Managing the Diabetic Foot E-Book

Michael E. Edmonds

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 215

Veröffentlichungsjahr: 2013

Beschreibung

Foot problems in diabetic patients are some of the most challenging complications to treat, due to an often quite late presentation of symptoms from the patient. Therefore visual recognition of presenting clinical signs is absolutely key for a successful diagnosis and subsequently, the right management programme. 

The 3rd edition of Managing the Diabetic Foot once again provides a practical, handy and accessible pocket guide to the clinical management of patients with severe feet problems associated with diabetes, such as ulcers, infections and necrosis.  By focusing on the need for a speedy response to the clinical signs, it will enable doctors make rapid, effective management decisions in order to help prevent deterioration and avoid the need for evental foot amputation.

Each chapter focuses specifically on the different stages of foot disease and the clinical management required at that particular stage, ie, the normal foot; high-risk foot, ulcerated foot, infected foot, necrotic foot and unsalvageable foot.

Full colour throughout, it will feature over 150 clinical photos, numerous hints and tips to aid rapid-reference, as well as the latest national and international guidelines on diabetic foot management.

Managing the Diabetic Foot, 3E, is the ideal go-to clinical tool for all diabetes professionals, specialist diabetes nurses and podiatrists managing patients with diabetic foot problems.

Leseprobe

Table of Contents

Dedication

Title page

Copyright page

Acknowledgements

Preface

Abbreviations

1: Introduction

New Approach to the Diabetic Foot

Modern Management of the Diabetic Foot

Assessing the Diabetic Foot

Classifying the Diabetic Foot

Staging of the Diabetic Foot

Intervention

2: Managing Stage 1: the normal foot

Presentation and Diagnosis

Management

3: Managing Stage 2: the high-risk foot

Presentation and Diagnosis

Management

Painful Neuropathy

4: Managing Stage 3: the ulcerated foot

Presentation and Diagnosis

Management

Charcot Osteoarthropathy

5: Managing Stage 4: the infected foot

Presentation and Diagnosis

Management

6: Managing Stage 5: the necrotic foot

Presentation and Diagnosis

Management

7: Managing Stage 6: the unsalvageable foot

Presentation

Major Amputation

Appendix: Problems of differential diagnosis

Further reading

Index

Dedication

This book is dedicated to all health-care professionals that faithfully and valiantly look after diabetic patients with foot problems throughout the world.

The authors’ royalties from this book will be devoted to the Ali Foster Travel Fund, which will support young practitioners to visit centres of excellence to enrich their experience and expertise.

This edition first published 2014 © 2000, 2005, 2014 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Edmonds, M. E., author.

Managing the diabetic foot / Michael E Edmonds, Alethea VM Foster. – Third edition.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-65505-4 (pbk.)

I. Foster, Alethea VM, author. II. Title.

[DNLM: 1. Diabetic Foot–therapy. WK 835]

RC918.D53

616.4'62–dc23

2013034288

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: Courtesy of the author

Cover design by Steve Thompson

Acknowledgements

I would like to express my gratitude for the excellent assistance of Rachael Winter in the production of this third edition.

We are grateful to Mr Hisham Rashid, Consultant Vascular Surgeon, and Mr Venu Kavarthapu, Consultant Orthopaedic Surgeon, for their excellent surgical leadership in the Diabetic Foot Service.

