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Diabetic Foot: Ulcer, Infection, Ischemic Gangrene

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Foot and Ankle Disorders

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References

  1. Johnson JE, Klein SE, Brodsky JW. Diabetes. In: Coughlin MJ, Saltzman CL, Anderson RB, editors. Mann’s surgery of the foot and ankle. Philadelphia: Mosby; 2013. p. 1385–480.

    Google Scholar 

  2. Cho NH. The epidemiology of diabetes in Korea: from the economics to genetics. Korean Diabetes J. 2010;34(1):10–5.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Lavery LA, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288–93.

    Article  PubMed  Google Scholar 

  4. Holewski JJ, et al. Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic. J Rehabil Res Dev. 1989;26(3):35–44.

    CAS  PubMed  Google Scholar 

  5. Abbott CA, 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(5):377–84.

    Article  CAS  PubMed  Google Scholar 

  6. Lavery LA, Peters EJ, Armstrong DG. What are the most effective interventions in preventing diabetic foot ulcers? Int Wound J. 2008;5(3):425–33.

    Article  PubMed  Google Scholar 

  7. Brand PW, Ebner JD. Pressure sensitive devices for denervated hands and feet. A preliminary communication. J Bone Joint Surg Am. 1969;51(1):109–16.

    CAS  PubMed  Google Scholar 

  8. Masson EA, et al. Abnormal foot pressures alone may not cause ulceration. Diabet Med. 1989;6(5):426–8.

    Article  CAS  PubMed  Google Scholar 

  9. Prompers L, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007;50(1):18–25.

    Article  CAS  PubMed  Google Scholar 

  10. Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132–73.

    Article  PubMed  Google Scholar 

  11. Peters EJ, Lavery LA, Armstrong DG. Diabetic lower extremity infection: influence of physical, psychological, and social factors. J Diabetes Complications. 2005;19(2):107–12.

    Article  PubMed  Google Scholar 

  12. Richard JL, et al. Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. Diabetes Metab. 2011;37(3):208–15.

    Article  PubMed  Google Scholar 

  13. Lipsky BA, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39(7):885–910.

    Article  PubMed  Google Scholar 

  14. Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26(3–4):259–65.

    Article  CAS  PubMed  Google Scholar 

  15. Cutting KF, White R. Defined and refined: criteria for identifying wound infection revisited. Br J Community Nurs. 2004;9(3):S6–S15.

    Article  PubMed  Google Scholar 

  16. Brodsky JW. Evaluation of the diabetic foot. Instr Course Lect. 1999;48:289–303.

    CAS  PubMed  Google Scholar 

  17. Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg. 1996;35(6):528–31.

    Article  CAS  PubMed  Google Scholar 

  18. Oyibo SO, et al. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24(1):84–8.

    Article  CAS  PubMed  Google Scholar 

  19. Schaper N. 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(S1):S90–5.

    Article  PubMed  Google Scholar 

  20. Lavery LA, et al. Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system. Clin Infect Dis. 2007;44(4):562–5.

    Article  PubMed  Google Scholar 

  21. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28.

    Article  CAS  PubMed  Google Scholar 

  22. Aerden D, et al. The ankle--brachial index and the diabetic foot: a troublesome marriage. Ann Vasc Surg. 2011;25(6):770–7.

    Article  PubMed  Google Scholar 

  23. 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 

  24. Graziani L, et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg. 2007;33(4):453–60.

    Article  CAS  PubMed  Google Scholar 

  25. Weledji EP, Fokam P. Treatment of the diabetic foot – to amputate or not? BMC Surg. 2014;14:83.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Walls MC, Thavendiranathan P, Rajagopalan S. Advances in CT angiography for peripheral arterial disease. Cardiol Clin. 2011;29(3):331–40.

    Article  PubMed  Google Scholar 

  27. Cavanagh PR, et al. Radiographic abnormalities in the feet of patients with diabetic neuropathy. Diabetes Care. 1994;17(3):201–9.

    Article  CAS  PubMed  Google Scholar 

  28. Sanverdi SE, ErgenBF, OznurA. Current challenges in imaging of the diabetic foot. Diabetic Foot Ankle. 2012;3.

    Google Scholar 

  29. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008;47(4):519–27.

    Article  PubMed  Google Scholar 

  30. Jeffcoate WJ, Lipsky BA. Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. Clin Infect Dis. 2004;39 Suppl 2:S115–22.

    Article  PubMed  Google Scholar 

  31. Rajbhandari S, et al. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45(8):1085–96.

    Article  CAS  PubMed  Google Scholar 

  32. Donovan A, Schweitzer ME. Current concepts in imaging diabetic pedal osteomyelitis. Radiol Clin North Am. 2008;46(6):1105–24, vii.

    Article  PubMed  Google Scholar 

  33. Armstrong DG, Harkless LB. Outcomes of preventative care in a diabetic foot specialty clinic. J Foot Ankle Surg. 1998;37(6):460–6.

    Article  CAS  PubMed  Google Scholar 

  34. Tan PL, Teh J. MRI of the diabetic foot: differentiation of infection from neuropathic change. Br J Radiol. 2007;80(959):939–48.

    Article  CAS  PubMed  Google Scholar 

  35. Loredo RA, Garcia G, Chhaya S. Medical imaging of the diabetic foot. Clin Podiatr Med Surg. 2007;24(3):397–424, viii.

    Article  PubMed  Google Scholar 

  36. Becker W. Imaging osteomyelitis and the diabetic foot. Q J Nucl Med. 1999;43(1):9–20.

    CAS  PubMed  Google Scholar 

  37. Palestro CJ, Love C. Nuclear medicine and diabetic foot infections. Semin Nucl Med. 2009;39(1):52–65.

    Article  PubMed  Google Scholar 

  38. Delcourt A, et al. Comparison between Leukoscan (Sulesomab) and Gallium-67 for the diagnosis of osteomyelitis in the diabetic foot. Diabetes Metab. 2005;31(2):125–33.

    Article  CAS  PubMed  Google Scholar 

  39. Loredo R, et al. Imaging of the diabetic foot diagnostic dilemmas. Foot Ankle Spec. 2010;3(5):249–64.

    Article  PubMed  Google Scholar 

  40. Eneroth M, Larsson J, Apelqvist J. Deep foot infections in patients with diabetes and foot ulcer: an entity with different characteristics, treatments, and prognosis. J Diabetes Complications. 1999;13(5):254–63.

    Article  CAS  PubMed  Google Scholar 

  41. Armstrong DG, et al. Leukocytosis is a poor indicator of acute osteomyelitis of the foot in diabetes mellitus. J Foot Ankle Surg. 1996;35(4):280–3.

    Article  CAS  PubMed  Google Scholar 

  42. Eneroth M, Apelqvist J, Stenstrom A. Clinical characteristics and outcome in 223 diabetic patients with deep foot infections. Foot Ankle Int. 1997;18(11):716–22.

    Article  CAS  PubMed  Google Scholar 

  43. Akanji AO, Famuyiwa OO, Adetuyibi A. Factors influencing the outcome of treatment of foot lesions in Nigerian patients with diabetes mellitus. Q J Med. 1989;73(271):1005–14.

    CAS  PubMed  Google Scholar 

  44. Lipsky BA, et al. Clinical predictors of treatment failure for diabetic foot infections: data from a prospective trial. Int Wound J. 2007;4(1):30–8.

    Article  PubMed  Google Scholar 

  45. Fleischer AE, et al. Post-treatment leukocytosis predicts an unfavorable clinical response in patients with moderate to severe diabetic foot infections. J Foot Ankle Surg. 2011;50(5):541–6.

    Article  PubMed  Google Scholar 

  46. Jeandrot A, et al. Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study. Diabetologia. 2008;51(2):347–52.

    Article  CAS  PubMed  Google Scholar 

  47. Cierny G, et al. Orthopaedic knowledge update: musculoskeletal infection. Rosemont: American Academy of Orthopaedic Surgeons; 2009.

    Google Scholar 

  48. Chakraborti C, Le C, Yanofsky A. Sensitivity of superficial cultures in lower extremity wounds. J Hosp Med. 2010;5(7):415–20.

    Article  PubMed  Google Scholar 

  49. Gardner SE, et al. Diagnostic validity of three swab techniques for identifying chronic wound infection. Wound Repair Regen. 2006;14(5):548–57.

    Article  PubMed  Google Scholar 

  50. Angel DE, et al. The clinical efficacy of two semi-quantitative wound-swabbing techniques in identifying the causative organism(s) in infected cutaneous wounds. Int Wound J. 2011;8(2):176–85.

    Article  PubMed  Google Scholar 

  51. Cardinal M, et al. Early healing rates and wound area measurements are reliable predictors of later complete wound closure. Wound Repair Regen. 2008;16(1):19–22.

    Article  PubMed  Google Scholar 

  52. Ince P, Game FL, Jeffcoate WJ. Rate of healing of neuropathic ulcers of the foot in diabetes and its relationship to ulcer duration and ulcer area. Diabetes Care. 2007;30(3):660–3.

    Article  PubMed  Google Scholar 

  53. Taylor Jr LM, Porter JM. The clinical course of diabetics who require emergent foot surgery because of infection or ischemia. J Vasc Surg. 1987;6(5):454–9.

    Article  PubMed  Google Scholar 

  54. Gibbons GW. Lower extremity bypass in patients with diabetic foot ulcers. Surg Clin North Am. 2003;83(3):659–69.

    Article  PubMed  Google Scholar 

  55. Faglia E, et al. Limb revascularization feasibility in diabetic patients with critical limb ischemia: results from a cohort of 344 consecutive unselected diabetic patients evaluated in 2009. Diabetes Res Clin Pract. 2012;95(3):364–71.

    Article  PubMed  Google Scholar 

  56. Zhu YQ, et al. Subintimal angioplasty for below-the-ankle arterial occlusions in diabetic patients with chronic critical limb ischemia. J Endovasc Ther. 2009;16(5):604–12.

    Article  PubMed  Google Scholar 

  57. Jain AKC, Varma AK, Mangalanandan, Kumar H. Revascularization in the diabetic lower limb. J Diabetic Foot Complications. 2013;5(1):18–23.

    Google Scholar 

  58. Boulton AJM. Diabetic foot – what can we learn from leprosy? Legacy of Dr Paul W. Brand. Diabetes Metab Res Rev. 2012;28:3–7.

    Article  PubMed  Google Scholar 

  59. Martin RL, Conti SF. Plantar pressure analysis of diabetic rocker bottom deformity in total contact casts. Foot Ankle Int. 1996;17(8):470–2.

    Article  CAS  PubMed  Google Scholar 

  60. Sinacore DR. Healing times of diabetic ulcers in the presence of fixed deformities of the foot using total contact casting. Foot Ankle Int. 1998;19(9):613–8.

    Article  CAS  PubMed  Google Scholar 

  61. Walker SC, Helm PA, Pullium G. Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. Arch Phys Med Rehabil. 1987;68(4):217–21.

    CAS  PubMed  Google Scholar 

  62. Hartsell HD, Brand RA, Saltzman CL. Total contact casting: its effect on contralateral plantar foot pressure. Foot Ankle Int. 2002;23(4):330–4.

    PubMed  Google Scholar 

  63. Shaw JE, et al. The mechanism of plantar unloading in total contact casts: implications for design and clinical use. Foot Ankle Int. 1997;18(12):809–17.

    Article  CAS  PubMed  Google Scholar 

  64. Leibner ED, et al. Unloading mechanism in the total contact cast. Foot Ankle Int. 2006;27(4):281–5.

    PubMed  Google Scholar 

  65. Lewis J, Lipp A. Pressure-relieving interventions for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2013;1:CD002302.

