1):1.

    PubMed  CAS  Google Scholar 

  25. Boulton AJ, Hardisty CA, Betts RP, Franks CI, Worth RC, Ward JD, et al. Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care. 1983;6(1):26–33.

    Article  PubMed  CAS  Google Scholar 

  26. Fernando DJ, Masson EA, Veves A, Boulton AJ. Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care. 1991;14(1):8–11.

    Article  PubMed  CAS  Google Scholar 

  27. Lee L, Blume PA, Sumpio B. Charcot joint disease in diabetes mellitus. Ann Vasc Surg. 2003;17(5):571–80.

    Article  PubMed  Google Scholar 

  28. Veves A, Fernando D, Walewski P, et al. A study of plantar pressures in a diabetic clinic population. Foot. 1991;2:89.

    Article  Google Scholar 

  29. Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679–85.

    Article  PubMed  Google Scholar 

  30. Masson E, Hay E, Stockley I, Veves A, Betts R, Boulton A. Abnormal foot pressures alone may not cause ulceration. Diabet Med. 1989;6:426–8.

    Article  PubMed  CAS  Google Scholar 

  31. Morag E, Pammer S, Boulton A, Young M, Deffner K, Cavanagh P. Structural and functional aspects of the diabetic foot. Clin Biomech (Bristol, Avon). 1997;12(3):S9–10.

    Article  Google Scholar 

  32. Saltzman C, Pedowitz W. Diabetic foot infection. AAOS Instr Course Lect. 1999;48:317–23.

    CAS  Google Scholar 

  33. Habershaw G, Chzran J. Management of diabetic foot problems. In: Kozak GP, Campbell DR, Frykberg RG, Habershaw GM, editors. Biomechanical considerations of the diabetic foot. Philadelphia, PA: W.B. Saunders; 1995. p. 53–65.

    Google Scholar 

  34. Sumpio BE. Foot ulcers. N Engl J Med. 2000;343(11):787–93.

    Article  PubMed  CAS  Google Scholar 

  35. Bullock G, Stavosky J. Surgical wound management of the diabetic foot. Surg Technol Int. 2001;6:301–10.

    Google Scholar 

  36. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care. 1989;12(1):24–31.

    Article  PubMed  CAS  Google Scholar 

  37. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979;241(19):2035–8.

    Article  PubMed  CAS  Google Scholar 

  38. Melton 3rd LJ, Macken KM, Palumbo PJ, Elveback LR. Incidence and prevalence of clinical peripheral vascular disease in a population-based cohort of diabetic patients. Diabetes Care. 1980;3(6):650–4.

    Article  PubMed  Google Scholar 

  39. Eggers PW, Gohdes D, Pugh J. Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Int. 1999;56:1524–33.

    Article  PubMed  CAS  Google Scholar 

  40. Lavery LA, Hunt NA, Ndip A, Lavery DC, Van Houtum W, Boulton AJ. Impact of chronic kidney disease on survival after amputation in individuals with diabetes. Diabetes Care. 2010;33(11):2365–9.

    Article  PubMed  Google Scholar 

  41. Johnson BL, Glickman MH, Bandyk DF, Esses GE. Failure of foot salvage in patients end-stage renal disease after surgical revascularization. J Vasc Surg. 1995;22:280–6.

    Article  PubMed  CAS  Google Scholar 

  42. Adam DJ, Naik J, Hartshorne T, Bello M, London NJ. The diagnosis and management of 689 chronic leg ulcers in a single-visit assessment clinic. Eur J Vasc Endovasc Surg. 2003;25(5):462–8.

    Article  PubMed  CAS  Google Scholar 

  43. Weitz JI, Byrne J, Clagett GP, Farkouh ME, Porter JM, Sackett DL, et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation. 1996;94(11):3026–49.

    Article  PubMed  CAS  Google Scholar 

  44. Pressley Z, Foster J, Kolm P, Zhao L, Warren F, Weintraub W, et al. Digital image analysis: a reliable tool in the quantitative evaluation of cutaneous lesions and beyond. Arch Dermatol. 2007;143(10):1331–3.

