Management of Diabetic Foot Complications

Professor Cliff Shearman is Professor of Vascular Surgery at University of Southampton and Associate Medical Director for R&D in Southampton University Hospitals NHS Trust, UK. He is also Head of Wessex School of Surgery and President of the Vascular Society of Great Britain and Ireland. He has a research and clinical interest in diabetic vascular disease and its complications and heads a multidisciplinary diabetic foot care team. Professor William Jeffcoate is Consultant Endocrinologist at Nottingham University Hospitals NHS trust. He first established a specialist foot service in Nottingham in 1982 and co-founded the Foot Ulcer Trials Unit in 2002. His main research interest lies in collating evidence to underpin protocols for the clinical care of foot disease. He was Contributing Editor to The Lancet from 1997 to 2007 and is currently an Associate Editor for Diabetologia.

Public and political concern about the increasing prevalence of diabetes has prompted major concern about treatment of patients withthe condition. Foot complications are some of the commonest causes ofhospitalisation of people with diabetes and if not treated well often lead toamputation. There is evidence that 85% of these amputations can be prevented by better understanding of the problem and by multi-disciplinary teams working more effectively together. This has been recognised and NICE have recently published guidelines on diabetic footcomplications as have Diabetes UK and NHS Diabetes. These have been successful in raising awareness of the problem but the local multi-disciplinary teams need clear practical advice on how to manage the foot in diabetes and deliver high quality care. With the current interest in improving outcomes for patients with foot complications this is an ideal time to make a practical evidence-basedhandbook available. This book will provide clear practical guidelineson how to manage all aspects of the foot in diabetes as well as an in-depthanalysis of the most recent evidence. The book will be based on care pathways with algorithms for each section so it would be of practical value in any clinic in primary or secondary care. It will appeal to a wide range of health care professionals treating people with diabetes: vascular surgeons and trainees, orthopaedic surgeons, diabetes specialist nurses, podiatrists and tissue viability nurses.

Each section of this practical handbook on care pathways for feet affected by diabetes includes algorithms, key facts, and suggestions for clinical management. It also considers the public and political concern over the increasing prevalence of the disease.

A practical handbook based on care pathways, with algorithms for each section

1. Epidemiology - Numbers, outcomes, change in demographics, cost.- 2. athophysiology of foot in diabetes - Neuropathy, effects on circulation, infections.- 3. Underlying causes of foot complications of diabetes.- 4. Infection and antibiotics.- 5. Early recognition of the foot at risk and prevention.- 6. Foot wear, orthotics and prosthetics.- 7. Diabetic Foot Protection Teams: the role of multidisciplinary team.- 8. Treatment of foot complications both in the community and secondary care.- 9. Principles of Emergency treatment.- 10. Management of arterial disease and re-vascularisation in diabetes.- 11. Management of neuropathy and Charcots neuroarthropathy.- 12. Wound treatment.- 13. The role of foot surgery.- 14. Amputation - when and how.- 15. Rehabilitation and treatment to avoid further problems.