Clifford P. Shearman Editor Management of Diabetic Foot Complications 123 Management of Diabetic Foot Complications Clifford P. Shearman Editor Management of Diabetic Foot Complications Editor Clifford P. Shearman Vascular Surgery Southampton General Hospital Southampton UK ISBN 978-1-4471-4524-0 ISBN 978-1-4471-4525-7 (eBook) DOI 10.1007/978-1-4471-4525-7 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2015932099 © Springer-Verlag London 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduc- tion on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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While the advice and information in this book are believed to be true and accu- rate at the date of publication, neither the authors nor the editors nor the pub- lisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Pref ace D iabetes is becoming a major challenge for societies the world over, and foot complications are one of the most com- mon complications associated with this disease. Foot ulcer- ation and infection not only impact on the patients’ quality of life but also significantly increase their risk of losing their leg, which is a devastating outcome for most people. It is a costly condition to treat. Foot complications are difficult to prevent and treat when they do occur. However, encouragingly the message about care for patients at risk of developing foot complications is that it needs to be well organised and prompt. Unlike many services it is not a matter of acquiring new technology, increasing personnel or expensive medications. The team is there and all the facilities needed to manage these patients are available. All too often, however, the teams are poorly coordinated. Sometimes being part of a foot care service team feels like playing in a football team, the members of which have never met, the positions haven’t been decided and no one knows the rules. It must be even worse for the patient. Where it has been possible to bring together the team across primary and secondary care and identify clear care pathways, the results have been staggering: a dramatic reduc- tion in major amputations, fewer hospital admissions, and reduced costs to the health economy. This handbook has been written by podiatrists, nurses and doctors, all of whom are working in the field of diabetes foot care. They have described their experiences and how they address clinical challenges. The book is divided into preven- tion and early management, revascularisation of the ischaemic v vi Preface limb, prevention of recurrence and how to structure a team. I hope this will provide useful information to anyone respon- sible for the care of people with diabetes who may be at risk of developing foot complications. Southampton, Hampshire, UK Clifford P. Shearman Contents 1 Foot Complications in Diabetes: The Problem. . . . 1 Clifford P. Shearman 2 Screening and Treatment of Early Complications in the Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Graham C. Bowen 3 Emergency Management of the Acute Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Abigail H. M. Morbi and Clifford P. Shearman 4 Managing Diabetes in People with Foot Complications. . . . . . . . . . . . . . . . . . . . . . . 39 Mayank Patel and Keith G. McCormick 5 Predicting Wound Healing in the Diabetic Foot: Measuring Skin Viability . . . . . . . . . . . . . . . . . . . . . . 51 Javier Aragón-Sánchez and Rajgopal Mani 6 Imaging in the Patient with Foot Complications. . . 65 Duncan F. Ettles and Lynn Ling 7 Treatment of Infection in the Diabetic Foot: The Use of Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . 77 Anthony R. Berendt 8 Endovascular Revascularisation: When and How . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Andrew J . Wigham and Raman Uberoi vii viii Contents 9 Surgical Revascularisation of the Diabetic Foot. . . 113 Paul W. Moxey and Patrick F. S. Chong 10 Amputation Above the Ankle: Achieving the Best Outcome for the Patient. . . . . . 127 Nicola Storer , Marie Hulse , Ian M. Nordon , and Stephen J. Baxter 11 Neuro-osteoarthropathy: The Charcot Foot – Pathology, Diagnosis, and Treatment . . . . . . 143 William J. Jeffcoate 12 The Role of the Orthopaedic Surgeon in Diabetic Foot Complications. . . . . . . . . . . . . . . . . 155 Gavin W. Bowyer 13 Cardiovascular Risks in People with Diabetes Foot Complications . . . . . . . . . . . . . . 165 Martin Fox and Lisa Jane Lainton 14 Foot Care and the Prevention of Recurrent Ulcers. . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Laurie King 15 Foot Deformity and Pressure Management in the Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . 191 David A. Russell 16 The Role of the Multidisciplinary Team in the Management of Diabetic Foot Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Stella Vig and Kathryn H. Waite Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Contributors Javier Aragón-Sánchez, MD, PhD Department of Surgery, Diabetic Foot Unit and Endoluminal Therapy , La Paloma Hospital , Las Palmas de Gran Canaria , Spain Stephen J. Baxter, MB, ChB, FCS Departments of Cardiovascular and Thoracic Surgery , University Hospital Southampton , Southampton , Hampshire , UK Anthony R. Berendt, BM, BCh, FRCP Bone Infection Unit , Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust , Oxford , Oxfordshire , UK Graham C . Bowen, BSc Hons, FCPodMed Department of Podiatry, Solent NHS Trust, St. James Hospital , Portsmouth , Hampshire , UK Gavin W. Bowyer, MChir, FRCS(Orth) Department of Trauma and Orthopaedics , University Hospital Southampton , Southampton , Hants , UK Patrick F. S. Chong , MBBS, FRCS The Surrey Vascular Group Network, Frimley Park Hospital NHS Foundation Trust , Frimley , Surrey , UK Duncan F. Ettles, MBChB (Hons), MD, FRCP, FRCR Department of Radiology , Hull and East Yorkshire Hospitals NHS Trust , Hull , East Yorkshire , UK Martin Fox, BSc, FFPM RCPS (Glasg) Manchester Leg Circulation Service , Pennine Acute Hospitals Trust, Harpurhey Health Centre , Harpurhey, Manchester , Greater Manchester , UK ix