Since the publication of the first edition of this book, the International Diabetes Federation (IDF) has collected valuable international diabetic foot data for an IDF publication, ‘Time to Act’. Funds have been made available by the European Union for a multinational group, Eurodiale (a European study group for diabetes and the lower extremity), to run multicentre studies to compare outcomes in patients treated in 14 different European diabetic foot centres. The World Diabetes Foundation has funded a successful ‘Step by Step’ programme to improve diabetic foot care in developing countries, initially in India, Bangladesh, Sri Lanka, Nepal and Tanzania. The International Consensus Group on the Diabetic Foot has produced and updated simple and practical guidelines on diabetic foot care that have now been translated into 26 different languages: 80,000 copies have been distributed throughout the world. Robert Frykberg’s team has updated new American guidelines. As a result of these, and many other activities more multidisciplinary diabetic foot clinics than ever before are being established all over the world and a new generation of diabetic physicians is taking a real interest in the foot and regarding its management as an important area of their practice.
The work of the late Jacquie Lloyd Roberts, the UK podiatrist who established a successful group of diabetic foot clinics in Eastern Europe before her untimely death, is being continued by colleagues, and Dr Hermelinda Pedrosa continues to develop a chain of foot clinics in South America. Their work and the work of numerous other individuals and diabetic foot clinic teams, operating in many different parts of the world in very variable conditions, has clearly demonstrated the general principle that outcomes for diabetic foot patients improve when dedicated and enthusiastic individuals and teams organize a multidisciplinary diabetic foot service. With a flexible approach, many problems can be overcome. If key members of the team, such as podiatrists, are not available in certain countries, then doctors or nurses are taking on many aspects of the role of the podiatrist. In the ‘Step by Step’ project, health-care professionals from all over Tanzania were taught podiatry skills by using scalpels on sweet limes.
Successful interventions in the real world do not depend on the possession of high-technology equipment and vast financial budgets. Barriers to care which at first glance appear to be insurmountable can usually be overcome if we learn lessons from our own and other people’s experiences, and, in the words of E. M. Forster, ‘only connect’ with each other.
NEW AREAS COVERED IN THIS EDITION
- A new edition is an opportunity to present revised and updated material, together with many new photographs and case studies and descriptions of fresh developments in the field. The reading lists at the end of each chapter have incorporated recent references. Older references have been retained when they have described fundamental work on the diabetic foot.
- The authors have simplified our system for managing the infected foot and describe three distinct entities, of local infection, spreading infection and severe infection, together with up-to-date details of new antibiotics available for the diabetic foot. They give more information on commonly encountered organisms, and modern methods of diagnosis and management of infections. Infections with methicillinresistant Staphylococcus aureus (MRSA) and other ‘resistant’ organisms, vancomycin-resistant enterococcus (VRE) and bacteria producing extended-spectrum beta-lactamases (ESBLs) are discussed. The table of antibiotics with reduction of dosage in renal impairment has been updated.
- Diabetic foot problems in pregnancy are very rare: describe a case, and include new tables of antibiotics that can safely be taken in pregnancy and by breastfeeding mothers. Infection with Clostridium difficile, as a complication of antibiotic therapy, is also considered.
- We have also updated the management of painful neuropathy. In addition, the section on Charcot’s osteoarthropathy have been revised, describing specific risk factors in type 1 patients compared with type 2 diabetes, and Lee Sanders discusses the latest techniques to reconstruct the unstable or deformed Charcot foot. Always mindful of the importance of the ischaemic foot, particularly when complicated by infection, they have described a fast-track service to deliver immediate vascular assessment and intervention on a day-case basis, where appropriate. They give up-to-date advice on smoking cessation and discuss the impact of Vacuum-assisted Closure (VAC) therapy which has improved outcomes in patients with ischaemic feet.
- Following in the footsteps of the late Roger Pecararo, we have described common pathways to amputation in our chapter on the unsalvageable foot (Chapter 7). Emphasis has been placed on preventing and managing the comorbidities of the diabetic foot patient, which all healthcare professionals should recognize.
- For the first time there are an illustrated description of the partial nail avulsion procedure, the permanent solution to a recurrent ingrowing toe nail. Nail problems are very common in people with diabetes in all countries of the world and we are frequently asked for details of management. Some illustrations have been also added to the descriptions of total-contact cast and Scotchcast boot manufacture.
- All diabetic foot enthusiasts will enjoy this new edition of our Practical Manual, and will find it asuseful, practical and easy to use as its predecessor.
PRACTICE POINTS
- The multidisciplinary diabetic foot service has been developed as a successful model of care throughout the world.
- The triad of early presentation, early diagnosis and early treatment is the key to success.
- Diabetic foot problems are frequently underestimated: there is no such thing as a trivial lesion of the diabetic foot.
- Diabetic foot patients may not know what is best for them once neuropathy and ischaemia develop.
- Increased interest in the diabetic foot over the last 25 years has resulted in major advances in the care of the diabetic foot patient but expensive, high-tech methods are not always needed.
Contents
- Acknowledgements
- Prologue
- 1 Introduction
- 2 Stage 1: The Normal Foot
- 3 Stage 2: The High-risk Foot
- 4 Stage 3: The Ulcerated Foot
- 5 Stage 4: The Infected Foot
- 6 Stage 5: The Necrotic Foot
- 7 Stage 6: The Unsalvageable Foot
- 8 Surgical Approach to the Diabetic Foot
- Index
Book Details
- Hardcover: 304 pages
- Publisher: Wiley-Blackwell; 2 edition (February 19, 2008)
- Language: English
- ISBN-10: 1405161477
- ISBN-13: 978-1405161473
List Price: $171.95