Atlas of the Diabetic Foot

Ioanna Eleftheriadou, Alexandros Kokkinos, Stavros Liatis, Konstantinos Makrilakis, Nicholas Tentolouris, Anastasios Tentolouris, Panagiotis Tsapogas

• Publisher: Wiley-Blackwell
• Year: 2019
• ISBN:
  9781119255307
• Edition: 3
• Topic: Medicina
• Subtopic: Endocrinologia e metabolismo

The revised and updated third edition of the essential guide to the diagnosis and treatment of the diabetic foot

The revised third edition of the Atlas of the Diabetic Foot is an updated guide to the information needed for the prevention and treatment of diabetic foot problems with the aim of reducing amputations. In addition to offering the theoretical knowledge, the book is filled with more than 500 color photos from real-life cases. The cases explore a wide-variety of foot issues and the text includes information about differential diagnosis and treatment. The authors—noted experts in the field—describe the epidemiology, pathophysiology and classification of diabetic foot ulcers. In addition, the book highlights the diagnosis of the main risk factors for the diabetic foot, namely diabetic neuropathy, peripheral arterial disease and the anatomic deformities of the lower extremities.

The updated third edition, include 5 videos that clearly demonstrate the methods of examination for diabetic neuropathy and peripheral arterial disease. The text incldues methods of callus removal and debridement as well as offloading. In addition, it contains information on how a total contact cast is constructed. This essential resource:

• Contains a full colour presentation of diabetic foot cases
• Explains the prevention and treatment of diabetic foot problems in a revised and updated edition
• Includes a larger format that allows for a better quality images
• Offers a companion website with high-resolution digital files of photographs of the case studies presented
• Presents a multidisciplinary approach appropriate for a wide audience foot and diabetic professionals

Written for diabetes specialists, endocrinologists and diabetic nurse specialists, podiatrists and podiatry nurse specialists, Atlas of the Diabetic Foot offers the information needed to help with the prevention, diagnosis and management of the diabetic foot.

1
Introduction

N. Tentolouris

First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece

1.1 Definition

Diabetic foot is defined as the presence of infection, ulceration and/or destruction of deep tissues associated with neurologic abnormalities and various degrees of peripheral arterial disease (PAD) in the lower limb in patients with diabetes.

1.2 Epidemiology

The prevalence of foot ulceration in the general diabetic population is 4–10%, being lower (1.5–3.5%) in young and higher (5–10%) in older patients. The annual incidence of foot ulceration ranges from less than 1 to 3.6% among people with type 1 or type 2 diabetes. It is estimated that about 5% of patients with diabetes have a history of foot ulceration, whereas the lifetime risk for this complication today is between 19 and 34%. A selection of epidemiologic data on diabetic foot problems from large studies are summarized in Table 1.1. In a community‐based study in the northwestern United Kingdom, the prevalence of active foot ulcers identified at screening among persons with diabetes was 1.7%, and the annual incidence was 2.2%. Higher annual incidence rates have been reported in specific populations: 6.0% among Medicare beneficiaries with diabetes, 5.0% among U.S. veterans with diabetes, and 6.3% in the global population of persons with diabetes.

Table 1.1 Epidemiological data on the diabetic foot.

Reference	Country	Population‐ or clinic‐based	Prevalence (%)		Incidence
			Foot ulcers	Amputation	Foot ulcers	Amputation
Borssen et al. (1990)	Sweden	Population	0.75	–	–	–
McLeod et al. (1991)	UK	Clinic	2.6	2.1	–	–
Walters et al. 1992	UK	Population	7.4	‐	–	–
Moss et al. (1992)	USA	Population	–	3.6	10.1^a	2.1^a
Bouter et al. (1993)	The Netherlands	Population	–	–	0.8^b	0.4
Siitonen et al. (1993)	Finland	Population			–	0.5
Pendsey et al. (1994)	India	Clinic	3.6	–	–	–
Kumar et al. (1994)	UK	Population	1.4	–	–	–
Humphrey et al. (1996)	Nauru	Population	–	–	–	0.76
Abbott et al. (2002)	UK	Population	1.7	1.3	2.2	–
Mueller et al. (2002)	The Netherlands	Population	–	–	2.1	0.6
Centers for Disease Control and Prevention (2003)	USA	Population	11.8	–	–	–
Lavery et al. (2003)	USA	Population	–	–	6.8	0.6
Manes et al. (2002)	Balkan region	Clinic	7.6	–	–	–

^a Incidence over four years. Data from the Balkan region include Albania, Bulgaria, Greece, Romania, Serbia and the Former Republic of Macedonia.

^b Include annual incidence of foot ulcers in patients hospitalized for foot problems.

There are ethnic differences in the prevalence of foot problems. Foot ulcers are more common in Caucasians than in Asian patients of the Indian subcontinent. This difference may be related to physical factors (a lower prevalence of limited joint mobility and lower plantar pressures in Asians) and to better foot care in certain religious groups such as Muslims. The risk for foot ulcers is higher in black, Native American and Hispanic American individuals in comparison to white Americans.

It is thought that foot ulcers are more common on the plantar aspect of the feet. However, clinic‐based data from 10 European countries participating in the European Study Group on Diabetes and the Lower Extremity (EURODIALE) project showed that 48% of the ulcers affect the plantar aspect of the feet, while 58% are in non‐plantar areas. Similar findings have been reported by other authors.

The majority ...