Diabetic foot historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
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%.[1][2] Throughout the 20th century, advances in surgical limb revascularization and the advent of angioplasty drastically reduced the need for amputation.[3][4]
IDSA published initial clinical practice guideline for the diagnosis and treatment of diabetic foot infections in 2004, with the most recent updates in 2012.[5]
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
- ↑ 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)
- ↑ 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)
- ↑ 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)
- ↑ 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)
- ↑ 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)