Index

The Diabetic Foot Robert J. Hinchliffe, Nicolaas C. Schaper, Matt M. Thompson, Ramesh K. Tripathi

SECTION 1: GENERAL ASPECTS
CHAPTER 1:Epidemiology of diabetic foot disease and etiology of ulceration
- ■ INTRODUCTION
- ■ BACKGROUND
- ■ FOOT ULCER: PREVALENCE AND INCIDENCE IN INDIVIDUALS WITH DIABETES MELLITUS
- ■ METHODOLOGICAL CONSIDERATIONS WITH REGARD TO INCIDENCE AND PREVALENCE OF FOOT ULCER
- ■ ETIOLOGY OF FOOT ULCER IN INDIVIDUALS WITH DIABETES MELLITUS
- ■ INCIDENCE AND PREVALENCE OF DIABETES-RELATED LOWER LEG AMPUTATION
- ■ METHODOLOGICAL CONSIDERATIONS WITH REGARD TO INCIDENCE AND PREVALENCE OF LOWER LEG AMPUTATION
- ■ CONCEIVABLE PITFALLS IN THE REGISTRATION OF DIABETES-RELATED AMPUTATIONS
  - ■ Indication for amputation
- ■ SELECTION OF AMPUTATION LEVEL
- ■ ADDITIONAL CONFOUNDERS WHEN COMPARING AMPUTATION-RELATED DATA
- ■ AMPUTATION AS A MARKER OF QUALITY OF CARE
CHAPTER 2:Diabetic foot assessment and classification of risk
- ■ BACKGROUND AND HISTORY
- ■ PATHOPHYSIOLOGY
- ■ ANGIOPATHY
- ■ NEUROPATHY
- ■ STRUCTURAL ABNORMALITIES/GAIT ABNORMALITIES
- ■ SCREENING
- ■ RISK CLASSIFICATION
- ■ CONCLUSION
CHAPTER 3:Setting up a diabetic foot service
- ■ INTRODUCTION
- ■ REALIZATION OF DIABETIC FOOT SERVICES: A SHORT HISTORY
- ■ MULTIDISCIPLINARY DIABETIC FOOT CARE APPROACH
  - ■ Multidisciplinary approach in the developed world: experience from Europe
- ■ MULTIDISCIPLINARY APPROACH IN THE DEVELOPING WORLD
- ■ HOW TO START A DIABETIC FOOT SERVICE
- ■ INTERNATIONAL GUIDELINES ON THE DIABETIC FOOT
- ■ DIABETIC FOOT SERVICE AT A PRIMARY CARE LEVEL
  - ■ Minimal model clinic
- ■ DIABETIC FOOT SERVICE AT SECONDARY CARE LEVEL
  - ■ Intermediate model foot clinic
- ■ PATHWAYS OF CARE
- ■ ENSURING QUALITY OF DIABETIC FOOT CARE
- ■ RESOURCES FOR THE DEVELOPMENT AND SUSTAINABILITY OF DIABETIC FOOT CARE SERVICES
CHAPTER 4:Economic aspects of foot care
- ■ INTRODUCTION
- ■ THE HUMAN COST
- ■ THE FINANCIAL COST
- ■ THE QUALITY OF CARE
- ■ ASSESSING THE COST-EFFECTIVENESS OF NEW INTERVENTIONS
  - ■ Example: The Multidisciplinary Team (MDT) at The James Cook University Hospital, Middlesbrough, England
  - ■ Interpreting the results of cost-effectiveness analysis
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 5:Medical therapy and metabolic control to optimize cardiovascular risk and reduce overall mortality
- ■ INTRODUCTION
- ■ QUANTIFYING CV RISK IN DFU
- ■ EVIDENCE OF CV RISK MODIFICATION IN DFU
- ■ BLOOD PRESSURE CONTROL
