Atlas of the Diabetic Foot

Nicholas Katsilambros MD, Professor in Internal Medicine Athens University Medical School Eygenideio Hospital and Research Laboratory Christeas Hall Athens, Greece Eleftherios Dounis MD, FACS, Director Orthopedia Department Laiko General Hospital Athens, Greece Konstantinos Makrilakis MD, MPH, PhD, Assistant Professor in Internal Medicine Athens University Medical School 1st Department of Propaedeutic Medicine Laiko General Hospital Athens, Greece Nicholas Tentolouris MD, Asssistant Professor 1st Department of Propaedeutic Medicine Athens University Medical School Laiko General Hospital Athens, Greece Panagiotis Tsapogas MD, Medical and Diabetes Department Medical Bioprognosis Corfu, Greece

INTRODUCTION. Epidemiology. Economy aspects. Aetiopathogenesis of foot problems in diabetes text & 2 graphs. Classification of foot problems text & table & graphs. I. DIABETIC NEUROPATHY. Methods of assessment of the foot at risk. Physical examination. Monofilaments. Tactile sensation (Light touch cotton wool). Vibration perception (tuning fork) Biothesiometer. Pain sensation. Proprioception. Temperature percption. Reflexes. Pedobarograph. II. ANATOMY RISK FACTORS FOR THE DIABETIC FOOT FOOT DEFORMITIES. Muscle weakness. Prominence of metatarsal heads. Claw toes. Hammer toes. Hallux valgus. Halux varus. Hallux rigidus. Hallux pronation. Bunionette. Splaying of the front foot. Curly toes. Mallet. Toe overriding. Pes cavus. Pes planus. Previous (minor) amputation. III. OTHER FOOT RISK FACTORS. Callus. Haemorhagic callus. Oedema. Corns. Nail deformities. Bullae diabeticorum. Inappropriate footware. IV. OTHER RISK FACTORS. Postural instability. Poor vision. Social factors. V. NEUROPATHIC ULCERS. Over a callus in various sites of the foot. Over a bone prominence or in various foot deformities. On a toe (tips, dorsum of phalanges). Over a metatarsal head. Heat injuries. (figures, pedobarograph images, radiology studies etc as applied in each case) VI. PERIPHERAL VASCULAR DISEASE. Clinical history. Physical examination. Non-invasive tests. Arteriography. VII. ISCHAEMIC ULCERS. At various sites. Toes and inner aspects of toes. Foot dorsum. Sole. Outer and inner aspect of the foot. Dry gangrene. Wet gangrene. VIII. CHARCOT FOOT. Ulcer on a Charcot foot. IX. THE NEUROISCHAEMIC ULCER. X. INFECTIONS. Nail infections. Fungal infections of toes and foot. Cellulites. Deep tissue infections. Osteomyelitis. (radiology studies, CT scans, MRI, scintigraphy etc). XI. METHODS OF PREVENTION. Patient education. Appropriate footware, socks. XII. METHODS OF ULCER HEALING. OFFLOADING. Bed resting, wheelchair, crutches, total cast, scotch cast boot, shoes, insoles. DRESSINGS. OTHER METHODS. Hyperbaric oxygen.