Pocket Guideline of Diabetic Foot

Zulfiqarali G Abbas MBBS DTM&H MMed FRCP Consultant Physician, Endocrinologist and Diabetologist; Founder and Chairman, Pan-African Diabetic Foot Study Group; Vice-President, D-Foot; International Executive Member of Infection Committee, International Working Group on the Diabetic Foot (IWGDF), Department of Internal Medicine, Abbas Medical Centre, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Arun Bal MS PhD Consultant Diabetic Foot Surgeon, Founder and President, Diabetic Foot Society of India; Department of Diabetic Foot Surgery, Raheja Hospital, Hinduja Hospital, Mumbai, Maharashtra; Visiting Professor, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Section 1: Medical Aspect of Diabetic Foot

1. Diabetes Mellitus—A Clinical Challenge

2. Top Ten Countries for Number of Adults with Diabetes

3. Epidemiology of the Diabetic Foot

4. Economical Burden of the Diabetic Foot Ulcer

5. Pathway to Diabetic Foot Ulcer

6. Factors Associated with Foot Ulcer

7. Pathophysiology of Foot Ulceration

8. Diabetic Peripheral Neuropathy

9. Types of Peripheral Neuropathy

10. Tests for Peripheral Neuropathy

11. Vibration Test

12. Biothesiometer or Neuro-esthesiometer

13. Other Tests for Peripheral Neuropathy

14. Neuropad (Autonomic Test)

15. Neuro-osteoarthropathy (Charcot Foot)

16. Indications for a Neurological Referral in Patients with Suspected Diabetic Sensorimotor Neuropathy

17. Oral Symptomatic Therapies in Painful Diabetic Neuropathy

18. Peripheral Arterial Diseases

19. Stages of Peripheral Arterial Disease

20. Chronic Critical Ischemia

21. Classification of Peripheral Arterial Disease

22. Interpretation of the Ankle-brachial Index

23. Computed Tomography Scan Angiogram of Lower Limbs

24. Transcutaneous Oxygen Monitor

25. Clinical Symptoms of Neuropathic and Ischemic Foot Ulcers

26. Neuroischemic Diabetic Foot (Mixed)

27. Diabetic Foot Infections

28. Risk Factors for Infection

29. Three Most Important Clinical Categories of Infections

30. Cellulitis

31. Deep Soft Tissue Infection

32. Chronic Osteomyelitis

33. Criteria for Diagnosis of Osteomyelitis

34. Typical Features of Diabetic Foot Osteomyelitis on Plain X-rays

35. Classification and Severity of Infection

36. Indications of Worsening Infection

37. Characteristics Suggesting a More Serious Diabetic Foot Infection and Potential Indications for Hospitalization

38. Factors that May Influence Choices of Antibiotics Therapy for Diabetic Foot Infections (Specific Agents, Route of Administration, Duration of Therapy)

39. Factors Potentially Favoring Selecting Either Primarily Antibiotics or Surgical Resection for Diabetic Foot Osteomyelitis

40. Antibiotic Regimens for Mild, Moderate, and Severe Diabetic Foot Infections

41. Duration of Treatment for Infected Diabetic Foot

42. Wagner Classification

43. PEDIS Classification

44. The University of Texas Classification

45. SINDBAD Classification

46. Lower Extremity Threatened Limb Classification System

47. Ischemia: Clinical Category

48. Foot Infection: Clinical Category

49. Simple Staging of the Diabetic Foot

50. Consider the Whole Patient and not the Hole in the Patient to Ensure Effective Care of the Foot Ulcer

51. Foot Examination

52. Ulcer Assessment

53. Wound Bed

54. Examination of Edge, Wall, and Base

55. A Summary of the Management of Diabetic Foot Ulcer

56. Local Wound Treatment

57. Role of Debridement in Ulcer Management

58. Debridement Methods and Its Characteristics

59. Summary of Indications for Different Dressings/Devices

60. Ulcer Healing

61. Surgical Intervention in Severe Cases where Abnormal Pressure Distribution is Causing Persistent and Nonresolvable Ulceration

62. Biomechanics Factors and Footwear

63. Plantar Pressure Reduction

64. Footwear and Offloading for the Diabetic Foot: An Evidence-based Guideline

65. General Guide to Footwear Based on Risk Status

66. Examination of the Insensate Diabetic Foot

67. The Diabetic Foot Ulcers: Outcome and Management

68. Global Burden of Limb Amputation

69. Preventing Diabetic Foot Amputation

70. Nonulcerative Pathology of Ulcers

71. Social Factors of the Diabetic Foot

72. Time is Tissue in the Diabetic Foot

73. Pathway to Clinical Care for Diabetic Foot Ulcer

74. Risk Categorization System

75. How to Prevent Foot Problems

76. Ulcer Prevention

77. Training of Health Care Workers

78. The Step-by-Step Diabetic Foot Project

79. Train the Foot Trainer Project

80. Organization of Foot Care

81. The Minimal Foot Clinic Model

82. Pathway of Refer for Foot Care

83. Tropical Diabetic Hand Syndrome

84. Algorithm for Management of Tropical Diabetic Hand Syndrome

85. Issues—Particular Importance in Developing Countries





Section 2: Surgical Aspect of Diabetic Foot

86. Diabetes Mellitus—Surgical Challenge

87. Team Approach

88. Foot Salvage Surgery

89. Neuropathy and Surgery

90. Charcot Foot

91. Imaging in Charcot Foot

92. Indication for Surgical Treatment

93. Surgical Treatment for Charcot Foot

94. Choice of Surgical Procedures

95. Healing Time in Surgical Treatment of Charcot Foot

96. Complication of Surgical Treatment

97. Peripheral Arterial Disease and Surgery

98. How Peripheral Arterial Disease is Different in Diabetes than Nondiabetic Patients

99. Peripheral Arterial Disease, Transcutaneous Oxygen Pressure, and Surgery

100. Imaging Modalities

101. Selection of Type of Imaging

102. When and How to Treat Foot Gangrene When Revascularization is not Feasible

103. Selection of Type of Revascularization

104. Steps to Prevent Acute Kidney Injury in a Susceptible Patient

105. Use of Non-iodine Based Contrast

106. Post-revascularization Treatment

107. Schedule for Antibiotics is as Follows

108. Post-revascularization Prevention

109. Necrotizing Fasciitis

110. Osteomyelitis

111. The Conservative Treatment of Osteomyelitis

112. Debridement in Patients with Infection and Vasculopathy

113. Conservative Management of Localized Gangrene

114. Factors That Influence Wound Closure Procedure

115. Factors That Retard Healing

116. Commonly Used Procedures within Each Surgical Category

117. Different Types of Dressing

118. Acute Wound Flowchart

119. Chronic Wound Flowchart

120. Skin Grafting in Diabetic Foot

121. Advantages of Split Thickness Skin Graft

122. Local/Regional Anesthesia for Diabetic Foot Surgery

123. Total Contact Cast for Diabetic Foot Patients

124. Advantages of Contact Casting in Diabetic Foot Ulcers

125. Contraindication for Total Contact Casting in Diabetic Foot Ulcers

126. Why Diabetes Patients Gets Bilateral Pedal Edema?

127. Wound Bed Preparation

128. Evolution of Time Frame Work

129. Tissue Management Debridement

130. Selection of Types of Debridement

131. Types of Debridement

132. Callus Debridement in Diabetic Foot

133. Adhesive Felt for Offloading

134. Pressure Relief Gel Pads and Support

135. Deformed but Walkable Diabetic Feet

136. Vacuum-assisted Wound Closure

137. Footwear in Diabetes

138. Footwear Insole

139. Total Contact Orthosis

140. Rocker Outsole

141. Pathology Causing Toe Injuries due to Deformities and Poor Foot Care/Footwear

142. Guidelines for Footwear Prescription in Diabetes

143. Why Early Detection and Treatment of Critical Limb Ischemia

144. Fungal Infection in Diabetic Foot

145. Ten Commandments of Foot Care in Diabetes





Wound Care Mini: Glossary

Further Reading