We are grateful to colleagues past and present, who include: Simon Fraser, Huw Walters, Mary Blundell, Cathy Eaton, Mark Greenhill, Susie Spencer, Maureen McColgan-Bates, Mel Doxford, Sally Wilson, Adora Hatrapal, E Maelor Thomas, Mick Morris, John Philpott-Howard, Jim Wade, Andrew Hay, Robert Lewis, Anne-Marie Ryan, Irina Mantey, Robert Hills, Rachel Ben-Salem, Muriel Buxton-Thomas, Mazin Al-Janabi, Dawn Hurley, Stephanie Amiel, Stephen Thomas, Daniela Pitei, Paul Baskerville, Anthony Giddings, Irving Benjamin, Mark Myerson, Paul Sidhu, Joydeep Sinha, Patricia Wallace, Gillian Cavell, Lesley Boys, Magdi Hanna, Sue Peat, Colin Roberts, David Goss, Colin Deane, Sue Snowdon, Ana Grenfell, Tim Cundy, Pat Ascott, Lindis Richards, Kate Spicer, Debbie Broome, Liz Hampton, Timothy Jemmott, Michelle Buckley, Rosalind Phelan, Maggie Boase, Maria Back, Julie Lambert, Avril Witherington, Daniel Rajan, Ghulam Mufti, Karen Fairbairn, Ian Eltringham, Nina Petrova, Lindy Begg, Barbara Wall, Mark O'Brien, Sacha Andrews, Barry Pike, Jane Preece, Briony Sloper, Christian Pankhurst, Jim Beaumont, Matthew McShane, Tim Cooney, Lin Pan, Cheryl Clark, Marcello Perez, Nicholas Cooley, Paul Bains, Patricia Yerbury, Charlotte Biggs, Anna Korzon Burakowska, David Ross, Jason Wilkins, David Evans, Dean Huang, Carol Gayle, David Hopkins, Rifat Malik, Pratik Choudhary, Keith Jones, Bob Edmondson, Enid Joseph, Karen Reid, David Williams, Doris Agyemang-Duah, Jennifer Tremlett, Om Lahoti, Mark Phillips, Sarah Phillips, Dom Valenti, Hani Slim, Indira Maharaj, Surabhi Taori, Paula Gardiner, Ian Alejandro, Barbara Chirara, Victoria Morris, Hany Zayed, Igor Kubelka, Daksheka Jayaratnam, Thoraya Ammar, Nicola Mulholland, Gill Vivian, Riddhika Chakravartty, Naveen Cavale, Wegin Tang, Natalya Hedger, Sophie Whitelaw, Joanne Casey, Leye Stephen, Jody Lucas, Vesna Vincent, Olla Shitta-Bey, Leila Howe, Marcus Simmgen, Rajan Patel, Chris Manu, Paul Donohoe, Sui Phin Kon, David Elias, Lisa Meakin, Ben Whitelaw, James Dent, Ben Freedman, Victoria Rose, Esther Dontoh and two great stalwarts of the Foot Clinic, Peter Watkins and the late David Pyke.

The Podiatry Managers and Community Podiatrists from Lambeth, Southwark and Lewisham have also contributed greatly to the work of the Foot Clinic at King's over many years. We are also grateful to Lee Sanders, who was our co-author in writing A Practical Manual of Diabetic Foot Care.

We are particularly grateful for the advice of the members of the Dermatology Department, Anthony du Vivier, Daniel Creamer, Claire Fuller, Elisabeth Higgins, Sarah MacFarlane, Rachel Morris-Jones, Sarah Walsh and Saqib Bashir. We give special thanks to Yvonne Bartlett, Alex Dionysiou, David Langdon, Lucy Wallace, Margaret Delaney and Moira Lovell from the Department of Medical Photography.

I would like to thank Audrey Edmonds for her support and patience.

We are particularly grateful to Jennifer Seward, Senior Development Editor, Rebecca Huxley, Senior Production Editor, and Oliver Walter, Senior Editor Wiley-Blackwell for their patience and help.

This is a practical hands-on manual uninterrupted by references. At the end of the book we have given a further reading list.

Preface

It was C.S. Lewis who said ‘I wrote the books I should have liked to read if I could have got them.’ and this was rather our approach when we first developed Managing the Diabetic Foot. Back in 2000, our aim was to fill what we perceived as a need for a very practical handbook. We wanted a book that could be used within the clinic as a basis for rapid and effective clinical decisions; a book incorporating a very simple and practical method of classifying and staging the diabetic foot that could be used as a framework for care, even by health-care practitioners who did not necessarily have a lot of previous experience in managing the diabetic foot. We wanted a book that would be useful for all members of the diabetic foot multidisciplinary team, a book that would help individual members of the team to appreciate the differing roles of other members, and above all, a book to emphasize the need for a multidisciplinary team approach in this most challenging field of health care; a book that could save the lives and limbs of diabetic foot patients.

These principles live on in this third updated edition of Managing the Diabetic Foot. Since the second edition in 2005, we have refined our classification of the diabetic foot, subdividing the ischaemic foot into the neuroischaemic foot, the critically ischaemic foot, acutely ischaemic foot and the renal ischaemic foot. We have developed our simple staging system, to emphasize that there is a rapid progress to necrosis in the natural history of the diabetic foot and this amounts to what we call a ‘diabetic foot attack’, which demands immediate treatment just like a heart or brain attack.

Over the years we have been increasingly alarmed by the devastating impact of neuropathy on our patients and have developed the concept of the need to practise neuropathic medicine. When classical signs of disease are absent or minimal and yet the pathology advances quickly, practitioners need to be aware of this and act like good detectives to recognize the early and subtle signs of disease and react quickly. When it is not possible to rely on the nervous system to reflect accurately what is going on inside the body, we have to use modern imaging more readily. This edition has illustrated the use of single-photon emission computer tomography and conventional computed tomography (SPECT/CT) in the diagnosis of Charcot foot, grey-scale ultrasound and magnetic resonance imaging (MRI) in the diagnosis of infection and CT angiography and magnetic resonance angiography in delineating disease of the peripheral arterial system.

