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Contemporary Diabetes
Series Editor: Aristidis Veves
AristidisVeves JohnM.Giurini MarcL.SchermerhornEditors
TheDiabetic Foot
Medical and Surgical Management
Contemporary Diabetes
Series Editor
AristidisVeves, Beth Israel Deaconess Medical Center,Boston,MA,USA
e Contemporary Diabetes series focuses on the clinical aspects of obesity and diabetes and provides the practicing health provider with all the latest information regarding their management. e series also targets both basic and clinical researchers. e audience includes endocrinologists, internists, cardiologists, neurologists, nephrologists, podiatrists, ophthalmologists, family physicians, nurse practitioners, nurse educators, and physician assistants.
Aristidis Veves • John M. Giurini Marc L. Schermerhorn
Editors
The Diabetic Foot
Medical andSurgical Management
Fifth Edition
Editors
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Aristidis Veves The Rongxiang Xu, MD, Center for Regenerative Therapeutics Boston, MA, USA
Marc L. Schermerhorn Vascular and Endovascular Surgery Beth Israel Deaconess Medical Center Boston, MA, USA
John M. Giurini Division of Podiatric Surgery Beth Israel Deaconess Medical Center Boston, MA, USA
ISSN 2197-7836 ISSN 2197-7844 (electronic) Contemporary Diabetes ISBN 978-3-031-55714-9 ISBN 978-3-031-55715-6 (eBook)
https://doi.org/10.1007/978-3-031-55715-6
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2006, 2012, 2018, 2024 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Humana imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
Preface
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It is with great joy that we present the fth edition of our textbook, The Diabetic Foot: Medical and Surgical Management. As with previous editions, we aimed to maintain a 5-year interval
between updates. While it may be argued that major breakthroughs have occurred in diabetic lower extremity problems since the last edition, nonetheless, signicant advances in our under­standing of their pathogenesis and management justify a new edition. We have therefore kept the structure of the book the same, dividing it into four sections that cover clinical features and diagnosis, pathophysiology, the management of diabetic foot problems, and the organization of preventive care. Each chapter has been revised to incorporate new knowledge, and addi­tional chapters have been added, mainly in the pathophysiology section.
Although the COVID-19 pandemic has dominated news and attention in recent years, dia­betes remains a serious pandemic that, unlike COVID-19, shows no signs of improvement. As a result, signicant resources will continue to be necessary for its management, and every indication suggests that diabetic foot pathologies will be among the more serious problems, consuming a larger portion of the resources spent on diabetes. As with previous editions, we have taken advantage of the extensive experience accumulated at the Joslin-Beth Israel Deaconess Foot Center over the decades and described our multidisciplinary approach that combines state-of-the-art management with a focus on avoiding unnecessary waste of valuable resources.
Among the various changes in the book, the most prominent in this edition is the replace­ment of one of the editors. Dr. Raul Guzman has left our institution for a more prominent posi­tion as Chief of Vascular Surgery at Yale University, where we have no doubt that he will excel, as he has in all his previous positions. We are delighted that his position has been taken by Dr. Marc Schermerhorn, Chief of Vascular Surgery at our institution, the Beth Israel Deaconess Medical Center. He brings with him not only extensive experience in the clinical management of diabetic lower extremities but also an impressive research record.
The success of the previous four editions gives us condence that the new edition will be similarly judged by the medical community as a helpful tool in improving the management of diabetic foot problems, preserving the lower extremity, and avoiding amputations. To this end, we want to acknowledge the contributions of all the authors and sincerely thank them for their outstanding work. Last but not least, we want to express our gratitude to Humana Press for their continuing support of this project.
Boston, MA, USA AristidisVeves Boston, MA, USA JohnM.Giurini Boston, MA, USA MarcL.Schermerhorn
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Contents
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Part I Clinical Features and Diagnosis
1 The Epidemiology of Diabetic Foot Ulcer and Amputation . . . . . . . . . . . . . . . . . . 3
David J. Margolis
2 Clinical Examination and Risk Classification of the Diabetic Foot . . . . . . . . . . . . 11
Lawrence A. Lavery and Mehmet A. Suludere
3 Diabetic Neuropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Solomon Tesfaye and Triantafyllos Didangelos
4 Clinical Features and Diagnosis of Peripheral Arterial Disease . . . . . . . . . . . . . . . 47
Nicholas J. Swerdlow and Allen D. Hamdan
5 Imaging of Infection in the Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Mary G. Hochman and Caitlin Connolly
6 Principles of Care in the Diabetic Surgical Patient . . . . . . . . . . . . . . . . . . . . . . . . . 93
Natasha Khazai and Osama Hamdy
Part II Pathophysiology
7 Physiology and Pathophysiology of Wound Healing in Diabetes . . . . . . . . . . . . . . 109
Irena Pastar, Nathan C. Balukoff, Andrew P. Sawaya, Nicole M. Vecin, and Marjana Tomic-Canic
8 Regeneration of the Skin and Peripheral Nerves in the Adult . . . . . . . . . . . . . . . . 135
