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Boulton AJM, De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, et al.
. Date of publication 2016 Oct 26;volume ():.
1. The Diabetic Foot. Boulton AJM(15). In: De Groot LJ(1), Chrousos G(2), Dungan K(3), Feingold KR(4), Grossman A(5), Hershman JM(6), Koch C(7), Korbonits M(8), McLachlan R(9), New M(10), Purnell J(11), Rebar R(12), Singer F(13), Vinik A(14), editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. 2016 Oct 26. Author information: (1)Research Professor, Cell and Molecular Biology, College of the Environment and Life Sciences, University of Rhode Island, Kingston, RI (2)Department of Paediatrics, National University of Athens, Athens, Greece (3)Associate Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Ohio State University (4)Professor of Medicine, University of California - San Francisco, CA; Staff Physician and Chief of the Endocrine Clinic, San Francisco VA Medical Center, San Francisco, CA (5)Professor of Endocrinology and Director of the Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK (6)Distinguished Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Associate Chief, Endocrinology and Diabetes Division and Director, Endocrine Clinic, West Los Angeles VA Medical Center, Los Angeles, CA (7)Professor, University of Mississippi Medical Center, Jackson, MS (8)Co-Centre Head, Department of Endocrinology, Barts and the London School of Medicine, London, England (9)Director of Clinical Research, Prince Henry's Institute, Clayton, Victoria, Australia; Consultant Endocrinologist, Monash Medical Centre, Melbourne, Australia (10)Professor of Pediatrics, Professor of Genetics and Genomic Sciences, and Director of the Adrenal Steroid Disorders Program, Mount Sinai School of Medicine, New York, NY; Associate Dean for Clinical Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (11)Professor of Medicine, Knight Cardiovascular Institute and the Division of Endocrinology, Oregon Health and Science University, Portland, OR (12)Executive Director, American Society for Reproductive Medicine in Birmingham, Alabama; Volunteer Clinical Professor, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL (13)Director of the Endocrine/Bone Disease Program, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA; Clinical Professor of Medicine, UCLA School of Medicine, Los Angeles, CA (14)Professor of Medicine and Director, Strelitz Diabetes Center, Eastern Virginia Medical School, Norfolk, VA (15)Professor of Medicine, Faculty of Biology, Medicine and Health, University of Manchester. Manchester, UK. Diabetic foot ulcers (DFU) are associated with significant impairment of quality of life, increased morbidity and mortality and are a huge drain on health care resources. In western countries, the annual incidence of foot ulceration in the diabetic population is around 2%. DFUs develop as a consequence of a combination of factors, most commonly peripheral neuropathy (loss of the gift of pain), peripheral vascular disease and some form of unperceived trauma. Recent studies emphasize the very high prevalence of foot ulceration in diabetic patients on dialysis as a consequence of end-stage renal disease. The mortality in this patient group is higher than for most forms of cancer. All patients with diabetes should have an annual screen to identify their foot ulcer risk status: those with any risk factors require specific foot care education as well as regular contact with a health care professional, usually a podiatrist. DFUs should heal if there is an adequate arterial inflow, infection is aggressively managed and pressure is removed from the wound and its margins. In the management of plantar neuropathic ulcers, offloading is critical and all efforts must be made to enhance patient understanding of the need for offloading. Antibiotic usage should be guided by clinical signs of infection and microbiologic analysis of deep tissue specimens. Most adjunctive therapies have little evidence to support their use though negative pressure wound therapy has been shown to be helpful in certain cases. There is currently no indication for hyperbaric oxygen usage. Charcot neuroarthropathy (CN) should be easily preventable: most important is to treat any neuropathic patient with a warm swollen foot as having CN until proven otherwise. For complete coverage of all related aeas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG. PMID: 28121117
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Diabetic Foot Ulcer - Treatment