The Foot in Diabetes

Name: The Foot in Diabetes
Brand: Wiley-Blackwell
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Andrew J. M. Boulton Gerry Rayman Dane K. Wukich(Herausgeber*in)

Wiley-Blackwell (Verlag)

5. Auflage

Erschienen am 9. April 2020

568 Seiten

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Inhalt

Cover
Title Page
Copyright Page
Contents
List of Contributors
Preface
Introduction
References
Chapter 1 Epidemiology and Economic Impact of Foot Ulcers
1.1 Introduction
1.2 Diabetic Foot Ulcer (DFU) Definition
1.3 DFU Classification
1.4 DFU Incidence and Prevalence
1.5 DFU Recurrence
1.6 Risk Factors for Diabetic Foot Ulcers and Lower Extremity Amputation
1.7 Diabetic Foot Ulcer Outcomes
1.7.1 Health Centred Outcomes
1.7.2 Patient Centred Outcomes
1.8 Economic Considerations
References
Chapter 2 Cost of Diabetic Foot Disease in England
2.1 Introduction
2.2 Human Costs
2.2.1 Prevalence and Incidence
2.2.2 Quality of Life
2.2.3 Mortality
2.3 Financial Costs
2.4 Why Measure Costs?
2.5 Establishing Healthcare Priorities
2.5.1 Care Quality and Scope for Improvement
2.5.2 Clinical Effectiveness
2.5.3 Cost Effectiveness
2.6 Conclusions
References
Chapter 3 Epidemiology of Amputation and the Influence of Ethnicity
3.1 Why Study the Epidemiology of LEA?
3.2 LEA Incidence Study Design: The Risk of Bias
3.3 LEA Risk Assessment Study Design
3.4 Risk Factors for LEA
3.5 Incidence Rates of LEA
3.6 International and Regional Differences
3.7 Time Trends in LEA Rates
3.8 Ethnic Differences in Diabetes-Related LEA
3.8.1 Why Study Ethnic Differences in LEA?
3.9 Ethnic Differences in Diabetes-Related LEA Risk
3.9.1 Native Americans
3.9.2 Hispanic Americans
3.9.3 Populations of Black African Descent
3.10 Indian Asians
References
Chapter 4a The Diabetic Foot Worldwide: India
4a.1 Introduction
4a.2 Epidemiology of Diabetes in India
4a.3 Socio Economic Burden Due to Diabetes
4a.4 Common Risk Factors for Amputation in India
4a.5 Diagnosing High Risk Feet in Developing Countries
4a.6 Comparison in Risk Factors between India and the Western World
4a.7 DFI as a Cause for Declining Kidney Function
4a.8 Helping People with Amputation Cope Up with the Disability
References
Chapter 4b The Diabetic Foot Worldwide: Pakistan
4b.1 Introduction
4b.1.1 Burden of Diabetes and Diabetic Foot
4b.2 Concept of Multidisciplinary Diabetic Foot Care Team (MDFCT)
4b.3 Nationwide Diabetic Foot Programme (Step by Step-[SbS])
4b.4 Footwear for Every Diabetic (FED)
4b.5 Further Steps Ahead of SbS
References
Chapter 4c The Diabetic Foot Worldwide: Sub-Saharan Africa
4c.1 Introduction
4c.2 Pathophysiology of Foot Ulcers
4c.3 Peripheral Neuropathy (PN)
4c.4 Peripheral Arterial Diseases (PAD)
4c.5 Foot Ulceration in SSA
4c.6 Foot Infection
4c.7 Amputation
4c.8 Mortality
4c.9 Prevention
4c.9.1 Step by Step Foot Project
4c.9.2 Train the Foot Trainer (TtFT) Project
4c.10 Conclusions
References
Chapter 4d Burden of Diabetic Foot Disease in Brazil
References
Chapter 4e Diabetic Foot in Romania and Eastern Europe
4e.1 Introduction
4e.2 The Aim
4e.3 Diabetic Foot in Romania
4e.4 Diabetic Foot in Eastern Europe
4e.5 Conclusions
References
