GLOBAL PERSPECTIVE ON DIABETIC FOOT ULCERATIONS Edited by Thanh Dinh Global Perspective on Diabetic Foot Ulcerations Edited by Thanh Dinh Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Mirna Cvijic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team Image Copyright kentoh, 2010. Used under license from Shutterstock.com First published November, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Global Perspective on Diabetic Foot Ulcerations, Edited by Thanh Dinh p. cm. ISBN 978-953-307-727-7 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Global Impact of Diabetic Foot Complications 1 Chapter 1 Possible Diabetic-Foot Complications in Sub-Saharan Africa 3 Ezera Agwu, Ephraim O. Dafiewhare and Peter E. Ekanem Chapter 2 Reducing Diabetic Foot Problems and Limb Amputation: An Experience from India 15 Sharad Pendsey Part 2 Diagnostic Considerations in Diabetic Foot Complications 25 Chapter 3 Screening of Foot Inflammation in Diabetic Patients by Non-Invasive Imaging Modalities 27 Takashi Nagase, Hiromi Sanada, Makoto Oe, Kimie Takehara, Kaoru Nishide and Takashi Kadowaki Chapter 4 Wound Fluid Diagnostics in Diabetic Foot Ulcers 47 Markus Löffler, Michael Schmohl, Nicole Schneiderhan-Marra and Stefan Beckert Chapter 5 Wound Measurement in Diabetic Foot Ulceration 71 Julia Shaw and Patrick M. Bell Chapter 6 The Temporary Orthesio-Therapy for Diabetic Foot 83 Richard Florence Chapter 7 The Biomechanics of the Diabetic Foot 103 Dennis Shavelson Chapter 8 A Protocol for Primary Podogeriatric Assessment for Older Patients with Diabetes Mellitus 129 Arthur E. Helfand VI Contents Part 3 Treatment of Diabetic Foot Ulcerations 153 Chapter 9 The Pathogenesis of the Diabetic Foot Ulcer: Prevention and Management 155 F. Aguilar Rebolledo, J. M. Terán Soto and Jorge Escobedo de la Peña Chapter 10 Role of Nitric Oxide in Extracellular Matrix Metabolism and Inflammation in Diabetic Wound Healing 183 Victor L. Sylvia, Audra D. Myers, Brandon M. Seifert, Eric M. Stehly, Michael A. Weathers, David D. Dean and Javier LaFontaine Chapter 11 Nutritional Treatment of Diabetic Foot Ulcers - A Key to Success 201 Patrizio Tatti and Annabel Barber Chapter 12 Intralesional Human Recombinant Epidermal Growth Factor for the Treatment of Advanced Diabetic Foot Ulcer: From Proof of Concept to Confirmation of the Efficacy and Safety of the Procedure 217 Pedro A. López-Saura, Jorge Berlanga-Acosta, José I. Fernández-Montequín, Carmen Valenzuela-Silva, Odalys González-Díaz, William Savigne, Lourdes Morejon-Vega, Amaurys del Río-Martín, Luis Herrera-Martínez, Ernesto López-Mola and Boris Acevedo-Castro Chapter 13 Lactoferrin as an Adjunctive Agent in the Treatment of Bacterial Infections Associated with Diabetic Foot Ulcers 239 Maria Elisa Drago-Serrano, Mireya De la Garza and Rafael Campos-Rodríguez Chapter 14 Charcot Neuro-Osteoarthropathy 271 A.C. van Bon Preface Over the last decade, it is becoming increasingly clear that diabetes mellitus is a global epidemic. The influence of diabetes is most readily apparent in its manifestation in foot complications across cultures and continents. In this unique collaboration of global specialists, we examine the explosion of foot disease in locations that must quickly grapple with both mobilizing medical expertise and shaping public policy to best prevent and treat these serious complications. In other areas of the world where diabetic foot complications have unfortunately been all too common, diagnostic testing and advanced treatments have been developed in response. The bulk of this book is devoted to examining the newest developments in basic and clinical research on the diabetic foot. It is hoped that as our understanding of the pathophysiologic process expands, the devastating impact of diabetic foot complications can be minimized on a global scale. Dr. Thanh Dinh Assistant Professor, Surgery, Harvard Medical School Podiatric Surgeon, Beth Israel Deaconess Medical Center Boston, USA [...]