Alan Z. Yang, Daniela Lee, Daniella Dennis, and Samuel J. Lin
9 Neuropeptides, Inflammation, and Diabetic Wound Healing: Lessons from
Experimental Models and Human Subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Lucas Mota, Frank W. LoGerfo, Aristidis Veves, and Leena Pradhan-Nabzdyk
10 Pathophysiology of Microvascular Disease in Diabetes . . . . . . . . . . . . . . . . . . . . . . 185
Brandon J. Sumpio and Aristidis Veves
11 High Content Single Cell and Spatial Tissue Profiling Modalities
for Deciphering the Pathogenesis and Treatment of Wound Healing . . . . . . . . . . 199
Yered H. Pita-Juarez, Nikolas Kalavros, Dimitra Karagkouni, Yuling Ma, Xanthi-Lida Katopodi, and Ioannis S. Vlachos
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12 Structural and Functional Changes in Skin of the Diabetic Foot. . . . . . . . . . . . . . 219
Paschalis Chatzipantelis, Eleftheria Angeliki Valsami, Antonios Kafanas, and Aristidis Veves
13 Biomechanics of the Diabetic Foot: The Road to Foot Ulceration . . . . . . . . . . . . .233
Panagiotis V. Tsaklis and Nikolaos Tentolouris
14 Cell Therapies: New Frontier for the Management of Diabetic
Foot Ulceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Sasha Shenk, Ramone Brown, Olga Kashpur, Avi Smith, Ryan Imbriaco, Bradford Greaves, Behzad Gerami-Naini, and Jonathan A. Garlick
15 Role of Extracellular Vesicles, Modified mRNA, miRNA, and siRNA
in Diabetic Lower Extremity Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Georgios Theocharidis and Jenny Li
16 Tissue-Engineered Wound Dressings for Diabetic Foot Ulcers . . . . . . . . . . . . . . .287
Simon Matoori, Sahar Rahmani, and David J. Mooney
17 Infection in Diabetes: Epidemiology, Immune Dysfunctions,
and Therapeutics
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Ruchi Roy, Raj Singh, and Sasha H. Shakhani
18 Biomarkers of Diabetic Foot Ulcers and Its Healing Progress . . . . . . . . . . . . . . . . 327
Monika A. Niewczas and Hetal Shah
Contents
19 Experimental Animal Models in Research: Diabetes and Impaired
Wound Healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Mauricio Contreras and Enya Wang
Part III Management of the Diabetic Foot
20 Microbiology and Treatment of Diabetic Foot Infection . . . . . . . . . . . . . . . . . . . . . 363
Mary T. LaSalvia and Adolf W. Karchmer
21 Preparation of the Wound Bed of the Diabetic Foot Ulcer . . . . . . . . . . . . . . . . . . . 379
Kevin Riemer and Kevin Buczkowski
22 Topical Wound Care Treatment and Indications for Their Use . . . . . . . . . . . . . . . 389
Abby Hargis, Narges Maskan Bermudez, Marita Yaghi, and Robert S. Kirsner
23 Surgical Treatment of the Ulcerated Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Juan Ceja Solorio and John M. Giurini
24 Lower Extremity Arterial Reconstruction in Patients with Diabetes Mellitus:
Principles of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Sophie X. Wang and Mark C. Wyers
25 Reconstruction of the Diabetic Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Eric Shiah, Amy Chen, Ryan P. Cauley, and Arriyan S. Dowlatshahi
26 The Charcot Foot in Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .477
Lee C. Rogers, Stephanie N. Campbell, and Robert G. Frykberg
27 Amputations and Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
John T. Marcoux, Thao Nguyen, and Lars Stangenberg
Contents
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Part IV Organization and Preventive Care
28 Organization of a Diabetic Foot Care Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .527
Thanh Dinh and Barry I. Rosenblum
29 Quality of Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535
Katherine M. McDermott and Caitlin W. Hicks
30 Psychosocial and Educational Implications of Diabetic
Foot Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
Elizabeth A. Beverly and Arlene Smaldone
31 The Role of Footwear in the Prevention of Diabetic Foot Problems . . . . . . . . . . . 565
Luigi Uccioli and Laura Giurato
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579
Contributors
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Nathan C. Balukoff Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
Narges Maskan Bermudez Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
Elizabeth A. Beverly Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
Ramone Brown Department of Diagnostic Sciences, School of Dental Medicine, Tufts University, Boston, MA, USA
KevinBuczkowski Division of Podiatric Surgery, Signature Healthcare, Brockton, MA, USA
Stephanie N. Campbell Department of Orthopaedics, University of Texas Health Science
Center at San Antonio, San Antonio, TX, USA
RyanP.Cauley Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
JuanCeja Solorio Rio Grande Foot and Ankle Specialist, Santa Fe, NM, USA
Paschalis Chatzipantelis Medical School, Democritus University of Thrace,
Alexandroupolis, Greece
Amy Chen Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Caitlin Connolly Nuclear Medicine, Department of Radiology, Harvard Medical School, Mount Auburn Hospital, Cambridge, MA, USA
Mauricio Contreras Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
Daniella Dennis Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Triantafyllos Didangelos Internal Medicine and Diabetology, Medical School, Aristotle University, “AHEPA” Hospital, Thessaloniki, Greece
ThanhDinh Harvard Medical School, Boston, MA, USA
Division of Podiatric Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
Arriyan S. Dowlatshahi Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
RobertG.Frykberg College of Podiatric Medicine at Midwestern University, Glendale, AZ, USA
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