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==Overview==
==Overview==
The discovery of the association between [[diabetes]] and [[foot]] [[ulcer|ulceration]] and subsequent [[infection]] dates back to the 1850s. Significant breakthroughs in the management of [[diabetic foot]] [[ulcer|wounds]] include the introduction of [[surgery|surgical]] [[debridement]] occurred in the early 1900s by Frederick Treves. He also introduced the critical role of [[foot]]wear in [[diabetic foot]] [[ulcers]]. Furthermore the discovery of [[penicillin]] in 1928 by Alexander Fleming reduced the [[mortality rate]] of [[diabetic foot]] [[patients]] and their related [[Complication (medicine)|complications]] significantly. Throughout the 20th century, advances in [[surgery|surgical]] [[Limb (anatomy)|limb]] [[revascularization]] and the advent of [[angioplasty]] drastically reduced the need for [[amputation]]. The latter method remained the mainstays of [[diabetic foot]] management, in the 2004 and 2012 Infectious Disease Society of America guidelines.


==Historical Perspective==
==Historical Perspective==
Marchal de Calvi and Thomas Hodgkin first identified an association between [[diabetes]] and foot ulceration and infection in the 1850s, a significant source of morbidity and mortality for these patients. All skin ulcers at that time were treated with prolonged bedrest, however the lesions returned soon after mobilization.  At the turn of the 19th century, Frederick Treves introduced surgical [[debridement]] of these wounds as well as modified footwear to more evenly distribute pressure across the heal. In 1928, Scottish scientist Alexander Fleming discovered [[penicillin]], further reducing mortality and need for major [[amputation]] from [[diabetic foot]] infections by nearly 50%.<ref name="PMID20277657">{{cite journal |author=McKittrick LS|title=Recent advances in the care of the surgical complications of diabetes mellitus|journal=N Engl J Med. |volume=235|issue=26|pages=929-32|year=1946|pmid 20277657|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/20277657}}</ref><ref name="PMID17859470">{{cite journal |author=McKittrick LS, McKittrick JB, Risley TS|title=Transmetatarsal amputation for the infection or gangrene in patients with diabetes mellitus|journal=Ann Surg.|volume=130|issue=4|pages=826-40|year=1949|pmid 17859470|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17859470}}</ref> Throughout the 20th century, advances in surgical limb [[revascularization]] and the advent of [[angioplasty]] drastically reduced the need for amputation.<ref name="PMID20804927 ">{{cite journal |author=Sanders LJ, Robbins JM, Edmonds ME|title=History of the team approach to amputation prevention: pioneers and milestones|journal=J Vasc Surg.|volume=52|issue=3|pages=3-16|year=2010 |pmid 20804927 |doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/20804927 }}</ref><ref name="PMID1575632 ">{{cite journal |author=LoGerfo FW, Gibbons GW, Pomposelli FB Jr, Campbell DR, Miller A, Freeman DV, Quist WC|title=Trends in the care of the diabetic foot. Expanded role of arterial reconstruction|journal=Arch Surg.|volume=127|issue=5|pages=617-620|year=1992|pmid 1575632|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/1575632}}</ref>
===Discovery===
 
*Marchal de Calvi and Thomas Hodgkin first identified an association between [[diabetes]] and [[foot]] [[ulceration]] and potential [[infection]] of that, as a significant source of [[morbidity]] and [[Mortality rate|mortality]] among these [[patients]], in 1850s. All [[skin]] [[ulcers]] at that time were treated with prolonged bedrest, however these lesions didn't response to immobilization.<ref name="PMID20277657">{{cite journal |author=McKittrick LS|title=Recent advances in the care of the surgical complications of diabetes mellitus|journal=N Engl J Med. |volume=235|issue=26|pages=929-32|year=1946|pmid 20277657|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/20277657}}</ref><ref name="PMID17859470">{{cite journal |author=McKittrick LS, McKittrick JB, Risley TS|title=Transmetatarsal amputation for the infection or gangrene in patients with diabetes mellitus|journal=Ann Surg.|volume=130|issue=4|pages=826-40|year=1949|pmid 17859470|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17859470}}</ref>  
 
*At the turn of the 19th century, Frederick Treves introduced [[surgery|surgical]] [[debridement]] of [[diabetes|diabetic]] [[ulcer|wounds]] as well as modified footwear in order to distribute [[pressure]] more evenly across the [[Sole (foot)|heal]].<ref name="PMID17859470">{{cite journal |author=McKittrick LS, McKittrick JB, Risley TS|title=Transmetatarsal amputation for the infection or gangrene in patients with diabetes mellitus|journal=Ann Surg.|volume=130|issue=4|pages=826-40|year=1949|pmid 17859470|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17859470}}</ref>   
 
