Preface

The global burden of diabetes and diabetes related complications is growing rapidly. In many ways it is a "perfect storm" that reflects the combined effects of aging, obesity and change of lifestyles around the world. Lower extremity complications are an obvious part of the diabetes epidemic. It has been estimated that every 30 seconds a leg is lost due to diabetes somewhere in the world. These amputations by themselves have been shown to lead to increased risk of further complications such as additional amputations, chronic wounds, hospital admissions and death.

Though feared by patients and doctors alike, amputations are not the only lower extremity complication of diabetes. Amputations are usually preceded by ulcers and wounds with a low tendency to heal. These chronic wounds can be a source of infection and further decay. There are several factors associated with the development of these skin lesions such as: peripheral vascular disease, numbness of the foot caused by peripheral symmetric polyneuropathy, foot deformities and ill fitting shoes. Patients at risk for foot complications can be identified by screening for these risk factors. In this book, we will try to shed light on the complex interaction of these risk factors and on their sequelae.

It was not long ago that recommendations about the evaluation and treatment of diabetic foot complications were solely based on expert opinion or small case series. Much of the work in this text references the level of medical evidence that is currently available. The authors applied the system used by the UK National Health Service to grade the level of evidence factored into recommendations for treatments or interventions. These recommendations will be present throughout the book and can be summarized by: