The Diabetic Foot

by Robert J. Hinchliffe, Nicolaas C. Schaper, Matt M. Thompson, Ramesh K. Tripathi

Epidemiology of diabetic foot disease, etiology of ulceration, diabetic foot assessment, classification of risk, procedure of setting up a diabetic foot service, diabetes self-management education for the patient are described. Management of infection in the diabetic foot along with medical and surgical management of osteomyelitis is important. Prevalence of peripheral arterial disease (PAD) is difficult to access due to many reasons. Intermittent claudication (IC), typical symptom of PAD is used as the main criterion for the diagnosis. Normal anatomy and physiology of the skin along with microcirculation and various methods used to assess microcirculation are described. Critical limb ischemia is defined by the presence of symptoms like chronic ischemic rest pain, ulcers or gangrene attributable arterial disease that has been present for at least 2 weeks. Angiosomes that comprises of anatomic vascular territories of skin and underlying muscles, tendons, nerves, and bones based on segmental or distributing arteries and the angiosome concept has been called as end artery disease. Distal bypasses are used to revascularize ischemic limbs with various techniques. Surgical anatomy of the foot, surgical debridement and free tissue transfer are considered for surgical treatment. Different aspect of foot charcot, types of amputations and preventive foot care programs are discussed.

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