*A significant breakthrough occurred in 1928, when a Scottish scientist, Alexander Fleming discovered [[penicillin]], which further reduced [[mortality rate|mortality]] and [[morbidity]] (such as major [[amputation]]) from [[diabetic foot]] [[infections]] by nearly 50%.<ref name="PMID20277657">{{cite journal |author=McKittrick LS|title=Recent advances in the care of the surgical complications of diabetes mellitus|journal=N Engl J Med. |volume=235|issue=26|pages=929-32|year=1946|pmid 20277657|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/20277657}}</ref><ref name="PMID17859470">{{cite journal |author=McKittrick LS, McKittrick JB, Risley TS|title=Transmetatarsal amputation for the infection or gangrene in patients with diabetes mellitus|journal=Ann Surg.|volume=130|issue=4|pages=826-40|year=1949|pmid 17859470|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17859470}}</ref>  
 
*Throughout the 20th century, advances in [[surgery|surgical]] [[Limb (anatomy)|limb]] [[revascularization]] and the advent of [[angioplasty]] drastically reduced the need for [[amputation]] and remained a mainstay of [[treatment]].<ref name="PMID20804927 ">{{cite journal |author=Sanders LJ, Robbins JM, Edmonds ME|title=History of the team approach to amputation prevention: pioneers and milestones|journal=J Vasc Surg.|volume=52|issue=3|pages=3-16|year=2010 |pmid 20804927 |doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/20804927 }}</ref><ref name="PMID1575632 ">{{cite journal |author=LoGerfo FW, Gibbons GW, Pomposelli FB Jr, Campbell DR, Miller A, Freeman DV, Quist WC|title=Trends in the care of the diabetic foot. Expanded role of arterial reconstruction|journal=Arch Surg.|volume=127|issue=5|pages=617-620|year=1992|pmid 1575632|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/1575632}}</ref>
 
*In 2004, the Infectious Disease Society of America published initial clinical practice guideline for the [[diagnosis]] and [[treatment]] of [[diabetic foot]] [[infection]] and with recent updates in 2012, provide an up-to-date [[diagnosis|diagnostic]] and [[treatment|therapeutic information]] to [[Physician|clinicians]].<ref name="PMID22619242">{{cite journal |author=Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E, Infectious Diseases Society of America|title=2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections|journal=Clin Infect Dis. |volume=54|issue=12 |pages=e132 |year=2012|pmid 16822461|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/22619242}}</ref>
IDSA published initial clinical practice guideline for the diagnosis and treatment of diabetic foot infections in 2004, with the most recent updates in 2012.<ref name="PMID22619242">{{cite journal |author=Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E, Infectious Diseases Society of America|title=2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections|journal=Clin Infect Dis. |volume=54|issue=12 |pages=e132 |year=2012|pmid 16822461|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/22619242}}</ref>
 
 
DDX
Other processes that lead to inflammatory changes in the skin of the lower extremities can mimic an infection. These include trauma, crystal-associated arthritis, acute Charcot arthropathy, fracture, thrombosis, and venous stasis. Usually, infection can be distinguished from these based on history, exam, and imaging findings. However, infection may co-exist with other inflammatory processes, and empiric antimicrobial therapy may be warranted in some cases when the diagnosis is unclear.
 
 
CLASSIFICATION
classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations)


==References==
==References==
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Latest revision as of 19:29, 17 September 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Daniel A. Gerber, M.D. [2] Anahita Deylamsalehi, M.D.[3]

Overview

The discovery of the association between diabetes and foot ulceration and subsequent infection dates back to the 1850s. Significant breakthroughs in the management of diabetic foot wounds include the introduction of surgical debridement occurred in the early 1900s by Frederick Treves. He also introduced the critical role of footwear in diabetic foot ulcers. Furthermore the discovery of penicillin in 1928 by Alexander Fleming reduced the mortality rate of diabetic foot patients and their related complications significantly. Throughout the 20th century, advances in surgical limb revascularization and the advent of angioplasty drastically reduced the need for amputation. The latter method remained the mainstays of diabetic foot management, in the 2004 and 2012 Infectious Disease Society of America guidelines.

Historical Perspective

Discovery

References

  1. 1.0 1.1 McKittrick LS (1946). "Recent advances in the care of the surgical complications of diabetes mellitus". N Engl J Med. 235 (26): 929–32. Text "pmid 20277657" ignored (help)
  2. 2.0 2.1 2.2 McKittrick LS, McKittrick JB, Risley TS (1949). "Transmetatarsal amputation for the infection or gangrene in patients with diabetes mellitus". Ann Surg. 130 (4): 826–40. Text "pmid 17859470" ignored (help)
  3. Sanders LJ, Robbins JM, Edmonds ME (2010). "History of the team approach to amputation prevention: pioneers and milestones". J Vasc Surg. 52 (3): 3–16. Text "pmid 20804927 " ignored (help)
  4. LoGerfo FW, Gibbons GW, Pomposelli FB Jr, Campbell DR, Miller A, Freeman DV, Quist WC (1992). "Trends in the care of the diabetic foot. Expanded role of arterial reconstruction". Arch Surg. 127 (5): 617–620. Text "pmid 1575632" ignored (help)
  5. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E, Infectious Diseases Society of America (2012). "2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections". Clin Infect Dis. 54 (12): e132. Text "pmid 16822461" ignored (help)