... Uganda was confirmed prospectively as due to lack of specialized diabetic foot clinic in the studied population, absence of specialised diabetes clinics, poor education and various complications influenced diabetic foot in South Western Uganda region of Africa 12 Global Perspective on Diabetic Foot Ulcerations Examination of the diabetic foot and appropriate documentation of findings among the diagnosis... report of patients not knowing about foot infection points to lack of diabetes education in the society The non-inclusion of foot inspection in the non -diabetic clinics has made it difficult to determine the prevalence of diabetic foot among the diabetics in the studied area In this study, we could not confirm the prevalence of diabetic foot among the studied population and we also have no result to compare... current prevalence and impact of diabetic foot and its associated complications among the diabetics in South Western Uganda 6 Global Perspective on Diabetic Foot Ulcerations 2 Methods This was a biphasic study made up of a prospective stake-holders descriptive survey and a retrospective cross sectional health-point survey of diabetic foot and its associated complications among diabetic patients attending... for diabetic foot among the diabetics The worst scenario is the high prevalence of unknown cases in where people only discover they are diabetic when they can no longer contain the associated complications Lack of diabetes clinic in major hospitals and at the grass root could explain the poor education of diabetic foot patients on what to do and how to manage the situation Evaluation of diabetic foot. .. 2009, diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the non vascular cases while other causes of amputation included: 35.7% trauma, 20% congenital defects, 14% infection and 12.8% tumours respectively (Ogeng’o et al., 2009) 4 Global Perspective on Diabetic Foot Ulcerations Kidmas et al., (2004) in Nigeria reported 26.4% diabetic foot sepsis as one of the main indications... diabetic foot care, in the Indian sub continent Trivial foot lesions precede 85 % of leg amputations Training of doctors and nurses will help them to take care of such trivial lesions and prevent the majority of leg amputations and simultaneously offer preventive foot care and advice about proper footwear 20 Global Perspective on Diabetic Foot Ulcerations The Step – by – Step project was hence conceived... prevention and control of diabetic foot complications is yielding good results as it is now common to see diabetic patients talking about how to avoid risky behavious such as avoiding certain food as a way of prevention and control of diabetes 5 Conclusion Africa and South Western Uganda have contributed to the knowledge about possible foot complications as outlined above Relative absence of diabetic foot. .. have diabetic foot because of loss of sense of touch 8 Global Perspective on Diabetic Foot Ulcerations due to peripheral neuropathy The diabetic foot complications reported by stakeholders include: peripheral neuropathy (sensory, motor and/or autonomic), chronic leg ulcers and gangrene The clinicians reported that many foot lesions treated among diabetic patients were not documented as part of the final... of diabetics worldwide increase, there will be more diabetic foot problems The escalating number of foot problems is due not only to the increasing diabetic population but to the fact that they are now living long enough to develop foot complications Many healthcare professionals involved in managing persons with diabetes show little interest in diabetic foot problems, furthermore the diabetic foot. .. data on diabetic foot Pre-tested data collection tool was used to obtain socio-demographic information from the case-files of diabetic patients in Mbarara region of Uganda and also diabetes and diabetic foot associated disease complications as contained in patient’s case-files To get a glimpse of the current diabetic management situation in an environment with few diabetic clinics, structured questionnaires . GLOBAL PERSPECTIVE ON DIABETIC FOOT ULCERATIONS Edited by Thanh Dinh Global Perspective on Diabetic Foot Ulcerations Edited by Thanh Dinh. current prevalence and impact of diabetic foot and its associated complications among the diabetics in South Western Uganda Global Perspective on Diabetic Foot Ulcerations 6 2. Methods This. know they have diabetic foot because of loss of sense of touch Global Perspective on Diabetic Foot Ulcerations 8 due to peripheral neuropathy. The diabetic foot complications reported by