- ■ LIPID MODIFICATION
- ■ GLYCEMIC CONTROL
  - ■ Glucose targets
  - ■ Glycemic control for ulcer prevention and healing
- ■ MULTIDISCIPLINARY CARE
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 6:Psychological aspects of diabetes-related foot disease
- ■ INTRODUCTION
- ■ MEASURING THE IMPACT OF DIABETES-RELATED FOOT DISEASE
- ■ THE IMPACT OF DIABETES-RELATED FOOT DISEASE
- ■ DEPRESSION AND ANXIETY IN DIABETES-RELATED FOOT DISEASE
- ■ THE INFLUENCE OF PSYCHOLOGICAL STATE ON OUTCOME IN DIABETES-RELATED FOOT DISEASE
- ■ SUMMARY
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 7:Diabetes self-management education for the preservation of patient and foot health and the prevention of foot ulcers and amputations
- ■ INTRODUCTION
- ■ DEFINITIONS
- ■ HISTORY OF DIABETES AND PATIENT EDUCATION
- ■ HISTORY OF THE DIABETIC FOOT
- ■ PATIENT EDUCATION: AN ESSENTIAL PART OF DIABETES CARE
  - ■ Guiding the review and revision of the DSME Standards
  - ■ Measuring the success of DSME
    - Education outcomes measures
- ■ EDUCATIONAL INTERVENTIONS TO PREVENT FOOT ULCERATIONS
- ■ PATIENT DIABETIC FOOT EDUCATION AS PART OF A DIABETIC FOOT PREVENTION PROGRAM
- ■ COST-EFFECTIVENESS OF PREVENTIVE MEASURES
- ■ SPECIAL CONSIDERATIONS FOR DEVELOPING COUNTRIES
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 2: INFECTION
CHAPTER 8:Managing infection in the diabetic foot
- ■ INTRODUCTION
- ■ PATHOPHYSIOLOGY OF INFECTIONS IN DIABETES MELLITUS
- ■ RISK FACTORS FOR DIABETIC FOOT INFECTION
- ■ CLINICAL SIGNS AND SYMPTOMS
- ■ CLASSIFICATION
  - ■ PEDIS and IDSA
- ■ MICROBIOLOGY
  - ■ Molecular microbiology
- ■ TREATMENT
  - ■ Uninfected wounds
  - ■ Infected wounds
- ■ ADJUNCTIVE THERAPY
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 9:Diabetic foot osteomyelitis: diagnosis and classification
- ■ INTRODUCTION
- ■ DIAGNOSIS
- ■ CONCLUSIONS
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 10:Osteomyelitis: medical management
- ■ INTRODUCTION
- ■ INDICATIONS FOR MEDICAL THERAPY
- ■ PATIENT SELECTION
- ■ DIAGNOSIS
- ■ TREATMENT REGIMENS
- ■ OUTCOMES OF MEDICAL THERAPY
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 11:Osteomyelitis: surgical management
- ■ INTRODUCTION
- ■ ANATOMICAL BASIS OF SURGERY FOR DIABETIC FOOT OSTEOMYELITIS
- ■ CLINICAL PRESENTATION OF DIABETIC FOOT OSTEOMYELITIS REQUIRING SURGERY
- ■ REMOVING THE INFECTED BONE: TYPES OF SURGERY
- ■ WHEN SHOULD SURGERY BE PERFORMED?
- ■ HOW MUCH BONE SHOULD BE REMOVED?
