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The Diabetic Foot

  • Dennis ShavelsonEmail author
  • John Steinberg
  • Bradley W. Bakotic
Reference work entry

Abstract

Diabetes is reaching epidemic proportions and carries the risk of multiple complications. Diseases of the foot are among the most feared complications of diabetes. Physician education plays a significant role in preventing, diagnosing, monitoring, and treating the diseases of the foot. This chapter is designed to provide an overview of both education about and the care of diabetic feet. It contains tables and illustrations meant to allow readers to “take home” important information they can share with patients and colleagues.

As this is the third printing of this text and chapter, we feel obliged to preface this update by stating that researchers found a 52% drop in the incidence of diabetic foot infection in the USA from 1996 to 2010. The findings of a study published in the American Journal of Infection Control also revealed that lower-extremity amputation from diabetic foot infection dropped from 33.2% in 1996 to 17.1% in 2010 (Duhon BM, et al., Am J Infect Control. 2015. doi:10.1016/j.ajic.2015.09.012).

Keywords

Diabetic foot Diabetic wounds Biomechanics Diabetic risk factors Foot typing PreCharcot foot 

References

  1. 1.
    Duhon BM, et al. Prevent care in people with diabetes – NCBI. Am J Infect Control. 2015, doi:10.1016/j.ajic.2015.09.012.Google Scholar
  2. 2.
    Brenner MA, editor. Management of the diabetic foot. New York: Williams and Wilkins; 1987 (chapter 6).Google Scholar
  3. 3.
    Bailey TS, Yu HM, Rayfield EJ. Patterns of foot examination in a diabetes clinic. Am J Med. 1985;78:371–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Mayfield J. Foot examinations reduce the risk of diabetic amputations. J Fam Pract. 1998;49:499–504.Google Scholar
  5. 5.
    American Diabetes Association. Foot care in patients with diabetes mellitus. Diabetes Care. 1998;21:54–8.CrossRefGoogle Scholar
  6. 6.
    Reiber GE, Raugi GJ. A model for foot care in people with diabetes. Lancet. 2005;366:1676–7, 1719–24.CrossRefPubMedGoogle Scholar
  7. 7.
    Barshes NR, Sigireddi M., Wrobel JS., et al. The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diab Foot Ankle. 2013;4. doi:10.3402/dfa.v4i0.21847.Google Scholar
  8. 8.
    Rice B, Desai U, Kate A. Burden of diabetic foot ulcers for medicare and private insurers. Diabetes Care. 2013;Online DC-132176.Google Scholar
  9. 9.
    Rogers L, Lavery L, Armstrong D. The right to bear legs – an amendmentto healthcare: how preventing amputations can save billions for the US Health-care System. J Am Pod Med Assoc. 2008;98(2):166–8. doi:10.2337/dc13-2176.Google Scholar
  10. 10.
    Rivo M. It’s time to start practicing population-based health care. Fam Pract Manag. 1998;5(6):37–46.PubMedGoogle Scholar
  11. 11.
    Boulton AJ, Vileikyte L, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719–24.CrossRefPubMedGoogle Scholar
  12. 12.
    Miller J, Carter C, Shih J, Armstrong D, et al. How to do a three minute diabetic foot exam. J Fam Pract. 2014;63(11):646–9, 653–6.PubMedGoogle Scholar
  13. 13.
    Ragnarson TG, Apelqvist J. Health and economic consequences of diabetic foot lesions. Clin Infect Dis. 2004;39 Suppl 2:S132–9.CrossRefGoogle Scholar
  14. 14.
    Armstrong DG, Lavery LA, Stern S, et al. Is prophylactic diabetes foot surgery dangerous? J Foot Ankle Surg. 1996;35:585–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim P, Attinger C, Evans K. Role of the podiatrist in diabetic limb salvage. J Vasc Surg. 2012;56(4):1168–72.CrossRefPubMedGoogle Scholar
  16. 16.
    LEAPP. Diabetes Care. 1998;21:23–5.CrossRefGoogle Scholar
  17. 17.
    Baek D, Steinberg J. Prophylactic foot surgery in patients with diabetes: is it worth the risk? Podiatr Today. 2008;21(8):238–42.Google Scholar
  18. 18.
    Krelin S, Heisler M, Piette J, et al. The effect of chronic pain on diabetes patients’ self-management. Diabetes Care. 2005;28(1):65–70.CrossRefGoogle Scholar
  19. 19.
    Van Schie J, Boulton A. Biomechanics of the diabetic foot (Chapter 10). In: The diabetic foot, The road to foot ulceration. New York: Humana Press; 2003. p. 185.Google Scholar
  20. 20.
    Shavelson D. Chapter 7: The biomechanics of the diabetic foot. In: Global perspective on diabetic foot ulcerations. InTech Pub. 2011; ISBN:978-953-307-727-7.Google Scholar
  21. 21.
    Kapandji IF. Chapter V: The plantar vault. In: The physiology of the joints: lower limb, The Physiology of the Joints. Elsevier: Churchill and Livingstone. vol. 2. 1988.Google Scholar