Chapter 4f Diabetic Foot Worldwide: Pacific Region
References
Chapter 4g The Diabetic Foot Worldwide: Middle East
4g.1 The Burden of Diabetic Foot Disease (DFD) in the Middle East (ME)
4g.2 Specific Regional Barriers to Healthy Feet and Foot Care
4g.2.1 Fatalism
4g.2.2 Complementary or Alternative Medicine (CAM)
4g.2.3 Healers' Popular Medicine
4g.3 Misconceptions
4g.3.1 Sedentary Life:
4g.3.2 Religious Practices
4g.4 Footwear
4g.5 Foot Care, Education and Awareness
References
Chapter 4h The Diabetic Foot Worldwide: Australasia
4h.1 Introduction
4h.2 Australia
4h.3 New Zealand
4h.4 Pacific Islands
References
4h.5 Conclusion
Chapter 5 Diabetic Neuropathy
5.1 Epidemiology
5.2 Classification
5.3 Symmetrical Neuropathies
5.3.1 Distal Symmetrical Polyneuropathy
5.3.2 Acute Painful Neuropathies
5.4 Asymmetrical Neuropathies
5.4.1 Proximal Motor Neuropathy (Femoral Neuropathy, Amyotrophy, Plexopathy)
5.4.2 Focal Peripheral Neuropathies
5.4.3 Pressure Palsies
5.5 Pathogenesis of Distal Symmetrical Neuropathy
5.5.1 Central Nervous System Involvement in Diabetic Neuropathy
5.6 Management of Diabetic Neuropathy
5.6.1 Prevention of Diabetic Neuropathy
5.6.2 Symptomatic Treatment of Painful Diabetic Neuropathy
References
Chapter 6 The Pathway to Ulceration: Aetiopathogenesis and Screening
6.1 Introduction
6.2 Peripheral Arterial Disease (PAD)
6.3 Diabetic Neuropathy
6.3.1 Sensorimotor Neuropathy
6.3.2 Peripheral Sympathetic Autonomic Neuropathy
6.4 Neuropathy: The Major Contributory Factor in Ulceration
6.5 Other Risk Factors for Foot Ulceration
6.5.1 Age and Duration of Diabetes
6.5.2 Sex
6.5.3 Previous Foot Ulceration
6.5.4 Other Diabetic Microvascular Complications
6.5.5 Race
6.5.6 Motor Neuropathy
6.5.7 Oedema
6.5.8 Callus
6.5.9 Deformity
6.5.10 Transplantation
6.6 Assessment of Foot Ulcer Risk
6.7 The Pathway to Ulceration
6.8 Mechanical Factors and Neuropathic Foot Ulceration
6.9 The Patient with Sensory Loss
References
Chapter 7 Biomechanics of the Diabetic Foot for the Uninitiated
7.1 Introduction
7.2 The Concept of Pressure and its Measurement
7.3 The Role of Elevated Plantar Pressure in Foot Ulceration
7.4 Mechanisms of Elevated Plantar Pressure
7.5 Foot Biomechanics in Treating a Plantar Foot Ulcer
7.6 Biomechanical Issues in Preventing a Foot Ulcer
7.7 Summary
Acknowledgement
References
Chapter 8 Psychological and Behavioural Aspects of Diabetic Foot Ulceration
8.1 The Role of Psychological and Behavioural Factors in DFU Development
8.1.1 Depression and Incident DFUs
8.1.2 DFU-Specific Emotional Distress Versus Depression in Shaping Foot Self-Care
8.1.3 Patient Cognitive Representations of DFU Risk and Preventive Foot Self-Care
8.2 The Role of Psychological and Behavioural Factors in DFU Healing
8.2.1 The Impact of Depression on DFU Healing
8.2.2 Determinants of Adherence to Offloading in DFU Healing
8.2.3 Predictors of Depression in Patients at High DFU Risk
8.2.4 Physical Activity and DFU Healing
8.3 The Impact of DFUs on Patients' Health Status and QoL
8.4 Measuring QoL in DFU Patients: Generic, DFU-Specific or Combined Approach?
Acknowledgement
References
Chapter 9 What Role for the Plain Radiograph of the Diabetic Foot?