- ■ FACTORS RELATED TO SURGERY OUTCOME
- ■ RECURRENCE AFTER SURGERY
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 3: ISCHEMIA
CHAPTER 12:Peripheral arterial disease in diabetes
- ■ INTRODUCTION
- ■ PREVALENCE OF PERIPHERAL ARTERIAL DISEASE IN THE GENERAL POPULATION
- ■ PREVALENCE OF PAD IN PEOPLE WITH DIABETES
- ■ NATURAL HISTORY OF PERIPHERAL ARTERIAL DISEASE IN THE GENERAL POPULATION
- ■ NATURAL HISTORY OF PERIPHERAL ARTERIAL DISEASE IN DIABETES
- ■ AREAS OF CONTROVERSY AND/ OR FUTURE RESEARCH
CHAPTER 13:Microvascular disease
- ■ INTRODUCTION
- ■ THE ANATOMY AND PHYSIOLOGY OF THE SKIN MICROCIRCULATION
- ■ STRUCTURAL MICROVASCULAR ABNORMALITIES IN THE DIABETIC FOOT
- ■ ASSESSMENT OF MICROVASCULAR FUNCTION AND ABNORMALITIES OBSERVED IN THE DIABETIC FOOT
- ■ PATHOGENESIS OF MICROANGIOPATHY AND IMPAIRED NUTRITION IN DIABETIC FOOT SKIN
  - ■ The hemodynamic hypothesis
  - ■ The capillary steal syndrome
- ■ THE ROLE OF ENDOTHELIAL DYSFUNCTION IN DIABETIC MICROANGIOPATHY
- ■ DIABETIC MICROANGIOPATHY AND CLI
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 14:The diagnosis of peripheral arterial disease
- ■ INTRODUCTION
- ■ SYMPTOMS OF PERIPHERAL ARTERIAL DISEASE
  - ■ Intermittent claudication
  - ■ Critical limb ischemia
- ■ CLINICAL EXAMINATION
- ■ ANKLE BRACHIAL PRESSURE INDEX
- ■ TOE PRESSURE MEASUREMENT
- ■ TISSUE PERFUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 15:Imaging of peripheral arterial disease
- ■ INTRODUCTION
- ■ ULTRASONOGRAPHY
  - ■ Modalities
- ■ COMPUTED TOMOGRAPHY ANGIOGRAPHY
- ■ MAGNETIC RESONANCE ANGIOGRAPHY
- ■ GADOLINIUM
- ■ DIGITAL SUBTRACTION ANGIOGRAPHY
- ■ CO2 ANGIOGRAPHY
- ■ ROTATIONAL ANGIOGRAPHY/CONE BEAM CT
- ■ INTRAVASCULAR ULTRASOUND
- ■ OPTICAL COHERENCE TOMOGRAPHY
- ■ MOLECULAR IMAGING
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 16:Angiosomes
- ■ INTRODUCTION
- ■ THE ANGIOSOME CONCEPT
- ■ VASCULAR ANATOMY OF ANGIOSOMES IN THE FOOT
- ■ CURRENT GUIDELINES
- ■ CHALLENGES FOR ANGIOSOME-BASED REVASCULARIZATION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
- ■ ACKNOWLEDGMENT
CHAPTER 17:Distal bypass techniques
- ■ INTRODUCTION
- ■ BYPASS TECHNIQUES
- ■ FOLLOW-UP AFTER DISTAL BYPASS
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 18:Angioplasty techniques
- ■ INTRODUCTION
- ■ INDICATIONS FOR PTA
- ■ REVASCULARIZATION FEASIBILITY
- ■ EFFECTIVENESS OF PTA
- ■ COMPLICATIONS
- ■ RESTENOSIS
- ■ REVASCULARIZATION AFTER FAILED ANGIOPLASTY
- ■ ANTITHROMBOTIC THERAPY
- ■ TECHNOLOGICAL INNOVATIONS
- ■ VASCULAR ACCESS
- ■ FEMOROPOPLITEAL ARTERIES
- ■ POPLITEAL ARTERY
- ■ BTK ARTERIES
- ■ NITINOL STENTS
- ■ DRUG ELUTING STENTS (DES) FOR BELOW-THE-KNEE ARTERIES