    Google Scholar 

  66. Goodman J, et al. Risk factors in local surgical procedures for diabetic gangrene. Surg Gynecol Obstet. 1976;143(4):587–91.

    CAS  PubMed  Google Scholar 

  67. Attinger CE, et al. Clinical approach to wounds: debridement and wound bed preparation including the use of dressings and wound-healing adjuvants. Plast Reconstr Surg. 2006;117(7 Suppl):72S–109S.

    Article  CAS  PubMed  Google Scholar 

  68. Attinger CE, Bulan E, Blume PA. Surgical debridement. The key to successful wound healing and reconstruction. Clin Podiatr Med Surg. 2000;17(4):599–630.

    CAS  PubMed  Google Scholar 

  69. Rao N, Lipsky BA. Optimising antimicrobial therapy in diabetic foot infections. Drugs. 2007;67(2):195–214.

    Article  CAS  PubMed  Google Scholar 

  70. Chantelau E, et al. Antibiotic treatment for uncomplicated neuropathic forefoot ulcers in diabetes: a controlled trial. Diabet Med. 1996;13(2):156–9.

    Article  CAS  PubMed  Google Scholar 

  71. Lipsky BA. Empirical therapy for diabetic foot infections: are there clinical clues to guide antibiotic selection? Clin Microbiol Infect. 2007;13(4):351–3.

    Article  CAS  PubMed  Google Scholar 

  72. Ramakant P, et al. Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia. 2011;54(1):58–64.

    Article  CAS  PubMed  Google Scholar 

  73. Vermeulen H, et al. Dressings and topical agents for surgical wounds healing by secondary intention. Cochrane Database Syst Rev. 2004;(2):CD003554.

    Google Scholar 

  74. Bergin SM, Wraight P. Silver based wound dressings and topical agents for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2006;(1):CD005082.

    Google Scholar 

  75. Ubbink DT, et al. Topical negative pressure for treating chronic wounds. Cochrane Database Syst Rev. 2008;(3):CD001898.

    Google Scholar 

  76. Zgonis T, Stapleton JJ, Roukis TS. Advanced plastic surgery techniques for soft tissue coverage of the diabetic foot. Clin Podiatr Med Surg. 2007;24(3):547–68, x.

    Article  PubMed  Google Scholar 

  77. Levin LS. The reconstructive ladder. An orthoplastic approach. Orthop Clin North Am. 1993;24(3):393–409.

    CAS  PubMed  Google Scholar 

  78. Robson MC. Wound infection. A failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am. 1997;77(3):637–50.

    Article  CAS  PubMed  Google Scholar 

  79. Izumi Y, et al. Mortality of first-time amputees in diabetics: a 10-year observation. Diabetes Res Clin Pract. 2009;83(1):126–31.

    Article  PubMed  Google Scholar 

  80. Evans KK, et al. The importance of limb preservation in the diabetic population. J Diabetes Complications. 2011;25(4):227–31.

    Article  PubMed  Google Scholar 

  81. Armstrong DG, Wrobel J, Robbins JM. Guest editorial: are diabetes-related wounds and amputations worse than cancer. Int Wound J. 2007;4(4):286–87.

    Article  PubMed  Google Scholar 

  82. Brodsky JW, Saltzman CL. Amputation of the foot and ankle. In: Coughlin MJ, Saltzman CL, Anderson RB, editors. Mann’s surgery of the foot and ankle. Philadelphia: Mosby; 2013. p. 1481–506.

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea

    Jae-Yong Park MD, PhD

  2. Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea

    Hong-Geun Jung MD, PhD

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  1. Jae-Yong Park MD, PhD
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Editors and Affiliations

  1. Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea (Republic of)

    Hong-Geun JUNG

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Park, JY., Jung, HG. (2016). Diabetic Foot: Ulcer, Infection, Ischemic Gangrene. In: JUNG, HG. (eds) Foot and Ankle Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54493-4_18

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