Managing the diabetic foot, second edition
Edmonds M.E., Foster A.V.M.
We have written the second edition to support and encourage all those people who valiantly care for patients with the diabetic foot - one of the most fascinating but challenging of all diabetic complications. Diabetic feet quickly reach the point of no return and it is extremely important to diagnose problems early and carry out rapid interventions. This is the only way to manage diabetic feet and to save them from amputation and it is a key theme of our second edition.
Since we wrote the first edition in 1999, there have been major changes in the way we look after diabetic feet and we highlight these advances in our second edition. In keeping with other diabetic foot clinics, we have noted a marked increase in the number of patients presenting with neuroischaemic feet. These are 'unforgiving' feet and management needs to be precise and prompt. We describe the increasingly intense and holistic multidisciplinary care of these patients in 'fast-track' clinics. There is growing emphasis on the prevention of vascular events with the widespread prescription of statins, angiotensin-converting enzyme inhibitors and platelet antagonists. There have been advances in angioplasty, with many distal angioplasties now being carried out as day cases. There has also been progress in the care of the wound including free tissue transfer; and the VAC pump .has been established as an important treatment for large ulcers and postoperative wounds. Advances have been made in Charcot osteoarthropathy both in surgical internal stabilisation as well as in the development of external means of stabilisation such as the Charcot Restraint Orthotic Walker. Progress has been achieved in the management of painful peripheral neuropathy.
We continue to describe simple investigations and techniques of which we have had experience and which are readily available in any hospital or clinic that looks after diabetic patients with foot problems. We refer to patients throughout the book as "he" simply because more men than women seem to develop diabetic foot ulcers. Since we wrote the first edition in 1999, there have been major
We have not endeavoured to produce a complete description of every aspect of the diabetic foot and we have deliberately not cited references but given a further reading list. We have also added an appendix of differential diagnosis lists for common presentations and hope this will be useful. Finally, we hope that this book will aid practitioners in their implementation of published guidelines which advise on the care of diabetic feet including the NICE (National Institute of Clinical Excellence) guidelines and the National Service Framework for Diabetes.
We must now accept that diabetes is pandemic and this will inevitably lead to an increase in the number of diabetic foot problems. However, amputations can be avoided by early diagnosis and prompt management and we hope that this book will improve survival of the diabetic foot in the 21 st century.