الفهرس 
Surgical Anatomy of the FootOnly 14 pages are availabe for public view
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Abstract
According to the World Health Organization, more than 150 million people worldwide suffered from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2025 this number will double. Diabetes mellitus affects people throughout the world, but is more common in the more developed countries. The increase in incidence of diabetes in the developing countries follows the trend of urbanization and life style changes.
Several factors predispose diabetic patients to develop a diabetic foot infection, including neuropathy, vasculopathy and immunopathy. Peripheral neuropathy occurs early in the pathogenesis of diabetic foot complications and is considered the most prominent risk factor for diabetic foot ulcers. Diabetic patients with impaired sensation and altered pain response are vulnerable to trauma and extrinsic forces from ill-fitting shoe wear. The dorsal toes and the planter surface are the most common sites for ulcers. Neuro-ischaemic ulcers tend to occur on the margins of the foot, and neuropathic ulcers tend to occur on the plantar surface of the foot.
Diagnosing a diabetic foot infection begins with clinical suspicion through a comprehensive history and physical exam, validated with a complete laboratory evaluation, microbiology assessment and diagnostic imaging.
According to the Infectious Disease Society of America (IDSA) guidelines, infection is present if there is obvious purulent drainage and/or the presence of two or more signs of inflammation (erythema, pain, tenderness, warmth, or induration). Deep tissue cultures have remained the standard for assessing infection, and the use of superficial swabs, especially in clinically uninfected wounds is discouraged. Treatment is more likely to be successful if the choice of antibiotic is based on the results of bone culture. Recent evidence supports the use of ESR and CRP for the evaluation of possible osteomyelitis., an ESR <70 mm/hr significantly increases the probability of OM. a CRP <3.2 mg/dl was a useful marker for differentiating OM from cellulitis.
The treatment of diabetic foot ulcers is a constant challenge in diabetes care and requires a multidisciplinary approach involving doctors, physiotherapists, and orthopedic technicians. Over the recent years, novel and promising therapeutic options have emerged for the treatment of chronic diabetic foot ulcers, However, clinical studies are needed in order to develop a well-structured algorithm for the assessment and treatment of diabetic ulcers to prevent lower-extremity amputations due to this complication.
For treatment of DFI stating that an empirical antibiotic regimen should be implemented primarily on the basis of infection severity and likely pathologic agents. Optimally, definitive therapy should be based upon culture and susceptibility analysis. Adjunctive therapies include the use of antibiotic impregnated beads, application of negative pressure wound therapy and hyperbaric oxygen treatment.
Leech Therapy, also known as Hirudotherapy augment blood flow to the distal parts of the body and alleviate coagulation disorders as the peripheral vascular complications in diabetic patients can lead to less blood flow to the distal parts of the body resulting in ischemic diseases of limbs like gangrene, since the microcirculation restoration effect of Hirudotherapy is essential in preventing amputation of fingers and toes.
Surgical management of moderate to severe DFI is often required and includes aggressive incision, drainage and debridement of non-viable soft tissue and bone. Multiple debridements are often necessary to provide adequate drainage and control of infection. The need for both minor (removal of a portion of foot distal to the ankle joint) and major amputations (proximal to the ankle joint) increased as the severity of infection increased. Foot infections can extend proximally into the leg through the tarsal tunnel, resulting in rapidly ascending limb and life threatening infection.
Recent Treatment Methods in Persistent Diabetic Foot Ulcers include the following:
1. Autologous Skin Transplantation in Diabetic Foot Ulcers
2-Tissue-engineered human skin equivalent in diabetic foot ulcers.
3- Bone Marrow-Derived Cells
4. Growth Factors
5. Granulocyte-colony-stimulating factor (G-CSF) in infected diabetic ulcers, but the results are difficult to interpret due to differences in (G-CSF) formulations
6. Subatmospheric Pressure Dressings