9.1 Introduction
9.1.1 Image Resolution
9.1.2 Radiographic Projections
9.1.3 Patient Preparation
9.1.4 Serial Radiography
9.2 Pathologies
9.2.1 Vasculopathy
9.2.2 Fracture
9.2.3 Osteomyelitis and Soft Tissue Infection
9.2.4 Charcot Neuroarthropathy
9.2.5 Gout
9.2.6 Normal Appearances
9.2.7 Clinical Information
9.3 Summary
References
Chapter 10 Advanced Cross-Sectional Radiology-Ultrasound, Computed Tomography and Magnetic Resonance Imaging of the Diabetic Foot
10.1 Introduction
10.2 Pathophysiology of Diabetic Foot Disease
10.2.1 Imaging Modalities
10.2.2 Future Directions
Disclosures
References
Chapter 11 Gait and Exercise Training in Diabetic Peripheral Neuropathy
11.1 Introduction
11.2 Gait Characteristics of People with Diabetes
11.3 Muscle Forces and the Biomechanics of Gait in Diabetes
11.4 Biomechanical Strategies to Alter Gait in Diabetic Peripheral Neuropathy
11.5 Falls and Diabetic Peripheral Neuropathy
11.6 Biomechanical Factors Leading to Increased Fall Risk
11.7 Diabetic Peripheral Neuropathy and Balance during Gait
11.8 Exercise and Diabetic Peripheral Neuropathy
11.9 Effects of Exercise in Patients with Diabetic Peripheral Neuropathy on Gait and Balance
11.10 The Case for Resistance Exercise Training
References
Chapter 12 Smart Technology for the Diabetic Foot in Remission
12.1 Background
12.2 Technologies to Guide the Prescription of Footwear-Related Offloading Treatments
12.3 Technologies to Facilitate Triaging those at High Risk of DFU
12.4 Technologies to Manage Dose of Physical Activities in People with Diabetes and Insensate Foot
12.5 Using Technology to Improve Patient Education for Effective Prevention of Diabetic Foot Ulcers
12.6 Mobile Health (mHealth) to Manage Diabetic Foot Ulcers
12.7 Internet of Things and Remote Management of Diabetic Foot Ulcers
12.8 Technologies to Facilitate Delivering of Therapy at Home and Reduce Risk of DFU
12.9 Conclusion
References
Chapter 13 How to Assess the Quality of Clinical Trials for Diabetic Foot Ulcer Therapies
13.1 Introduction
13.2 Hierarchy of Evidence
13.3 Items to Be Considered in Assessing Trials of Diabetic Foot Ulcer Therapies
13.4 The Population
13.5 The Person and Limb
13.6 The Ulcer
13.6.1 Area and Depth
13.6.2 Site
13.6.3 Infection
13.7 The Therapy
13.8 Outcomes
13.8.1 Person Outcomes
13.8.2 Limb Outcomes
13.8.3 Ulcer-Related Outcomes
13.8.3.1 Healing
13.9 Adverse Events
13.10 21 Point Checklist
References
Chapter 14a Bypass in Diabetic Peripheral Artery Disease
14a.1 Identifying Significant PAD Amongst Patients Presenting with Foot Ulcers
14a.2 Relative Benefits and Risks: Identifying Patients Who May Benefit from a Leg Bypass Operation
14a.3 Evaluating Relevant Vascular Anatomy for Planning a Bypass Operation
14a.4 The Operation and Early In-Hospital Recovery
14a.5 Follow-Up After a Leg Bypass Operation
References
Chapter 14b Surgery or Endovascular Intervention in Diabetic Peripheral Vascular Disease
14b.1 Introduction