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 19:Outcomes of angioplasty and bypass in diabetes
- ■ INTRODUCTION
  - ■ The natural history of PAD in patients with DFU
- ■ REVASCULARIZATION IN DIABETES WITH PAD
  - ■ International variations, patient selection, and suitability for intervention
- ■ OUTCOMES OF REVASCULARIZATION
- ■ SURGICAL BYPASS
- ■ ANGIOPLASTY
- ■ ALTERNATIVE THERAPIES IN NONREVASCULARIZABLE DISEASE: CELL-BASED THERAPY
- ■ OTHER APPROACHES: PRE-EMPTIVE REVASCULARIZATION
- ■ VOLUME–OUTCOME RELATIONSHIP IN PERIPHERAL ARTERIAL SURGERY
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 4: NEUROPATHY
CHAPTER 20:Pathobiology of neuropathy
- ■ INTRODUCTION
- ■ THE ANATOMY OF THE PERIPHERAL NERVOUS SYSTEM
- ■ TESTING FOR NEUROPATHY
- ■ THE CONSEQUENCES OF NERVE DAMAGE IN THE LOWER LIMBS AND FEET
- ■ EPIDEMIOLOGY
- ■ DIFFERENTIAL DIAGNOSIS OF A DISTAL SYMMETRIC POLYNEUROPATHY
- ■ PATHOLOGICAL MECHANISMS
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 21:The diagnosis and clinical impact of diabetic distal symmetrical polyneuropathy
- ■ INTRODUCTION
- ■ NEUROPATHIC SYMPTOMS
- ■ NEUROPATHY, MOBILITY, AND BALANCE
- ■ ALTERED BIOMECHANICS OF THE FOOT
- ■ NEUROPATHY AND PAD
- ■ NEUROPATHY AND TISSUE HOMEOSTASIS
- ■ DIAGNOSIS OF DSPN
- ■ MANAGEMENT OF DSPN
- ■ TREATMENT OF NEUROPATHIC PAIN
- ■ IMPROVING MOBILITY
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 22:Surgical treatment of diabetic neuropathy
- ■ INTRODUCTION
- ■ CAN MEDICAL MANAGEMENT PREVENT NEUROPATHY?
- ■ A PROACTIVE SURGICAL APPROACH TO SYMPTOMATIC DPN
  - ■ The nerve in diabetes is susceptible to compression
  - ■ Additional critical studies related to neurolysis
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 5: WOUNDS AND ULCERATION
CHAPTER 23:Acute and chronic wound healing biology in diabetes
- ■ INTRODUCTION
- ■ THE NORMAL WOUND HEALING PROCESS
  - ■ Hemostasis
  - ■ Inflammation
- ■ EARLY PHASE OF INFLAMMATION (DAYS 1–2)
- ■ LATE PHASE OF INFLAMMATION (DAYS 2–3)
- ■ LOCAL FACTORS CONTRIBUTING TO PROGRESSION OF DFUS
  - ■ Oxygenation
  - ■ Infection
- ■ POTENTIAL SYSTEMIC FACTORS CONTRIBUTING TO THE PROGRESSION OF DFUS
- ■ MOLECULAR MECHANISMS ACCOUNTING FOR DFUS
- ■ MANAGEMENT STRATEGIES BASED ON MOLECULAR TARGETS
- ■ FUTURE DIRECTIONS
- ■ CONCLUSIONS
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 24:Scoring systems and assessment of the ulcerated foot
- ■ INTRODUCTION
- ■ WHY CLASSIFY, SCORE, OR DESCRIBE?
- ■ WHAT SHOULD BE CLASSIFIED OR SCORED? LESIONS, ULCERS, FEET, OR PEOPLE?
  - ■ Multiple lesions
- ■ WHEN SHOULD CLASSIFICATION OR SCORING BE DONE?
- ■ CLASSIFICATION OR SCORING?
