The Foot in Diabetes

Professor Andrew J. M. Boulton, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK; Consultant Physician, Manchester Royal Infirmary, Manchester, UK; Visiting Professor, Diabetes Research Institute, University of Miami, Miami, FL, USA. Professor Gerry Rayman, The Diabetes Centre, Ipswich Hospital, Ipswich, UK; University of East Anglia, Norwich, UK; University of Suffolk, Ipswich, UK. Dr. Dane K. Wukich, Professor and Chair, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

List of Contributors xv Preface xix Introduction xxi 1 Epidemiology and Economic Impact of Foot Ulcers 1 Edward J. Boyko and Matilde Monteiro-Soares 1.1 Introduction 1 1.2 Diabetic Foot Ulcer (DFU) Definition 1 1.3 DFU Classification 2 1.4 DFU Incidence and Prevalence 3 1.5 DFU Recurrence 5 1.6 Risk Factors for Diabetic Foot Ulcers and Lower Extremity Amputation 6 1.7 Diabetic Foot Ulcer Outcomes 7 1.8 Economic Considerations 9 Reference 10 2 Cost of Diabetic Foot Disease in England 17 Marion Kerr 2.1 Introduction 17 2.2 Human Costs 17 2.3 Financial Costs 20 2.4 Why Measure Costs? 22 2.5 Establishing Healthcare Priorities 22 2.6 Conclusions 25 References 26 3 Epidemiology of Amputation and the Influence of Ethnicity 31 Caroline A. Abbott 3.1 Why Study the Epidemiology of LEA? 31 3.2 LEA Incidence Study Design: The Risk of Bias 32 3.3 LEA Risk Assessment Study Design 32 3.4 Risk Factors for LEA 33 3.5 Incidence Rates of LEA 34 3.6 International and Regional Differences 34 3.7 Time Trends in LEA Rates 34 3.8 Ethnic Differences in Diabetes-Related LEA 35 3.9 Ethnic Differences in Diabetes-Related LEA Risk 35 3.10 Indian Asians 38 References 38 4a The Diabetic Foot Worldwide: India 43 M. Viswanathan 4a.1 Introduction 43 4a.2 Epidemiology of Diabetes in India 43 4a.3 Socio Economic Burden Due to Diabetes 43 4a.4 Common Risk Factors for Amputation in India 43 4a.5 Diagnosing High Risk Feet in Developing Countries 44 4a.6 Comparison in Risk Factors between India and the Western World 44 4a.7 DFI as a Cause for Declining Kidney Function 44 4a.8 Helping People with Amputation Cope Up with the Disability 44 References 45 4b The Diabetic Foot Worldwide: Pakistan 47 Abdul Basit 4b.1 Introduction 47 4b.2 Concept of Multidisciplinary Diabetic Foot Care Team (MDFCT) 47 4b.3 Nationwide Diabetic Foot Programme (Step by Step-[SbS]) 48 4b.4 Footwear for Every Diabetic (FED) 48 4b.5 Further Steps Ahead of SbS 49 References 49 4c The Diabetic Foot Worldwide: Sub-Saharan Africa 51 Zulfiqarali G. Abbas 4c.1 Introduction 51 4c.2 Pathophysiology of Foot Ulcers 52 4c.3 Peripheral Neuropathy (PN) 52 4c.4 Peripheral Arterial Diseases (PAD) 53 4c.5 Foot Ulceration in SSA 54 4c.6 Foot Infection 55 4c.7 Amputation 56 4c.8 Mortality 56 4c.9 Prevention 56 4c.10 Conclusions 58 References 58 4d Burden of Diabetic Foot Disease in Brazil 61 Hermelinda C. Pedrosa and Luciana R. Bahia References 64 4e Diabetic Foot in Romania and Eastern Europe 67 Norina Alinta Gvan and C. I. Bondor 4e.1 Introduction 67 4e.2 The Aim 67 4e.3 Diabetic Foot in Romania 67 4e.4 Diabetic Foot in Eastern Europe 70 4e.5 Conclusions 71 References 71 4f Diabetic Foot Worldwide: Pacific Region 75 Shigeo Kono References 76 4g The Diabetic Foot Worldwide: Middle East 79 Samir H. Assaad-Khalil 4g.1 The Burden of Diabetic Foot Disease (DFD) in the Middle East (ME) 79 4g.2 Specific Regional Barriers to Healthy Feet and Foot Care 80 4g.3 Misconceptions 81 4g.4 Footwear 81 4g.5 Foot Care, Education and Awareness 81 References 82 4h The Diabetic Foot Worldwide: Australasia 85 Peter A. Lazzarini 4h.1 Introduction 85 4h.2 Australia 85 4h.3 New Zealand 86 4h.4 Pacific Islands 86 4h.5 Conclusion 87 References 87 5 Diabetic Neuropathy 89 Dinesh Selvarajah, Gordon Sloan, and Solomon Tesfaye 5.1 Epidemiology 89 5.2 Classification 89 5.3 Symmetrical Neuropathies 91 5.4 Asymmetrical Neuropathies 95 5.5 Pathogenesis of Distal Symmetrical Neuropathy 97 5.6 Management of Diabetic Neuropathy 98 References 101 6 The Pathway to Ulceration: Aetiopathogenesis and Screening 105 Andrew J.M. Boulton 6.1 Introduction 105 6.2 Peripheral Arterial Disease (PAD) 106 6.3 Diabetic Neuropathy 107 6.4 Neuropathy: The Major Contributory Factor in Ulceration 109 6.5 Other Risk Factors for Foot Ulceration 109 6.6 Assessment of Fo