    Article  PubMed  Google Scholar 

  45. Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995;273(9):721–3.

    Article  PubMed  CAS  Google Scholar 

  46. Lozano RM, Fernández LG, Hernández DM, Montesinos JVB, Jiménez SG, Jurado MAG. Validating the probe-to-bone test and other tests for diagnosing chronic osteomyelitis in the diabetic foot. Diabetes Care. 2010;33:2140–5.

    Article  Google Scholar 

  47. Collins KA, Sumpio BE. Vascular assessment. Clin Podiatr Med Surg. 2000;17(2):171–91.

    PubMed  CAS  Google Scholar 

  48. Feng Y, Schlosser FJ, Sumpio BE. The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg. 2009;50(3):675–82, 682.e1.

    Google Scholar 

  49. Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. Am Fam Physician. 1998;57(6):1325–32, 1337-8.

    Google Scholar 

  50. Birke J, Sims D. Plantar sensory threshold in the ulcerative foot. Lepr Rev. 1986;57:261.

    PubMed  CAS  Google Scholar 

  51. McNeely M, Boyko E, Ahroni J, Stensel V, Reiber G, Smith D. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration: how great are the risks? Diabetes Care. 1995;18:216–9.

    Article  PubMed  CAS  Google Scholar 

  52. Feng Y, Schlosser FJ, Sumpio BE. The Semmes Weinstein monofilament examination is a significant predictor of the risk of foot ulceration and amputation in patients with diabetes mellitus. J Vasc Surg. 2011;53(1):220–226.e1–5.

    Article  PubMed  Google Scholar 

  53. Cossman DV, Ellison JE, Wagner WH, Carroll RM, Treiman RL, Foran RF, et al. Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vasc Surg. 1989;10:522–9.

    PubMed  CAS  Google Scholar 

  54. Sumpio BE, Lee T, Blume PA. Vascular evaluation and arterial reconstruction of the diabetic foot. Clin Podiatr Med Surg. 2003;20(4):689–708.

    Article  PubMed  Google Scholar 

  55. Steed DL, Donohoe D, Webster MW, Lindsley L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg. 1996;183(1):61–4.

    PubMed  CAS  Google Scholar 

  56. Sumpio BE, Driver V, Gibbons G, Holloway G, Joseph W, McGuigan F, et al. A Multidisciplinary approach to limb preservation – the role of VAC therapy. Wounds. 2009;21(9 Suppl 2):1–19.

    Google Scholar 

  57. Granick M, Boykin J, Gamelli R, Schultz G, Tenenhaus M. Toward a common language: surgical wound bed preparation and debridement. Wound Repair Regen. 2006;14 Suppl 1:S1–10.

    Article  PubMed  Google Scholar 

  58. Bergstrom N, Bennett M, Carlson C. Treatment of pressure ulcers. Clinical practice guidelines, no. 15 (AHCPR publication no. 95-0652). Rockville, MD: Agency for Health Care Policy and Research; 1994. p. 1–102.

    Google Scholar 

  59. Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med. 1999;341(10):738–46.

    Article  PubMed  CAS  Google Scholar 

  60. Blume P, Driver VR, Tallis AJ, Kirsner RS, Kroeker R, Payne WG, et al. Formulated collagen gel accelerates healing rate immediately after application in patients with diabetic neuropathic foot ulcers. Wound Repair Regen. 2011;19:302–8.

    Article  PubMed  Google Scholar 

  61. Bello YM, Phillips TJ. Recent advances in wound healing. JAMA. 2000;283(6):716–8.

    Article  PubMed  CAS  Google Scholar 

  62. Lipsky BA, Armstrong DG, Citron DM, Tice AD, Morgenstern DE, Abramson MA. Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial. Lancet. 2005;366(9498):1695–703.

    Article  PubMed  CAS  Google Scholar 

  63. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885–910.

