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
