Management of Diabetic Foot Complications

227 Pages·2015·4.793 MB·English

by  Clifford P. Shearman (eds.)

Clifford P. Shearman
Editor
Management of
Diabetic Foot
Complications
123
Management of Diabetic Foot
Complications

Clifford P. Shearman
Editor

Management of
Diabetic Foot
Complications
Editor
Clifford P. Shearman
Vascular Surgery
Southampton General Hospital
Southampton
UK
ISBN 978-1-4471-4524-0 ISBN 978-1-4471-4525-7 (eBook)
DOI 10.1007/978-1-4471-4525-7
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2015932099
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Pref ace
D iabetes is becoming a major challenge for societies the
world over, and foot complications are one of the most com-
mon complications associated with this disease. Foot ulcer-
ation and infection not only impact on the patients’ quality of
life but also significantly increase their risk of losing their leg,
which is a devastating outcome for most people. It is a costly
condition to treat.
Foot complications are difficult to prevent and treat when
they do occur. However, encouragingly the message about
care for patients at risk of developing foot complications is
that it needs to be well organised and prompt. Unlike many
services it is not a matter of acquiring new technology,
increasing personnel or expensive medications. The team is
there and all the facilities needed to manage these patients
are available. All too often, however, the teams are poorly
coordinated. Sometimes being part of a foot care service
team feels like playing in a football team, the members of
which have never met, the positions haven’t been decided
and no one knows the rules. It must be even worse for the
patient. Where it has been possible to bring together the team
across primary and secondary care and identify clear care
pathways, the results have been staggering: a dramatic reduc-
tion in major amputations, fewer hospital admissions, and
reduced costs to the health economy.
This handbook has been written by podiatrists, nurses and
doctors, all of whom are working in the field of diabetes foot
care. They have described their experiences and how they
address clinical challenges. The book is divided into preven-
tion and early management, revascularisation of the ischaemic
v
vi Preface
limb, prevention of recurrence and how to structure a team.
I hope this will provide useful information to anyone respon-
sible for the care of people with diabetes who may be at risk
of developing foot complications.
Southampton, Hampshire, UK Clifford P. Shearman
Contents
1 Foot Complications in Diabetes: The Problem. . . . 1
Clifford P. Shearman
2 Screening and Treatment of Early Complications
in the Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Graham C. Bowen
3 Emergency Management of the Acute
Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Abigail H. M. Morbi and Clifford P. Shearman
4 Managing Diabetes in People
with Foot Complications. . . . . . . . . . . . . . . . . . . . . . . 39
Mayank Patel and Keith G. McCormick
5 Predicting Wound Healing in the Diabetic Foot:
Measuring Skin Viability . . . . . . . . . . . . . . . . . . . . . . 51
Javier Aragón-Sánchez and Rajgopal Mani
6 Imaging in the Patient with Foot Complications. . . 65
Duncan F. Ettles and Lynn Ling
7 Treatment of Infection in the Diabetic Foot:
The Use of Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . 77
Anthony R. Berendt
8 Endovascular Revascularisation:
When and How . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Andrew J . Wigham and Raman Uberoi
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viii Contents
9 Surgical Revascularisation of the Diabetic Foot. . . 113
Paul W. Moxey and Patrick F. S. Chong
10 Amputation Above the Ankle:
Achieving the Best Outcome for the Patient. . . . . . 127
Nicola Storer , Marie Hulse , Ian M. Nordon ,
and Stephen J. Baxter
11 Neuro-osteoarthropathy: The Charcot
Foot – Pathology, Diagnosis, and Treatment . . . . . . 143
William J. Jeffcoate
12 The Role of the Orthopaedic Surgeon
in Diabetic Foot Complications. . . . . . . . . . . . . . . . . 155
Gavin W. Bowyer
13 Cardiovascular Risks in People
with Diabetes Foot Complications . . . . . . . . . . . . . . 165
Martin Fox and Lisa Jane Lainton
14 Foot Care and the Prevention
of Recurrent Ulcers. . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Laurie King
15 Foot Deformity and Pressure Management
in the Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . 191
David A. Russell
16 The Role of the Multidisciplinary Team
in the Management of Diabetic
Foot Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Stella Vig and Kathryn H. Waite
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Contributors
Javier Aragón-Sánchez, MD, PhD Department of Surgery,
Diabetic Foot Unit and Endoluminal Therapy , La Paloma
Hospital , Las Palmas de Gran Canaria , Spain
Stephen J. Baxter, MB, ChB, FCS Departments of
Cardiovascular and Thoracic Surgery , University Hospital
Southampton , Southampton , Hampshire , UK
Anthony R. Berendt, BM, BCh, FRCP Bone Infection
Unit , Nuffield Orthopaedic Centre, Oxford University
Hospitals NHS Trust , Oxford , Oxfordshire , UK
Graham C . Bowen, BSc Hons, FCPodMed Department of
Podiatry, Solent NHS Trust, St. James Hospital , Portsmouth ,
Hampshire , UK
Gavin W. Bowyer, MChir, FRCS(Orth) Department of
Trauma and Orthopaedics , University Hospital
Southampton , Southampton , Hants , UK
Patrick F. S. Chong , MBBS, FRCS The Surrey Vascular
Group Network, Frimley Park Hospital NHS Foundation
Trust , Frimley , Surrey , UK
Duncan F. Ettles, MBChB (Hons), MD, FRCP, FRCR
Department of Radiology , Hull and East Yorkshire
Hospitals NHS Trust , Hull , East Yorkshire , UK
Martin Fox, BSc, FFPM RCPS (Glasg) Manchester Leg
Circulation Service , Pennine Acute Hospitals Trust,
Harpurhey Health Centre , Harpurhey, Manchester ,
Greater Manchester , UK
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