14b.2 Background
14b.3 Diagnosis
14b.4 Management
14b.5 Endovascular Revascularization
14b.5.1 Technique
14b.5.2 Advantages
14b.6 Results
14b.6.1 Open Vs. Endovascular Revascularizations
14b.6.2 Superficial Femoral Artery/Popliteal Artery Revascularization
14b.6.3 Tibial Revascularization
14b.7 Complications
14b.8 Conclusion
References
Chapter 15 Inpatient Diabetic Foot Care: A UK Perspective
15.1 Introduction
15.2 The Burden of Inpatient Diabetes
15.3 The Burden of Inpatient Diabetic Foot Disease
15.4 Recommended Foot Care for Inpatients with Diabetes
15.4.1 Multidisciplinary Foot Services
15.4.2 Simple Foot Examination on Admission
15.5 Summary
Disclosures
References
Chapter 16 Diagnosis and Management of Infection in the Diabetic Foot
16.1 Introduction
16.2 Pathophysiology of Infections in Persons with Diabetes Mellitus
16.3 Risk Factors for DFI
16.4 Clinical Signs and Symptoms
16.5 Classification
16.6 Microbiology
16.7 Treatment
16.7.1 Uninfected Ulcers
16.7.2 Infected Ulcers
16.8 IWGDF Grade 4 (Severe) Infections
16.8.1 Adjunctive Treatments
16.8.2 Topical Treatment
16.8.3 Revascularisation
16.8.4 Hyperbaric Oxygen Therapy
16.9 Osteomyelitis
16.9.1 Overview
16.9.2 Diagnosis
16.9.3 Treatment
References
Chapter 17 Surgical Approach to Diabetic Foot Infections
17.1 Introduction
17.2 Initial Evaluation
17.3 Initial Surgical Intervention
17.4 After Initial Surgical Intervention
17.5 Staged Surgical Intervention and Wound Closure
17.6 Surgical Offloading
17.7 Soft Tissue/Tendon Balancing and Definitive Osseous Surgical Reconstruction
17.8 Decision for Proximal Level Amputation
17.9 Conclusions
References
Chapter 18 The Evidence Base for the Choice of Dressings in the Management of Diabetic Foot Ulcers
18.1 The Problems
18.1.1 Failure of DFUs to Heal Promptly
18.1.2 Cost
18.1.3 Need for Evidence
18.2 Quality of Evidence
18.3 The Definition of a Dressing
18.4 The Roles of the Dressing
18.5 Basic Aspects of Wound Care
18.6 Evidence for Potential Contributions of Dressings and Wound Applications to Improve Wound Healing
18.6.1 Debridement
18.6.2 Hydrotherapy
18.6.3 Antiseptic Preparations
18.6.4 Honey
18.6.5 Other Components of Dressing Products
18.6.6 Acellular Wound Care Products and Skin Grafts
18.6.7 Topical Gases
18.7 Other Therapies which May Modulate Healing of Chronic Wounds
18.7.1 Negative Pressure Wound Therapy (NPWT)
18.7.2 Dressings which May Modulate Matrix Metalloproteinases
18.8 Summary
Conflicts of Interest
References
Chapter 19 Pathogenesis of Charcot Neuroarthropathy and Acute Management
19.1 Introduction
19.2 Pathogenesis of CN
19.2.1 From Fundamental Theories to a Novel Understanding of the Diabetic Charcot Foot
19.2.2 The Clinical Impact of Neuropathy on Bone
19.2.3 Neuropeptides
19.2.4 Anomalous Inflammatory Response to Trauma in CN
19.2.5 What Is the Link Between Inflammation and Bone Resorption in CN: Evidence from Clinical and In Vitro Studies and Histological Analysis of Bone Specimen