We describe major advances in the management of the diabetic foot since 2005. Reconstruction of the unstable Charcot hindfoot by internal stabilization has saved legs from certain amputation. Revascularization of the ischaemic foot has recently been achieved by very distal angioplasty and bypasses to the plantar arteries of the foot as well as by hybrid techniques involving both angioplasty and bypass in the same leg. Wound healing has also progressed with the increasing usage of negative pressure wound therapy and soft tissue reconstruction techniques including skin grafts and flaps. There has been increasing use of intravenous antibiotic therapy in the patients' homes utilizing peripherally inserted central catheter lines.

We stress the importance of the foot protection team in the community as well as the multidisciplinary foot care team based in the diabetic foot clinic, to which patients should have ready and open access when they are in trouble. We have come to learn that such is the vulnerability of the diabetic foot patient that the clinic door must always be open to give rapid treatment to a patient having a ‘diabetic foot attack’.

My co-author Ali Foster sadly died at the initial stages of this third edition. However, Ali had been greatly involved in the planning of this edition and I hope her thoughts and experience of her beloved diabetic foot patients live on in this completed edition.

In tribute to Ali Foster at the International Symposium on the Diabetic Foot in 2011, I stated that she was a great source of inspiration to us all. Ali transformed diabetic podiatry and planted seeds of friendship throughout the world. Indeed, these have lived on and will never die. Ali was a great teacher and keen to share her experience and expertise with all health-care professionals. To honour this, the authors' royalties from this book will be devoted to the Ali Foster Travel fund to support the visit of young foot practitioners to centres of excellence of their choice.

I sincerely hope (as also did Ali) that this third edition will be of assistance to all heath-care professionals throughout the world who so nobly strive to look after diabetic patients with foot problems. May it help to improve their outcome and prevent amputations, an aspiration to which Ali was so unselfishly devoted.

Michael E Edmonds

Alethea VM Foster (died January 2011)

London 2013

Every effort is made in the preparation and editing of this book to ensure that the details given are correct. The reader is however advised to refer to published information from the pharmaceutical companies and other works to check for accuracy.

Abbreviations

ABPIankle brachial pressure indexACCORDAction to Control Cardiovascular Risk in DiabetesAFOankle–foot orthosisb.d.twice dailyBCMbilayered cellular matrixCAPDcontinuous ambulatory peritoneal dialysisCARDSCollaborative-AtoRvastatin Diabetes StudyCAV/VVHDcontinuous arteriovenous/venovenous haemodialysiscmcentimetreCROWCharcot restraint orthotic walkerCRPC-reactive proteinCTcomputed tomographyCTAcomputed tomography angiographyDCCTDiabetes Control and Complications TrialDSAdigital subtraction angiographyECGelectrocardiogramECMextracellular matrixEDICEpidemiology of Diabetes Interventions and ComplicationseGFRestimated Glomerular Filtration RateESBLsextended-spectrum beta lactamasesEVAethylene-vinyl acetateggramsGFRGlomerular Filtration RatehhourHDintermittent haemodialysisHDFhaemodiafiltrationHDLhigh-density lipoproteinHgmercuryHOPEHeart Outcomes Prevention EvaluationHPSHeart Protection StudyHzhertzIMintramuscularIVintravenousLlitreLDLlow-density lipoproteinminminutesmLmillilitremmmillimetremolmolemmolmillimoleMRAmagnetic resonance angiographyMRImagnetic resonance imagingMRSAmethicillin-resistant Staphylococcus aureusNPWTnegative pressure wound therapyo.d.once dailypoorallyPTApercutaneous transluminal angioplastyPNApartial nail avulsionPRAFOpressure relief ankle foot orthosisq.d.s.four times dailyssecondsSPECTsingle-photon emission computed tomographyt.d.s.three times dailyTENStranscutaneous electrical nerve stimulationUKPDSUnited Kingdom Prospective Diabetes StudyVvolts

1

Introduction

New Approach to the Diabetic Foot

Diabetes has reached epidemic proportions, and with it has come a growing number of complex diabetic foot problems. This book is written to help practitioners tackle these problems. It attempts to give enough simple practical information to enable practitioners to understand the natural history of the diabetic foot, rapidly diagnose its pro­blems and confidently undertake appropriate interventions in a timely manner.