  22. 22.
    Fellner D. Tracing the origins of the vault theory of biomechanics-a historical perspective. present podiatry etalk. 30 Nov 2013. https://podiatry.com/etalk/index.php?topicid=14461#-1. Dec 5, 3022:103–28.
  23. 23.
    Gottlieb D. Comprehending Dr Shavelson’s functional foot typing system. Present Podiatry e-talk. 2 Jan 2012. https://www.podiatry.com/etalk/index.php?topicid=8450#-1
  24. 24.
    Peacock D. The peacock press. Podiatry Management Magazine. 2015;137–44.Google Scholar
  25. 25.
    Shavelson D. Aching feet-aching back…Is there a link? Rad the Mag. Fall 2008. http://www.homecareforyou.com/publication/read/article.asp?id=296&cat=27
  26. 26.
    Shavelson DA. Closer look at neoteric biomechanics. Podiatr Today. 2007;234–41.Google Scholar
  27. 27.
    Root ML, Orien WP, Weed JH. Normal and abnormal function of the foot. In: Clinical biomechanics, vol. 2. Los Angeles: Clinical Biomechanics Corp; 1977.Google Scholar
  28. 28.
    Inman VT. In: Mann RA, Inman VT, editors. The joints of the ankle. New York: Williams and Wilkins; 1976.Google Scholar
  29. 29.
    Donatelli R. The biomechanics of the foot and ankle. Philadelphia: FA Davis Comp; 1990.Google Scholar
  30. 30.
    Kevin KA. Biomechanics of the normal and abnormal foot. J Am Podiatr Med Assoc. 2000;90:88–92.Google Scholar
  31. 31.
    Levine P, Shavelson D, Poretsky L. The pre-charcot foot-anew clinical entity to prevent charcot joint disease. Pract Diabetol. 2006;25(3):24–28.Google Scholar
  32. 32.
    Boulton A, Armstrong D, Albert A, Frykberg R. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31(8):1679–85.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Armstrong, Nalini, et al. Preventing Foot Ulcers in Patients with Diabetes. JAMA. 2005;293(2):217–228.Google Scholar
  34. 34.
    Caputo GM. The nylon monofilament test for sensation. N Engl J Med. 1994;331:854–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Frykberg R, editor. The high risk foot in diabetes. New York: Churchill Livingstone; 1991.Google Scholar
  36. 36.
    Armstrong D, Lavery L, Harkless L. Who is at risk for diabetic foot ulceration? Clin Podiatr Med Surg. 1998;15:11–9.PubMedGoogle Scholar
  37. 37.
    Armstrong DG, Harkless LB, et al. Validation of a diabetic wound classification system: the importance of depth, infection and ischaemia. J Am Podiatr Med Assoc. 1998;79:144–53.Google Scholar
  38. 38.
    Alex R, Ratnarai B, Winston B, et al. Risk factors for foot ulcers in patients with diabetes mellitus. Indian J Community Med. 2010;35(1):183–5.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Frykberg R. Team approach toward lower extremity amputation prevention in diabetes. J Am Podiatr Med Assoc. 1997;87:5–12.CrossRefGoogle Scholar
  40. 40.
    Shoiaiefard A, Khorgami Z, Larijani B. Independent risk factors for amputation in diabetic foot. Int J Diab Dev Ctries. 2008;28(2):32–7.CrossRefGoogle Scholar
  41. 41.
    Kim P. Biomechanics of the diabetic foot: consideration in limb salvage. Adv Wound Care. 2013;2(3):107–11.CrossRefGoogle Scholar
  42. 42.
    Ulbrecht J, Hurley T, Cavanagh P. Prevention of recurrent foot ulcers with plantar pressure–based in-shoe orthoses. Diabetes Care. 2014;23:465–74.Google Scholar
  43. 43.
    Brunner J. Does your patient need diabetic therapeutic footwear? (Where benefit, evidence, and bureaucracy collide). Clin Diabetes. 2015;33(2):51–3.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Day MR, Harkless LB. Factors associated with pedal ulceration in patients with diabetes mellitus. J Am Podiatr Med Assoc. 1997;87:365–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Young MJ, Breddy JL, Veves A, et al. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. Diabetes Care. 1994;17:557–62.CrossRefPubMedGoogle Scholar
  46. 46.
    Fisher K, Armstrong D. Your annual comprehensive foot exam. Diabetes Self-Management. 2015. http://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/your-annual-comprehensive-foot-exam/
  47. 47.
    Gemechu F, Seemant F, Curley C. Diabetic foot infections. Am Fam Physician. 2013;88(3):177–84.PubMedGoogle Scholar
  48. 48.
    Alexiado K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;20:1–15.Google Scholar
  49. 49.
    Game F. Obesity and the diabetic foot. Diabesity Pract. 2013;2(3):112–7.Google Scholar
  50. 50.
    Wiebe C. Diabetics with sight problems prefer self-exam of feet. Medscape Medical News’. 2014. http://www.medscape.com/viewarticle/831898
  51. 51.
    The Medicare Therapeutic Shoe Bill. Department of health and human services, medical carriers manual, Section 2134, p2-85.1–2-86. Washington, DC: US Gov’t Printing Office; 1994.Google Scholar