  - ■ Clinical care
  - ■ Research and audit
- ■ DECIDING ON HOW AND WHAT TO SCORE
- ■ PUBLISHED CLASSIFICATION/SCORING SYSTEMS
- ■ COMPARISONS OF CLASSIFICATION/SCORING SYSTEMS
- ■ SUMMARY
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 25:Wound dressings and debridement
- ■ INTRODUCTION
- ■ WOUND-HEALING AND WOUND-BED PREPARATION
- ■ DRESSING SELECTION
- ■ PROPERTIES OF THE IDEAL DRESSING
- ■ TYPES OF WOUND DRESSINGS
- ■ BIOFILMS
- ■ TESTING
  - ■ Advanced therapies
    - Protease modulating dressings
  - ■ Wound diagnostics – point of care test
- ■ UNWANTED EFFECTS OF DRESSINGS
- ■ GROWTH FACTORS AND BIOENGINEERING
- ■ RESEARCH EVIDENCE FOR DRESSINGS FOR DFU
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 26:Adjuncts to wound healing
- ■ INTRODUCTION
- ■ NEGATIVE PRESSURE WOUND THERAPY
- ■ EVIDENCE SUPPORTING THE USE OF NPWT
- ■ HYPERBARIC OXYGEN THERAPY
- ■ EVIDENCE SUPPORTING THE USE OF HBO
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 27:Standardization of outcomes and end points of wound healing in everyday practice and clinical trials
- ■ INTRODUCTION
- ■ BACKGROUND, DEFINITIONS OF OUTCOME/END POINT, AND PRODUCING RECOMMENDATIONS
- ■ OUTCOMES USED IN WOUND HEALING STUDIES
- ■ BIASES THAT MAY INFLUENCE OUTCOME/END POINT EVALUATION OF STUDIES
- ■ RECOMMENDATIONS
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 6: SURGICAL INTERVENTION
CHAPTER 28:Surgical anatomy of the foot
- ■ INTRODUCTION
- ■ OSTEOLOGY
- ■ COLUMNS OF THE FOOT
- ■ JOINTS AND LIGAMENTS OF THE HINDFOOT
- ■ IMPORTANT JOINTS AND LIGAMENTS OF THE MIDFOOT AND FOREFOOT
- ■ ADAPTATION OF THE PLANTAR ASPECT OF THE FOOT TO WEIGHT BEARING
- ■ THE FOOT DURING AMBULATION AND PHASES OF GAIT
- ■ PLANTAR FASCIA
- ■ MUSCLES, TENDONS NERVES, ARTERIES, AND VEINS OF THE FOOT
- ■ COMPARTMENTS OF THE FOOT
- ■ LAYERS OF THE PLANTAR ASPECT OF THE FOOT
CHAPTER 29:Surgical debridement
- ■ INTRODUCTION
- ■ METHODS OF DEBRIDEMENT
- ■ TIMING
- ■ TECHNIQUE
  - ■ Tourniquet
  - ■ Debridement tools
- ■ CALLUS
- ■ SKIN
- ■ SUBCUTANEOUS TISSUE
- ■ FASCIA, MUSCLE, AND TENDON
- ■ BONE
  - ■ Wound irrigation
  - ■ Wound closure
- ■ SURGICAL DEBRIDEMENT IN CHRONIC WOUNDS
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 30:Skin and local tissue flaps
- ■ INTRODUCTION
- ■ VASCULAR AND CUTANEOUS ANATOMY
- ■ PREPARATION FOR SPLIT-THICKNESS SKIN GRAFT OR LOCAL FLAPS
- ■ SPLIT-THICKNESS SKIN GRAFTS
- ■ LOCAL FLAPS
- ■ SURGICAL OFF-LOADING OF EXTERNAL FIXATION FOR DIABETIC SOFT TISSUE RECONSTRUCTION
- ■ POSTOPERATIVE MANAGEMENT
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 31:Free tissue transfer
- ■ INTRODUCTION
- ■ MULTIDISCIPLINARY APPROACH
  - ■ Spectrum of care
  - ■ Role of microsurgery
- ■ SURGICAL ALGORITHM
  - ■ Debridement
  - ■ Vascular intervention
- ■ SOFT TISSUE RECONSTRUCTION USING FREE FLAPS
- ■ OUTCOME AFTER FREE FLAP RECONSTRUCTION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 7: CHARCOT
CHAPTER 32:The causes and diagnosis of acute Charcot foot in diabetes
- ■ DEFINITION
- ■ HISTORY
- ■ PRESENTATION
- ■ CAUSES
  - ■ The role of inflammation
  - ■ RANKL–NFκB
- ■ PREDISPOSITION TO THE DEVELOPMENT OF THE ACUTE CHARCOT FOOT
- ■ INCOMPATIBILITY BETWEEN KNOWN CAUSATIVE FACTORS AND THE CLINICAL PRESENTATION
- ■ DIAGNOSIS OF THE ACUTE CHARCOT FOOT IN DIABETES
  - ■ Clinical
  - ■ Imaging
- ■ MONITORING DISEASE ACTIVITY AND THE DIAGNOSIS OF REMISSION
- ■ OTHER OUTCOME MEASURES
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 33:Charcot osteoarthropathy: medical management and off-loading
- ■ INTRODUCTION
- ■ RATIONALE FOR IMMOBILIZATION AND OFF-LOADING
- ■ PUTATIVE MECHANISM OF ACTION OF OFF-LOADING AND IMMOBILIZATION
- ■ CRITERIA FOR IMMOBILIZATION AND OFF-LOADING
- ■ METHODS OF NONSURGICAL IMMOBILIZATION/OFF-LOADING
- ■ HOW CAN THE RESPONSE TO IMMOBILIZATION THERAPY BE MONITORED?