19.2.6 Why Only a Small Proportion of Patients with Neuropathy Develop CN - Is there a Genetic Predisposition?
19.3 Acute Management of CN
19.3.1 Presentation
19.3.2 Investigations and Diagnosis
19.3.3 Treatment
19.3.4 Pharmacological Therapies
19.4 Conclusions
References
Chapter 20 Surgical Reconstruction of the Charcot Foot
20.1 Introduction
20.2 Indications for Surgical Reconstruction
20.3 Radiographic Predictors for Ulceration
20.4 Timing of Surgery
20.5 Preoperative Medical Workup
20.5.1 Assessment for Peripheral Arterial Disease
20.6 Glycemic Control
20.7 Vitamin D
20.8 Renal Function
20.9 Procedures/Outcome Studies
20.9.1 Exostectomy
20.9.2 Realignment Arthrodesis
20.9.3 Ancillary Procedures
20.10 Outcomes of Charcot Reconstruction
20.11 Summary of Evidence Based Recommendations
References
Chapter 21 Amputation in the Diabetic Foot
21.1 Introduction
21.2 Impediments to Rehabilitation in the Diabetic Amputee
21.3 The Lower Extremity as an Organ of Weight Bearing
21.4 Metabolic Cost of Walking with an Amputation
21.5 Limb Salvage vs. Amputation
21.6 Amputation Level Selection
21.7 The Terminal Organ of Weight Bearing
21.8 The Soft Tissue Envelope
21.9 Tissue Management
21.10 Outcomes Following Amputation
21.11 Surgical Amputation Levels
21.11.1 Hallux Amputation
21.12 Lesser Toe Amputation
21.13 Ray Resection
21.14 Midfoot Amputation
21.15 Hindfoot Amputation
21.16 Symes's Ankle Disarticulation Amputation
21.17 Transtibial Amputation
21.18 Knee Disarticulation Amputation
21.19 Transfemoral Amputation
21.20 Conclusions
References
Chapter 22 Rehabilitation of the Amputee
22.1 Lower Limb Amputation and Prosthetics
22.2 Foot Amputations
22.3 Foot Orthotics
22.3.1 Proximal Foot Amputations
22.4 Transtibial Amputations
22.4.1 Transtibial Sockets
22.4.2 Suspension
22.4.3 Shank
22.5 Ankle/Foot Components
22.5.1 Knee Disarticulation Amputations
22.5.2 Transfemoral Amputation
22.5.3 Socket and Suspension
22.5.4 Knee Units
22.6 Conclusion
References
Chapter 23 Surgery for the Diabetic Foot: Prophylactic and Osteomyelitis Surgery - Is there an Evidence Base?
23.1 The Role of Surgery Preventing Occurrence and Recurrence of Foot Ulcers
23.2 Preoperative Care
23.3 Hallux and First Metatarsal Head Procedures
23.4 Lesser Toes
23.5 Lesser Metatarsal Heads
23.6 Tendon Achilles Lengthening
23.7 Curative Surgery for Treating Diabetic Foot Osteomyelitis
23.8 Surgery of Forefoot Osteomyelitis
23.9 Surgery of Midfoot Osteomyelitis
23.10 Surgery of Rear Foot Osteomyelitis
References
Chapter 24 Footwear and Orthoses for People with Diabetes
24.1 Introduction
24.2 What is a Therapeutic Shoe for a Person Living with Diabetes?
24.2.1 The Shoe Upper
24.2.2 Slip-On, Laces or Velcro?
24.2.3 Orthoses
24.2.4 Rigid Outsoles (Rocker and Roller Shoes)
24.2.5 Customizing Offloading for Individuals Using Plantar Pressure Measurement
24.2.6 Offloading by Plantar Area at Risk
24.2.7 Footwear Modification Versus Surgery
24.3 Who Needs Therapeutic Shoes?
24.4 Choosing the Appropriate Footwear for the Patient with LOPS
24.4.1 Shoe 'Break-in'
24.4.2 The Diabetic Patient with an Ulcer
24.4.3 The Diabetic Patient with a Recently Healed Ulcer
24.4.4 The Charcot Patient
24.4.5 Going Home with the Patient
24.5 Summary and Future Trends
Acknowledgement
Conflict of Interest Statement
References
Chapter 25 The Diabetic Foot in Remission
25.1 The Diabetic Foot in Remission
25.2 Maintaining Remission
25.2.1 Offloading
25.2.2 Surgical Offloading
25.2.3 Patient Education and Self-Management
25.2.4 Persistent Monitoring Technologies
25.3 Conclusion
References
Chapter 26 Setting up a Diabetic Foot Clinic
26.1 Natural History of the Diabetic Foot
26.2 Principles of Care of the Diabetic Foot
26.3 Space for the Diabetic Foot Clinic
26.4 Personnel for the Diabetic Foot Clinic
26.4.1 Role of the Podiatrist
26.4.2 Role of the Diabetologist
26.4.3 Role of the Nurse
26.4.4 Role of the Orthotist
26.4.5 Role of the Orthopaedic Surgeon
26.4.6 Role of the Vascular Surgeon
26.4.7 Role of the Plastic Surgeon
26.4.8 Role of the Interventional Radiologist
26.4.9 Role of the Vascular Scientist
26.4.10 Role of the Microbiologist
26.4.11 Role of the Pharmacist
26.4.12 Role of the Physiotherapist and Occupational Therapist
26.4.13 Role of the Dermatologist
26.4.14 Role of the Psychiatrist
26.5 Organisation of the Diabetic Foot Clinic
26.5.1 Treating Emergency Patients with Open Access to the Clinic
26.5.2 Organisation of the Clinic Including Joint Specialist Clinics
26.5.3 Joint Orthopaedic Clinic
26.5.4 Joint Vascular Clinic
26.5.5 The Multidisciplinary Vascular Radiology Meeting
26.5.6 Joint Plastic Clinic
26.5.7 Outpatient Parenteral Antibiotic Therapy (OPAT)
26.5.8 In-Patient Care
26.5.9 Reception of Patients and Administration
26.5.10 Leadership
26.5.11 Activities Other than Patient Care in the Diabetic Foot Clinic
26.6 Conclusion
References
Chapter 27 National Audit of Diabetic Foot Care: Continuing Audit Is Essential for the Delivery of Optimal Care of Diabetic Foot Ulcers