  52. 52.
    Shavelson D. Foundational wellness biomechanics: 2011. Abstract http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=69768. 21 Sept 2011.
  53. 53.
    Armstrong D, Lavery L, Nixon B, Boulton A. Techniques for debriding and off-loading the diabetic foot wound. Clinical Inf Dis (Suppl). 2004;39:592–9.Google Scholar
  54. 54.
    McNeely MJ, Boyko EJ, Ahroni JH, et al. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. Diabetes Care. 1995;18:216–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Bakotic B. Epidermal nerve fiber density testing-an overview. Pod Manage. 2010;141–52.Google Scholar
  56. 56.
    Bril V. Treatments for diabetic neuropathy. J Peripher Nerv Syst. 2012;17(s2):22–7.CrossRefPubMedGoogle Scholar
  57. 57.
    Shavelson D. Chapter 8: Local anesthetics and injectable cortisone. In: Delauro T, editor. Clinics in podiatric medicine and surgery. Philadelphia: W.B. Saunders; 1993.Google Scholar
  58. 58.
    Hounsom L, et al. GLA is effective against multiple indices of experimental diabetic neuropathy. Diabetologia. 1998;41:839–43.CrossRefPubMedGoogle Scholar
  59. 59.
    Mayo Clinic Reports. Alpha Lipoic Acid (ALA) improves symptoms of diabetic neuropathy. Diabetes Care. 2003;5:456–59.Google Scholar
  60. 60.
    Head KA. Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev. 2006:32–37.Google Scholar
  61. 61.
    Sessions J, Nickerson D. Biologic basis of nerve decompression surgery for focal entrapments in diabetic peripheral neuropathy. J Diabetes Sci Technol. 2014;8(2):412–8.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Malhotra R, Chan C, Nather A. Osteomyelitis in the diabetic foot. Diabet Foot Ankle. 2014;5. doi:10.3402/dfa.v5.24445.Google Scholar
  63. 63.
    Marcinko DE. Antibiotic-impregnated polymethyl methacrylate beads. In: Habershaw GM, editor. Infections of the foot: diagnosis and management. St Louis: Mosby-Year Book; 1998. p. 174–6.Google Scholar
  64. 64.
    Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Repair Regen. 1994;2(3):165–70.CrossRefPubMedGoogle Scholar
  65. 65.
    Ucciloi L, Izzo V, Meloni M, et al. Non-healing foot ulcers in diabetic patients: general and local interfering conditions and management options with advanced wound dressings. J Wound Care. 2015;24(4 Suppl):343–56.Google Scholar
  66. 66.
    Motzkau M, Tautenhahn J, Lehnert H, Lobmann R. Expression of matrix-metalloproteases in the fluid of chronic diabetic foot wounds treated with a protease absorbent dressing. Exp Clin Endocrinol Diabetes. 2011;119(5):286–90.CrossRefPubMedGoogle Scholar
  67. 67.
    Nain PS, Uppal SK, Garg R, et al. Role of negative pressure wound therapy in healing of diabetic foot ulcers. J Surg Tech Case Rep. 2011;3(1):17–22.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Thomas A, Thayer W. Debridement of chronic wounds: a review of past & present treatment strategies. Todays Wound Clinic. 2014;8(5).Google Scholar
  69. 69.
    Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer: a randomized study. Diabetes Care. 1996;19:1338–42.CrossRefPubMedGoogle Scholar
  70. 70.
    Snyder RJ, Simonson DA. Cadaveric allograft as adjunct therapy for non-healing wounds. J Foot Ankle Surg. 1999;38:93–101.CrossRefPubMedGoogle Scholar
  71. 71.
    Einhorn DA. The State of Diabetes Complications in America. The American Association of Clinical Endocrinologists 16th Annual Meeting and Clinical Congress, Seattle; 2007.Google Scholar
  72. 72.
    Todd WF, Armstrong DG, Liswood PJ. Evaluation and treatment of the infected foot in a community teaching hospital. J Am Podiatr Med Assoc. 1996;86:421–6.CrossRefPubMedGoogle Scholar
  73. 73.
    Shavelson D. The unequal limb syndrome: biomechanical considerations. J Am Podiatr Med Assoc. 1983;1:18–23.Google Scholar
  74. 74.
    Boulton, A. Diabetic foot what can we learn from leprosy? Legacy of Dr Paul W. Brand. Diabetes Metab Res Rev. Supplement 1, pg 3–7.Google Scholar
  75. 75.
    Falanga V. How to use Apligraf to treat venous ulcers. Skin Aging. 1999;2:30–6.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Dennis Shavelson
    • 1
    Email author
  • John Steinberg
    • 2
  • Bradley W. Bakotic
    • 3
  1. 1.Department of SurgeryBeth Israel Medical Center, Albert Einstein College of MedicineNew YorkUSA
  2. 2.Division of Wound Healing, Department of Plastic SurgeryGeorgetown University School of MedicineWashington DCUSA
  3. 3.Integrated Physician SolutionsAlpharettaUSA

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