    Article  PubMed  Google Scholar 

  64. Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341(25):1906–12.

    Article  PubMed  CAS  Google Scholar 

  65. Davis SC, Martinez L, Kirsner R. The diabetic foot: the importance of biofilms and wound bed preparation. Curr Diab Rep. 2006;6(6):439–45.

    Article  PubMed  CAS  Google Scholar 

  66. Lipsky BA, Tabak YP, Johannes RS, Vo L, Hyde L, Weigelt JA. Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost. Diabetologia. 2010;53:914–23.

    Article  PubMed  CAS  Google Scholar 

  67. 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(9):2819–28.

    Article  PubMed  Google Scholar 

  68. Nelson EA, O’Meara S, Golder S, Dalton J, Craig D, Iglesias C. Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med. 2006;23:348–59.

    Article  PubMed  CAS  Google Scholar 

  69. Blume P, Partagas L, Attinger C, Sumpio B. Single stage surgical treatment of noninfected diabetic foot ulcers. J Plast Reconstr Surg. 2002;109:601–9.

    Article  Google Scholar 

  70. Blume P, Salonga C, Garbalosa J, Pierre-Paul D, Key J, Gahtan V, et al. Predictors for the healing of transmetatarsal amputations: retrospective study of 91 amputations. Vascular. 2007;15(3):126–33.

    Article  PubMed  Google Scholar 

  71. Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, et al. The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev. 2008;24 Suppl 1:S162–80.

    Article  PubMed  Google Scholar 

  72. Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, et al. Specific guidelines on footwear and offloading. Diabetes Metab Res Rev. 2008;24 Suppl 1:S192–3.

    Article  PubMed  Google Scholar 

  73. Armstrong D, Lavery L, Stern S, Harkless L. Is prophylactic diabetic foot surgery dangerous? J Foot Ankle Surg. 1996;35(6):585–9.

    Article  PubMed  CAS  Google Scholar 

  74. Catanzariti A, Blitch E, Karlock L. Elective foot and ankle surgery in the diabetic patient. J Foot Ankle Surg. 1995;34(1):23–41.

    Article  PubMed  CAS  Google Scholar 

  75. Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE, Gurtner GC, et al. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009;146(1):40–51.

    Article  PubMed  Google Scholar 

  76. Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631–6.

    Article  PubMed  Google Scholar 

  77. Vig S, Dowsett C, Berg L, Caravaggi C, Rome P, Birke-Sorensen H, et al. International Expert Panel on Negative Pressure Wound Therapy. Evidence-based recommendations for the use of negative pressure wound therapy in chronic wounds: steps towards an international consensus. J Tissue Viability. 2011;20 Suppl 1:S1–18.

    Google Scholar 

  78. Blume PA, Key JJ, Thakor P, Thakor S, Sumpio B. Retrospective evaluation of clinical outcomes in subjects with split-thickness skin graft: comparing V.A.C.® therapy and conventional therapy in foot and ankle reconstructive surgeries. Int Wound J. 2010;7(6):480–7.

    Article  PubMed  Google Scholar 

  79. Sumpio BE, Thakor P, Mahler D, Blume PA. Negative pressure wound therapy as postoperative dressing in below knee amputation stump closure of patients with chronic venous insufficiency. Wounds. 2011;23(10):301–8.

    Google Scholar 

  80. Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE, Gurtner GC, et al. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009;146(1):40–51.

    Article  PubMed  Google Scholar 

  81. Sumpio BE, Allie DE, Horvath KA, Marston WA, Meites HL, Mills JL, et al. Role of negative pressure wound therapy in treating peripheral vascular graft infections. Vascular. 2008;16(4):194–200.

    Article  PubMed  Google Scholar 

  82. Barrow J, Hughes J, Clark P. A study of the effect of wear on the pressure-relieving properties of foot orthosis. Foot. 1992;1:195–9.

    Article  Google Scholar 

  83. Nawoczenski D, Birke J, Coleman W. Effect of rocker sole design on plantar forefoot pressures. J Am Podiatr Med Assoc. 1988;78:455–60.