- ■ MEDICAL THERAPY
- ■ CLINICAL MANAGEMENT OF THE CHRONIC, QUIESCENT PHASE OF CO
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 34:Charcot osteoarthropathy: surgical management and off-loading
- ■ INTRODUCTION
- ■ CLASSIFICATION REVIEW (TABLE 34.1)
- ■ SURGICAL INTERVENTION
- ■ SURGICAL APPROACH TO THE FOREFOOT/MIDFOOT
- ■ SURGICAL APPROACH TO THE HINDFOOT
- ■ SURGICAL APPROACH TO THE ANKLE
- ■ POSTOPERATIVE COMPLICATIONS
- ■ OFF-LOADING
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 8: AMPUTATION
CHAPTER 35:Minor amputation and major amputation
- ■ INTRODUCTION
- ■ PREOPERATIVE PLANNING
- ■ INDICATIONS FOR AMPUTATION
- ■ LEVEL OF AMPUTATION
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
CHAPTER 36:Rehabilitation post-amputation
- ■ INTRODUCTION
  - ■ Incidence, risk factors, and prevention of amputation
- ■ AMPUTATION OF THE FOOT
- ■ TRANSTIBIAL AMPUTATION
- ■ TRANSFEMORAL AMPUTATION
- ■ THROUGH HIP AND HINDQUARTER AMPUTATIONS
- ■ BILATERAL LOWER LIMB AMPUTEES
- ■ REHABILITATION PROGRAM AND MOBILITY OUTCOME
  - ■ Phases of lower limb rehabilitation
  - ■ Mobility and rehabilitation outcome
- ■ QOL OF PATIENTS WITH DIABETES AND AN AMPUTATION
- ■ REHABILITATION ISSUES IN AMPUTEES WITH DIABETES
  - ■ Wound healing
- ■ RESIDUAL AND PLP
- ■ DEGENERATIVE ARTHRITIS
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
SECTION 9: BIOMECHANICS AND PREVENTION
CHAPTER 37:Off-loading
- ■ INTRODUCTION
- ■ OFF-LOADING DEVICES
- ■ THE TOTAL CONTACT CAST
- ■ TCC MANUFACTURE
- ■ SURGICAL OFF-LOADING
- ■ CONCLUSION
- ■ AREAS OF CONTROVERSY AND/OR FUTURE RESEARCH
- ■ ACKNOWLEDGMENT
CHAPTER 38:Prevention of ulcer recurrence
- ■ INTRODUCTION
- ■ EPIDEMIOLOGY AND RISK FACTORS
- ■ TREATMENT EFFICACY
- ■ FOOTWEAR QUALITY AND ADHERENCE
- ■ SUMMARY AND CONCLUSION
- ■ AREAS OF CONTROVERSY/FURTHER RESEARCH
CHAPTER 39:Preventive foot care programs
- ■ INTRODUCTION AND EPIDEMIOLOGY
  - ■ Whom to educate?
  - ■ Who is responsible for the education of patients?
- ■ PATIENT EDUCATION ACCORDING TO RISK STRATIFICATION
- ■ DIABETES SELF-MANAGEMENT EDUCATION
  - ■ Poor adherence to self-care education
- ■ OUTCOME OF STEP-BY-STEP FOOT PROJECT TARGETED HEALTH-CARE WORKERS
- ■ MULTIDISCIPLINARY TEAM APPROACH
  - ■ Western perspective of diabetic foot care
  - ■ Diabetic foot care in less-developed countries
- ■ CONCLUSION
- ■ ACKNOWLEDGEMENTS

INDEX

TOC
Index

Chapter Notes