27.1 Why Should We Document the Outcome of Routine Care?
27.2 General Principles of Clinical Audit
27.2.1 Choice of Outcome Measures for Clinical Audit of Foot Care in Diabetes
27.2.2 Definition of the Population
27.2.3 Choice of Outcome Measure
27.2.4 Closing the Loop
27.3 National Diabetes Foot Care Audit of England and Wales
27.3.1 Design of the NDFA
27.3.2 The Findings of the NDFA from 2014 to 2017
27.3.3 Other Audit Initiatives
References
Chapter 28 Regenerative Medicine and the Diabetic Foot
28.1 Introduction
28.2 Stem Cells
28.3 Diabetes and Healing Impairment
28.4 Diabetes and Vascular Dysfunction
28.5 Functional Heterogeneity of Stem Cells
28.6 Advances in Regenerative Therapy
28.7 Conclusion
References
Chapter 29 Role of the Plastic Surgeon in Diabetic Foot Care
Synopsis
29.1 Introduction
29.2 Multidisciplinary Approach and the Spectrum of Care
29.3 Reconstruction Algorithm
29.4 Debridement (this Is Covered in Detail in another Chapter)
29.5 Evaluating and Enhancing the Vascular Status
29.6 Skin Grafts and Substitutes
29.7 Local Flaps
29.8 Free Flaps
29.9 Amputation
29.10 Conclusion
References
Chapter 30a Algorithms for Diabetic Foot Care: Management of the Hot Swollen Foot
References
Chapter 30b Approach to a New Diabetic Foot Ulceration
30b.1 Introduction
30b.2 Clinical Care for the Management of DFU
30b.2.1 Patient Assessment
30b.2.2 DFU Assessment
30b.2.3 Footwear
30b.2.4 Imaging
30b.2.5 Laboratory Blood Panel
30b.3 Management of DFU
Box 30b.2
30b.3.1 Wound Control
30b.3.2 Vascular Control
30b.3.3 Mechanical Control
30b.3.4 Microbiological Control
30b.3.5 Metabolic Control and Management of Comorbidities
30b.3.6 Education
30b.4 Structural Care Process in DFU Management
References
Chapter 30c Algorithms for Diabetic Foot Care: Vascular Evaluation
30c.1 Introduction
30c.2 Methods of Vascular Evaluation - Detecting Peripheral Artery Disease
30c.2.1 History and Examination
30c.2.2 Non-invasive Bedside Testing
30c.3 Vascular Imaging
30c.3.1 Colour Doppler Ultrasound
30c.3.2 Multidetector-Row Computed Tomography Angiography (MD-CTA)
30c.3.3 Contrast Enhanced Magnetic Resonance Angiography (CE-MRA)
30c.3.4 Intra-Arterial Digital Subtraction Angiography
30c.3.5 Vascular Evaluation - Example Algorithms
30c.4 Conclusions
References
Chapter 30d Algorithms for Diagnosis and Management of Infection in the Diabetic Foot
30d.1 Diagnosis of Infection
30d.2 Therapy of Infection
References
Index
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