    PubMed  CAS  Google Scholar 

  84. Tang PC, Ravji K, Key JJ, Mahler DB, Blume PA, Sumpio B. Let them walk! Current prosthesis options for leg and foot amputees. J Am Coll Surg. 2008;206(3):548–60.

    Article  PubMed  Google Scholar 

  85. Sarage A, Yui W, Blume P, Aruny J, Sumpio B. Aggressive revascularization options using cryoplasty in patients with lower extremity vascular disease. In: Geroulakos G, editor. Re-do vascular surgery. London: Springer; 2009. p. 79–84.

    Google Scholar 

  86. Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003;26(6):1879–82.

    Article  PubMed  Google Scholar 

  87. Margolis DJ, Bartus C, Hoffstad O, Malay S, Berlin JA. Effectiveness of recombinant human platelet-derived growth factor for the treatment of diabetic neuropathic foot ulcers. Wound Repair Regen. 2005;13:531–6.

    Article  PubMed  Google Scholar 

  88. Steed DL, Attinger C, Colaizzi T, Crossland M, Franz M, Harkless L, et al. Guidelines for the treatment of diabetic ulcers. Wound Repair Regen. 2006;14(6):680–92.

    Article  PubMed  Google Scholar 

  89. Veves A, Falanga V, Armstrong DG, Sabolinski ML. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care. 2001;24:290–5.

    Article  PubMed  CAS  Google Scholar 

  90. Boulton AJ, Kirsner RS, Vileikyte L. Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med. 2004;351(1):48–55.

    Article  PubMed  CAS  Google Scholar 

  91. DCCT: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977–86.

    Google Scholar 

  92. American Diabetes Association. Executive summary: standards of medical care in diabetes – 2011. Diabetes Care. 2011;34 Suppl 1:S4–10.

    Google Scholar 

  93. Tan T, Shaw EJ, Siddiqui F, Kandaswamy P, Barry PW, Baker M, Guideline Development Group. Inpatient management of diabetic foot problems: summary of NICE guidance. BMJ. 2011;342:d1280.

    Article  PubMed  CAS  Google Scholar 

  94. McMurray SD, Johnson G, Davis S, McDougall K. Diabetes education and care management significantly improve patient outcomes in the dialysis unit. Am J Kidney Dis. 2003;40:566–75.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Yale School of Medicine, 508 Blake St., New Haven, CT, 06515, USA

    Peter A. Blume D.P.M., F.A.C.F.A.S.

  2. Department of Orthopedics and Rehabilitation, Yale School of Medicine, 508 Blake St., New Haven, CT, 06515, USA

    Peter A. Blume D.P.M., F.A.C.F.A.S.

  3. Section of Vascular Surgery, Yale University, New Haven, CT, USA

    Akhilesh K. Jain M.D.

  4. Department of Vascular Surgery, Yale School of Medicine, New Haven, CT, USA

    Bauer Sumpio M.D., Ph.D.

Authors
  1. Peter A. Blume D.P.M., F.A.C.F.A.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akhilesh K. Jain M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bauer Sumpio M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter A. Blume D.P.M., F.A.C.F.A.S. .

Editor information

Editors and Affiliations

  1. Columbia University College of Physician, Division of Vascular Surgery, New York Presbyterian Hospital, 72 East 93rd Street, Apt 2 AB, New York, 10128, New York, USA

    Gautam V. Shrikhande

  2. Columbia University College of Physician, Division of Vascular Surgery, New York Presbyterian Hospital, 161 Fort Washington Ave. Suite 535, New York, 10032, New York, USA

    James F. McKinsey

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Blume, P.A., Jain, A.K., Sumpio, B. (2012). Diabetic Foot Ulceration and Management. In: Shrikhande, G., McKinsey, J. (eds) Diabetes and Peripheral Vascular Disease. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-158-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-62703-158-5_6

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-157-8

  • Online ISBN: 978-1-62703-158-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation