Table of Contents
Cover
Preface to the Third Edition
Preface to the Second Edition
Preface to the First Edition
Acknowledgements
About the Companion Website
1 Introduction
1.1 Definition
1.2 Epidemiology
1.3 Economic Aspects
1.4 Etiopathogenesis of Foot Problems
1.5 Other Risk Factors of Foot Ulceration
1.6 Classification of Foot Problems
References
Further Reading
2 Diabetic Neuropathy
2.1 Methods of Assessing the Foot at Risk
2.2 Physical Examination
Further Reading
3 Anatomic Risk Factors for Diabetic Foot Ulceration
3.1 Pes Planus or Adult‐Acquired Flatfoot Deformity (Flatfoot)
3.2 Bunion
3.3 Hallux Valgus and Convex Triangular Foot
3.4 Bunionette (Tailor's Bunion)
3.5 Protruding Interphalangeal Joints
3.6 Claw Toes
3.7 Prominent Metatarsal Heads
3.8 Pes Cavus
3.9 Curly Toe
3.10 Varus Deformity of the Toes
3.11 Talipes Equinus (Clubfoot)
3.12 Hammer Toe Deformity
3.13 Overriding Toe
3.14 Mallet Toe
3.15 Charcot Foot
3.16 The Consequences of Minor Amputation
3.17 Postsurgical Consequences of Hallux Surgery
3.18 Toe Disarticulations
3.19 Ray Amputations
3.20 Transmetatarsal Amputation and Tarsometatarsal (Lisfranc) Disarticulation
3.21 Chopart Disarticulation
Reference
Further Reading
4 Other Foot‐Related Risk Factors
4.1 Callus
4.2 Corns
4.3 Nail Deformities
4.4 Edema
4.5 Diabetic Bullae (Bullosis Diabeticorum)
4.6 Diabetic Thick Skin
Further Reading
5 Skin and Systemic Diseases with Manifestations in the Feet
5.1 Necrobiosis Lipoidica (Necrobiosis Lipoidica Diabeticorum)
5.2 Diabetic Dermopathy
5.3 Calcium Pyrophosphate Dihydrate Deposition Disease
5.4 Psoriasis
5.5 Palmoplantar Keratoderma
5.6 Hyperkeratotic Eczema
5.7 Squamous Cell Carcinoma
5.8 Dermatofibrosarcoma Protuberans
5.9 Malignant Fibrous Histiocytoma
5.10 Malignant Melanoma
5.11 Necrotizing Vasculitis
Further Reading
6 Neuropathic Ulcers
6.1 Over a Callus in Various Sites of the Foot
6.2 Over a Bony Prominence or in Various Foot Deformities
6.3 On a Toe (Tips, or Dorsum of Phalanges)
6.4 Over a Metatarsal Head
6.5 Heat Injuries
Further Reading
7 Peripheral Vascular Disease
7.1 Non‐Invasive Vascular Tests
7.2 Invasive Vascular Testing: Arteriography
Reference
Further Reading
8 Ischemic and Neuro‐Ischemic Ulcers and Gangrene
8.1 Blue toe Syndrome
8.2 Critical Limb Ischemia (CLI)
8.3 Ischemic Ulcers
8.4 Superficial Neuro‐Ischemic Ulcers of the Dorsum of the Foot
8.5 Diabetic Gangrene (“End‐artery” Disease)
8.6 Neuro‐Ischemic Ulcers of the Toes or Forefoot
8.7 Gangrene due to Abscess of the Plantar Space
8.8 Wet Gangrene
8.9 Dry Gangrene
Further Reading
9 Heel Ulcers
9.1 Heel Cracks and Common Diabetic Heel Ulcers
9.2 Pressure Ulcers
9.3 Staging of Pressure Ulcers
9.4 Prevention of Pressure Ulcers
Further Reading
10 Charcot Foot
10.1 Classification of Neuro‐Osteoarthropathy Based on Characteristic Anatomic Patterns of Bone and Joint Destruction
10.2 Clinical Presentation and Laboratory Findings
10.3 Radiologic Findings
10.4 Differential Diagnosis
10.5 Treatment
References
Further Reading
11 Infections
11.1 Classifications for Diabetic Foot Infections
11.2 Methods of Appropriate Microbiologic Sampling
11.3 Fungal Nail Infections (Onychomycosis)
11.4 Paronychia
11.5 Superficial Bacterial Foot Infections
11.6 Fungal Soft Tissue Infections
11.7 Phlegmon
11.8 Abscess
11.9 Gas Gangrene
11.10 Septic Arthritis
11.11 Osteomyelitis
11.12 Bone Scintigraphy Imaging
11.13 Magnetic Resonance Imaging
11.14 Antibiotic Treatment
Further Reading
12 Methods of Prevention
12.1 Patient Cases Highlighting the Importance of Avoiding Improper Footwear
Reference
Further Reading
13 Methods of Ulcer Healing
13.1 Chronic Diabetic Wounds
13.2 Wound Bed Preparation
13.3 Debridement
13.4 Dressings
13.5 Off‐loading
13.6 Growth Factors
13.7 Bioengineered Skin Substitutes
13.8 Extracellular matrix proteins
13.9 Other Agents
Further Reading
14 Amputations
14.1 Amputation of the Toes
14.2 Midfoot (Lisfranc and Chopart) Amputations
14.3 Hindfoot Amputations
Further Reading
Appendix
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Epidemiological data on the diabetic foot.
Table 1.2 Direct and indirect costs per patient with foot ulcers of various s...
Table 1.3 Meggitt‐Wagner classification of foot ulcers.
Table 1.4 The University of Texas classification system for diabetic foot wou...
Chapter 2
Table 2.1 Neurological assessment for identification of loss of protective se...
Chapter 7
Table 7.1 Classification of peripheral arterial disease: Fontaine's stages an...
Table 7.2 Peak systolic velocity (PSV) ratio in the determination of degree o...
Table 7.3 Criteria for lower limb arterial stenosis in spectral analysis.
Chapter 12
Table 12.1 Risk classification based on a comprehensive foot examination.
Chapter 13
Table 13.1 Properties of and indications for available dressings.
Table 13.2 Advantages and disadvantages of available types of dressing.
Table 13.3 Selection of dressings according to the characteristics of the ulc...
List of Illustrations
Chapter 1
Figure 1.1 Costs of ulcer per patient (Euros) according to outcome in 10 Euro...
Figure 1.2 The pathways to foot ulceration.
Chapter 2
Figure 2.1 Application of the Semmes–Weinstein 5.07 monofilament on the plant...
Figure 2.3 Application of the Semmes‐Weinstein 5.07 monofilament to the plant...
Figure 2.4 The pinprick examination.
Figure 2.5 Examination of vibration perception using a tuning fork on the dor...
Figure 2.6 Examination of vibration perception using a tuning fork on the med...
Figure 2.7 The biothesiometer.
Figure 2.8 The vibration perception threshold is tested at the tip of the big...
Figure 2.9 The Jendrassik maneuver. While the patellar reflexes are being tes...
Figure 2.10 The ankle (Achilles tendon) reflex with the patient kneeling on a...
Figure 2.11 The ankle (Achilles tendon) reflex in lying position.
Figure 2.12 The knee (patellar) reflex.
Figure 2.13 Examination of temperature sensation by applying the plastic part...
Figure 2.14 Examination of temperature sensation by applying the metal part o...
Figure 2.15 Examination for position sense (proprioception). The great toe is...
Figure 2.16 Examination for position sense (proprioception). The great toe is...
Figure 2.17 The podoscope. The patient stands barefoot on a transparent, unbr...
Figure 2.18 A carbon‐paper representation of the sole of a diabetic patient, ...
Figure 2.19 The foam‐mark box (Novotritt; Acuive, Ruinerwold, The Netherlands...
Figure 2.20 The foam‐mark made by the soles of a diabetic patient.
Figure 2.21 A measurement platform while the patient is standing on it.
Figure 2.22 A measurement platform while the patient is walking on it.
Figure 2.23 A measurement treadmill. The patient can walk or run on it and th...
Figure 2.24 Analysis of the dynamic force/pressure distribution from the meas...
Figure 2.25 Analysis of the dynamic force/pressure distribution from the meas...
Figure 2.26 A scanner. The patient stands on the scanner surface barefoot, wh...
Figure 2.27 The report of the scanned feet of a diabetic patient as seen on t...
Figure 2.28 The in‐shoe measurement system. This comprises insoles with attac...
Figure 2.29 Results of an analysis of in‐shoe pressure measurement during sta...
Figure 2.30 Results of an analysis of in‐shoe pressure measurement during wal...
Chapter 3
Figure 3.1 Pes planus.
Figure 3.2 Pes planus, with mild callus formation over the plantar and latera...
Figure 3.3 Pes planus with bunionette and a subungual hematoma seen at the ha...
Figure 3.4 Pes planus (acquired left flatfoot) in a 60‐year‐old gentleman wit...
Figure 3.5 Pes planus (plantar aspect) of the left foot of the patient shown ...
Figure 3.6 A bunion and bunionette with claw toes, muscle atrophy and promine...
Figure 3.7 An infected neuropathic ulcer and bursitis over a bunion with hall...
Figure 3.8 An infected neuropathic ulcer and bursitis over a bunion seen on t...
Figure 3.10 Convex triangular foot with hallux valgus, bunion and bunionette....
Figure 3.11 Triangular forefeet with bunionette. Callus and a neuropathic ulc...
Figure 3.12 Familial convex triangular feet (hallux valgus and quintus varus)...
Figure 3.13 Familial convex triangular feet. The second and the fourth left t...
Figure 3.14 Triangular forefeet with overriding toe. Hallux valgus and a buni...
Figure 3.15 Triangular forefeet with the second toe overriding the third toe ...
Figure 3.16 Bunions and boutonnière deformity. The proximal interphalangeal j...
Figure 3.17 Bilateral hallux valgus, bunions and muscle atrophy are seen on b...
Figure 3.18 Hallux valgus, quintus varus (convex triangular foot), bunionette...
Figure 3.19 Osteoarthritis of the hands of the patient whose feet are shown i...
Figure 3.20 An infected neuropathic ulcer over a bunionette is seen on the ri...
Figure 3.21 Quintus varus and bunionette with an infected neuropathic ulcer a...
Figure 3.22 A callus over the medial aspect of the second interphalangeal joi...
Figure 3.24 A debrided callus over the medial aspect of the second interphala...
Figure 3.25 A friction ulcer over the medial aspect of the right great toe is...
Figure 3.26 Splaying of the forefoot/triangular forefoot and osteomyelitis of...
Figure 3.27 Quintus varus, claw toes and osteomyelitis of the hallux are show...
Figure 3.28 A callus over the crown of the second interphalangeal joint of th...
Figure 3.29 Calluses over the crown of the second interphalangeal joint of bo...
Figure 3.31 An ulcer developed after the application of a callus removal plas...
Figure 3.32 Bilateral bunion and convex triangular feet.
Figure 3.34 A painful corn of the fourth left toe on the left foot of the pat...
Figure 3.35 Claw toes with overriding second toe and onychogryphosis of the f...
Figure 3.36 Muscle atrophy with claw toes and hallux valgus with quintus varu...
Figure 3.37 Splaying of the right forefoot and bilateral polydactyly.
Figure 3.38 Splaying of the forefoot and claw toes of the right foot of the p...
Figure 3.40 Claw toes with overlapping fifth toe and bunionette. There is als...
Figure 3.41 Claw toe.
Figure 3.42 Claw toes and pes cavus (a high plantar arch). The metatarsal hea...
Figure 3.43 The development of claw toes and protruding metatarsal heads. Shi...
Figure 3.44 A radiograph of the left foot of the patient whose feet are shown...
Figure 3.45 Prominent metatarsal heads on the left foot of a 49‐year‐old gent...
Figure 3.46 Prominent metatarsal heads. Callosity has developed bilaterally u...
Figure 3.47 Pes cavus, which is probably familial. Hallux valgus, claw toes a...
Figure 3.48 Case 3.1: Pes cavus with claw toes. Extensive callosity is seen o...
Figure 3.50 Case 3.1: Pes cavus and claw toes. A neuropathic ulcer has formed...
Figure 3.51 Case 3.1: Pes cavus with claw toes. Calluses have formed under th...
Figure 3.52 Case 3.1: Liposarcoma. A medium‐sized vessel has been infiltrated...
Figure 3.55 Case 3.1: Liposarcoma. The round cell component that constitutes ...
Figure 3.56 Curly fourth left toe, with claw toes and a hammer deformity of t...
Figure 3.57 Curly fourth toe.
Figure 3.58 Curly fourth toe with medial malrotation.
Figure 3.59 Varus deformity of the toes, without ulcerative pathology. Claw t...
Figure 3.60 Congenital talipes equinus in a 57‐year‐old gentleman with type 2...
Figure 3.61 An underlapping second hammer toe. Hallux valgus and sheer pressu...
Figure 3.62 An underlapping second hammer toe, with hallux valgus and sheer p...
Figure 3.63 Hammer toe.
Figure 3.64 Congenital sixth overriding toe. Sheer pressure ulcers are seen o...
Figure 3.65 An overriding second toe (clawing of the second toe in supraductu...
Figure 3.66 An overriding second toe due to hallux valgus.
Figure 3.67 Mallet toe.
Figure 3.68 Bilateral Charcot foot with neuropathic ulcers at the apex of the...
Figure 3.69 Case 3.2: Left hallux valgus and bunion. The right foot has a sur...
Figure 3.71 Case 3.2: A triangular forefoot with a bunion.
Figure 3.72 Disarticulation of the first toe. Neuropathic ulcers can be seen ...
Figure 3.73 A neuropathic ulcer three months after second toe disarticulation...
Figure 3.74 Disarticulation of the second toe. A neuropathic ulcer after six ...
Figure 3.75 A neuropathic ulcer after amputation of the first four toes with ...
Figure 3.76 First ray amputation of the foot shown in Figures 3.79 and 3.80....
Figure 3.77 First ray amputation.
Figure 3.78 The left foot shows first ray amputation, and the right foot firs...
Figure 3.79 A neuropathic ulcer is seen under a callus on the lateral side of...
Figure 3.80 Gentle probing through a callus reveals bony exposure and osteomy...
Figure 3.81 Second ray amputation. Claw toes are evident, together with a neu...
Figure 3.83 Fourth ray amputation with a neuropathic ulcer under the base of ...
Figure 3.84 Fifth ray amputation. Claw toes and prominent veins are evident. ...
Figure 3.85 Fourth toe disarticulation and fifth ray amputation.
Figure 3.86 Right fourth and fifth ray amputation, with claw toes.
Figure 3.87 Case 3.3: Postsurgical hallux valgus after second toe amputation ...
Figure 3.88 Case 3.3: Postsurgical hallux valgus after second toe amputation ...
Figure 3.89 Case 3.3: Postsurgical hallux valgus after second toe amputation ...
Figure 3.90 Case 3.3: Corrected postsurgical hallux valgus (after second toe ...
Figure 3.91 Case 3.3: Corrected postsurgical hallux valgus (after second toe ...
Figure 3.92 Transmetatarsal amputation. A neuropathic ulcer has formed under ...
Figure 3.93 Transmetatarsal amputation. A neuropathic ulcer has formed under ...
Figure 3.94 Transmetatarsal amputation seen on a radiograph of the foot shown...
Figure 3.95 Chopart disarticulation. A full‐thickness neuropathic ulcer, whic...
Chapter 4
Figure 4.1 Callus over prominent metatarsal heads.
Figure 4.2 Callus over a prominence of the metatarsal heads. Pes cavus and ha...
Figure 4.3 Heel cracks due to a combination of dry skin and ischemia in the p...
Figure 4.4 Heel cracks due to dry skin.
Figure 4.5 A neuropathic ulcer under a hemorrhagic callus.
Figure 4.6 Plantar pressures recorded by a pedobarograph for the patient show...
Figure 4.7 Gross callus formation on the right forefoot, and hemorrhagic call...
Figure 4.8 A neuropathic ulcer under a callus.
Figure 4.9 Hemorrhagic callus under a hallux.
Figure 4.10 Callus over bony prominences due to bilateral Charcot neuro‐osteo...
Figure 4.11 Callus over the heel.
Figure 4.12 Gross callus formation with cracking of the skin of the left heel...
Figure 4.13 Bilateral callus formation.
Figure 4.14 Gross callus on the great toe.
Figure 4.15 Heloma durum (hard corn), bunion, bursitis and claw toes.
Figure 4.16 Multiple heloma durum (hard corns).
Figure 4.17 Heloma molle (soft corn).
Figure 4.18 Typical site of a heloma molle.
Figure 4.19 An infected heloma molle.
Figure 4.20 An ulcer under a heloma molle in the patient shown in Figure 4.19...
Figure 4.21 An infected heloma molle after debridement, in the same patient a...
Figure 4.22 An infected heloma molle three weeks after debridement and treatm...
Figure 4.23 Onychocryptosis (ingrowing toenail) of both halluxes. Note the br...
Figure 4.24 Paronychia caused by onychocryptosis.
Figure 4.25 Paronychia caused by onychocryptosis in a patient with peripheral...
Figure 4.26 Onychodystrophy in a patient with peripheral neuropathy.
Figure 4.27 Onychogryphosis.
Figure 4.28 Ankle edema in a patient with a foot ulcer.
Figure 4.29 Gross ankle edema in a patient with advanced diabetic nephropathy...
Figure 4.30 A ruptured diabetic bulla.
Figure 4.31 Diabetic bullae.
Figure 4.32 Increased skin thickness of the hand in a patient with long‐stand...
Figure 4.33 Normal skin thickness of the hand of a non‐diabetic subject of si...
Figure 4.34 Cheiroarthropathy. Failure to approximate the palms with the fing...
Figure 4.35 Hallux limitus in the patient shown in Figure 4.34. Note the limi...
Figure 4.36 Preservation of plantar flexion in patients with hallux limitus. ...
Chapter 5
Figure 5.1 Necrobiosis lipoidica. Scaly, irregular plaques with minimal centr...
Figure 5.2 Ulcerated lesions of necrobiosis lipoidica. Note a lesion that is ...
Figure 5.3 Lesions of ulcerated necrobiosis lipoidica, infected with pseudomo...
Figure 5.4 The lesion of Figure 5.3 after a 15‐day course of antibiotic thera...
Figure 5.5 Necrobiosis lipoidica. There are irregular plaques with severe atr...
Figure 5.6 Histology of the patient shown in Figure 5.1, with necrobiosis lip...
Figure 5.7 Histology of the patient from Figure 5.1, with necrobiosis lipoidi...
Figure 5.8 Histology of the patient shown in Figure 5.1, with necrobiosis lip...
Figure 5.9 Necrobiosis lipolytica (patient shown in Figures 5.3 and 5.4) afte...
Figure 5.10 Diabetic dermopathy.
Figure 5.11 Diabetic dermopathy in another patient.
Figure 5.12 Plantar wart (verruca, verruca pedis), which appears as a hard an...
Figure 5.13 The appearance of the plantar warts of the patient shown in Figur...
Figure 5.14 Plantar warts.
Figure 5.15 A painful inflammatory lesion of the fifth toe, due to calcium py...
Figure 5.16 Radiodense deposits in the articular bursae of the distal interph...
Figure 5.17 Plaque psoriasis (or psoriasis vulgaris) on the sole.
Figure 5.18 Plaque psoriasis (or psoriasis vulgaris) on the sole of the patie...
Figure 5.19 Plaque psoriasis (or psoriasis vulgaris) on the palm of the patie...
Figure 5.20 Pustular psoriasis of the sole.
Figure 5.21 Nail involvement in psoriasis. Note the longitudinal striations, ...
Figure 5.22 Fingernail involvement in psoriasis in the patient shown in Figur...
Figure 5.23 Palmoplantar keratoderma.
Figure 5.24 Fingernail involvement in psoriasis in a patient with both type 2...
Figure 5.25 Hyperkeratotic eczema: a hyperkeratotic lesion with dense yellowi...
Figure 5.26 Squamous cell carcinoma presented as an ulcer on the lateral aspe...
Figure 5.27 Squamous cell carcinoma presenting as an ulcer over the fifth met...
Figure 5.28 The result after a fifth ray amputation in the patient shown in F...
Figure 5.29 Ulceration in recurrent dermatofibrosarcoma protuberans of the he...
Figure 5.30 Malignant fibrous histiocytoma at the ankle.
Figure 5.31 Malignant melanoma.
Figure 5.32 The result after removal of the melanoma and reconstructive surge...
Figure 5.33 Subungual malignant melanoma with Hutchinson's sign.
Figure 5.34 Necrotizing vasculitis affecting the feet of a diabetic patient w...
Figure 5.35 Necrotizing vasculitis affecting the lower legs and feet of the p...
Figure 5.36 Necrotizing vasculitis on the hands of the patient from Figure 5....
Chapter 6
Figure 6.1 A callus over the head of the right first metatarsal, together wit...
Figure 6.2 A small ulcer developed at the site of the callus, three months af...
Figure 6.3 Healing of the ulcer shown in Figure 6.2 over the next seven month...
Figure 6.4 A large hemorrhagic callus over the head of the first metatarsal o...
Figure 6.5 Debridement of the callus shown in Figure 6.4.
Figure 6.6 Debridement of the thick hyperkeratosis in Figure 6.5 revealed an ...
Figure 6.7 The ulcer over the head of the first metatarsal shown in Figure 6....
Figure 6.8 Hemorrhagic callus under the fourth metatarsal head. Claw toes and...
Figure 6.9 A neuropathic ulcer in the same patient whose foot is shown in Fig...
Figure 6.10 Plantar pressures before (a) and after (b) orthotic insoles in th...
Figure 6.11 Ulcers on the lateral sides of the first metatarsals, bilaterally...
Figure 6.12 The shoes of the patient referred to in Figure 6.11, showing the ...
Figure 6.13 Improvement of the ulcers on the lateral sides of the first metat...
Figure 6.14 Improvement of the ulcer on the lateral side of the left first me...
Figure 6.15 Neuropathic ulcers under prominent metatarsal heads, and on the m...
Figure 6.16 Neuropathic ulcer surrounded by callus. Claw toe. Right foot of p...
Figure 6.17 Original in‐shoe peak plantar pressures at the left (upper panel)...
Figure 6.18 A patient with Charcot osteoarthropathy and an ulcer over the hea...
Figure 6.19 The patient in Figure 6.18, three weeks later. Note the improved ...
Figure 6.20 The patient from Figure 6.18, four months later. Notice that the ...
Figure 6.21 The patient from Figure 6.20, revealing an ulcer under the callus...
Figure 6.22 An X‐ray of the right big toe showing excessive destruction of th...
Figure 6.23 Hyperkeratotic callus over the left fifth metatarsal head of the ...
Figure 6.24 A non‐inflamed callus on the dorsum of the right fourth toe in th...
Figure 6.25 Debridement of the hyperkeratotic callus shown in Figure 6.24 rev...
Figure 6.26 The foot of the patient shown in Figure 6.25, one month later. Th...
Figure 6.27 Hyperkeratosis at the base of the right big toe.
Figure 6.28 Ulcers on the inner surfaces of the second toes bilaterally (betw...
Figure 6.29 An ulcer on the inner surface of the left second toe, without sig...
Figure 6.30 A nearly healed ulcer on the inner surface of the left second toe...
Figure 6.31 Recurrence of the ulcer on the inner surface of the left second t...
Figure 6.32 A marked improvement of the ulcer shown in Figure 6.31, four mont...
Figure 6.33 A deep, infected ulcer over the head of the third left metatarsal...
Figure 6.34 Remarkable reduction in the area and depth of the ulcer, with no ...
Figure 6.35 Ulcer area even smaller, with a depth of 4 mm.
Figure 6.36 Forty days after initial presentation, the ulcer first shown in F...
Figure 6.37 An ulcer covered with hyperkeratosis is present over the head of ...
Figure 6.38 A new lesion is present on the dorsal aspect of the right second ...
Figure 6.39 Pus is coming out of the lesion over the right second metatarsal ...
Figure 6.40 An improvement in the fistula of the dorsal aspect of the right s...
Figure 6.41 An improvement in the ulcer on the plantar aspect of the right th...
Figure 6.42 A large ulcer has developed over the head of the second metatarsa...
Figure 6.43 A neuropathic ulcer over the head of the third metatarsal. Note t...
Figure 6.44 Significant hyperkeratosis around the ulcer of the patient in Fig...
Figure 6.45 The ulcer of the patient in Figure 6.43 had nearly healed three m...
Figure 6.46 A chronic neuropathic ulcer at the head of the right first metata...
Figure 6.47 A therapeutic ambulatory cast for forefoot off‐loading on the pat...
Figure 6.48 The ulcer at the head of the right first metatarsal, shown in Fig...
Figure 6.49 The patient from Figure 6.46 with burst blisters on both soles af...
Figure 6.50 Three weeks after local and systemic treatment of the blisters sh...
Figure 6.51 Right foot: a neuropathic ulcer over the fifth metatarsal head. L...
Figure 6.52 A plain radiograph of the right foot of the patient shown in Figu...
Figure 6.53 Nearly complete healing of the ulcer shown in Figure 6.51.
Figure 6.54 Thermal injury of the feet of the patient from Figure 6.51.
Figure 6.55 Neuropathic ulcers over the fifth metatarsal heads and progressio...
Figure 6.56 Disarticulation of the right hallux at the metatarsophalangeal jo...
Chapter 7
Figure 7.1 Measurement of the dorsalis pedis systolic blood pressure. A blood...
Figure 7.3 Measurement of the brachial systolic blood pressure using a Dopple...
Figure 7.4 The technique of ankle–brachial pressure index measurement.
Figure 7.5 Extensive calcification of the posterior tibial artery.
Figure 7.6 Toe pressure measurement.
Figure 7.7 Transcutaneous oximetry.
Figure 7.8 Normal segmental pressures (the numbers representing mmHg). The pr...
Figure 7.9 Plethysmography pulse volume waveforms associated with different d...
Figure 7.10 Qualitative analysis of spectral waveforms proximal to the site o...
Figure 7.11 A normal triphasic spectral waveform from the right superficial f...
Figure 7.18 The lower panel shows complete obstruction of the right superfici...
Figure 7.19 Computed tomography angiography. Three‐dimensional reconstruction...
Figure 7.20 Computed tomography angiography. Three‐dimensional reconstruction...
Figure 7.21 Magnetic resonance angiography of the abdominal aorta and iliac a...
Figure 7.23 Magnetic resonance angiography of the tibial and peroneal arterie...
Figure 7.24 Digital subtraction angiography of a diabetic patient with signif...
Figure 7.25 Digital subtraction angiography of the right common femoral arter...
Figure 7.27 Digital subtraction angiography of the right popliteal and tibiop...
Chapter 8
Figure 8.1 “Blue toe syndrome.”
Figure 8.2 Case 8.1: “blue toe syndrome.” Ischemic purple patches on the toes...
Figure 8.3 Case 8.1: “blue toe syndrome.” Ischemic purple patches on the toes...
Figure 8.4 Case 8.1: Digital subtraction angiography showing multiple insigni...
Figure 8.5 Case 8.1: Digital subtraction angiography. Note two significant oc...
Figure 8.6 A painful infected ischemic ulcer over the fourth metatarsal head ...
Figure 8.7 An ischemic ulcer with a necrotic lesion at the top right of the s...
Figure 8.9 A large neuro‐ischemic ulcer with exposed fascia on the dorsum of ...
Figure 8.10 A painless superficial neuro‐ischemic ulcer on the medial aspect ...
Figure 8.11 A relatively painless healing ischemic ulcer on the anterior lowe...
Figure 8.12 A shallow neuro‐ischemic ulcer on the dorsum of the foot. The bas...
Figure 8.13 Case 8.2: A painful infected ischemic ulcer over the left fourth ...
Figure 8.14 Case 8.2: Calcification of the first dorsal metatarsal artery in ...
Figure 8.15 Case 8.2: A healing ulcer from the patient shown in Figure 8.13, ...
Figure 8.16 Case 8.3: An infected neuro‐ischemic ulcer on the medial aspect o...
Figure 8.17 Case 8.3: Digital subtraction angiography showing multiple athero...
Figure 8.18 Case 8.3: Digital subtraction angiography showing total obstructi...
Figure 8.19 Ischemic necrosis (dry gangrene) of the tip of the halluxes, whic...
Figure 8.20 Ischemic ulcers with necrotic lesions of the first and second toe...
Figure 8.21 Wet gangrene of the right hallux due to onychocryptosis and paron...
Figure 8.22 A black ischemic ulcer on the dorsum of the left second toe, with...
Figure 8.23 The mechanism underlying diabetic gangrene. Obliteration of the s...
Figure 8.24 Wet gangrene of the fifth toe. Fontaine stage IV, Rutherford grad...
Figure 8.27 Dry gangrene of the fourth and fifth toes. Injury to the fifth to...
Figure 8.28 Necrotic lesion on the tip of the hallux in a patient with known ...
Figure 8.29 Necrotic lesion on the tip of the hallux in a patient with known ...
Figure 8.30 Diabetic gangrene (wet gangrene) of the left hallux. Note the bel...
Figure 8.31 Hallux disarticulation and claw toes on the same foot as in Figur...
Figure 8.32 Case 8.4: Bilateral ischemic ulcers of the hallux, with osteomyel...
Figure 8.33 Case 8.4: A right second ray amputation with a second overriding ...
Figure 8.34 Case 8.4: Healed bilateral ischemic ulcers of the great toes. The...
Figure 8.35 Case 8.5: A plain radiograph of the patient shown in Figures 8.44...
Figure 8.36 Case 8.5: Digital subtraction angiography showing severe stenosis...
Figure 8.37 Case 8.5: Post‐stenting digital subtraction angiography.
Figure 8.38 Case 8.5: Dry gangrene of the right fourth toe. A neuro‐ischemic ...
Figure 8.39 Case 8.6: A hematoma of the bed nail of the hallux after total on...
Figure 8.40 Case 8.6 : a hematoma of the bed nail of the hallux after total o...
Figure 8.41 The same foot as in Figures 8.38 and 8.39 after removal of the he...
Figure 8.42 A neuro‐ischemic ulcer on the medial surface of the hallux.
Figure 8.43 Neuroischemic ulcers on the top of the fourth toe and the dorsum ...
Figure 8.44 A neuro‐ischemic ulcer on the tip of a hallux valgus caused by fr...
Figure 8.46 A neuro‐ischemic ulcer on the medial aspect of the hallux. Note t...
Figure 8.47 Neuro‐ischemic ulcers on the dorsum of claw toes.
Figure 8.48 Painless interdigital neuro‐ischemic ulceration caused by tight s...
Figure 8.49 A neuro‐ischemic ulcer of the fifth toe.
Figure 8.50 A neuro‐ischemic ulcer on the medial aspect of the first metatars...
Figure 8.51 Neuro‐ischemic ulcers over the first and fifth metatarsal heads. ...
Figure 8.52 Arteriography of the patient whose foot is shown in Figure 8.60. ...
Figure 8.53 A persisting neuro‐ischemic ulcer under an osteolytic lesion of t...
Figure 8.54 Osteomyelitis of the first metatarsal on the foot seen in Figure ...
Figure 8.55 A healing neuro‐ischemic ulcer on the medial surface of the hallu...
Figure 8.56 An infected neuro‐ischemic ulcer soaked in profound discharge, on...
Figure 8.57 The same patient whose foot is illustrated in Figure 8.56, two ye...
Figure 8.58 Wet gangrene of the plantar space and dry gangrene of the second,...
Figure 8.59 Dry gangrene of the tip of the hallux and the second, third and f...
Figure 8.60 The normal plantar arch receives contributions from the medial an...
Figure 8.61 Case 8.7: Gangrene of the second toe and cellulitis of the dorsum...
Figure 8.62 Case 8.7: Wet gangrene of the second toe due to a plantar space a...
Figure 8.63 Case 8.7: Wet gangrene of the second toe due to a plantar space a...
Figure 8.64 Case 8.8: Wet gangrene of the sole of the forefoot and the fourth...
Figure 8.65 Case 8.8: Wet gangrene of the lateral aspect of the right forefoo...
Figure 8.66 Case 8.8: Digital subtraction angiography showing obstruction of ...
Figure 8.67 Wet gangrene involving the forefoot, with cellulitis extending as...
Figure 8.69 Wet gangrene involving the fifth toe, the base of the fourth toe ...
Figure 8.70 Wet gangrene involving the fifth toe, the base of the fourth toe ...
Figure 8.71 The same foot as in Figures 8.69 and 8.70, three days after disar...
Figure 8.72 Wet gangrene of the midfoot and an infected necrotic (ischemic) u...
Figure 8.73 Wet gangrene of the right foot. Redness and edema, due to infecti...
Figure 8.74 Case 8.9: dry gangrene of the right hallux. Note the distinct dem...
Figure 8.75 Case 8.9: dry gangrene of the great toe. An infusion of povidone‐...
Figure 8.76 Case 8.9: A plain radiograph of osteomyelitis of the first and se...
Figure 8.77 Case 8.9: Dry gangrene of the great toe.
Figure 8.78 Case 8.9: Dry gangrene of the great toe. An ischemic ulcer is pre...
Figure 8.79 Case 8.9: A plain radiograph of osteomyelitis of the first and se...
Figure 8.80 Case 8.9: Dry gangrene of the great toe. An ischemic ulcer is pre...
Figure 8.81 Case 8.9: Wet gangrene of the plantar aspect of the foot after a ...
Figure 8.82 Dry gangrene of the toes. Note the black, hard and wrinkled wood‐...
Figure 8.83 Dry gangrene of the tips of all the toes. Cellulitis (wet gangren...
Figure 8.84 Dry gangrene involving all the toes of the left foot with a necro...
Chapter 9
Figure 9.1 A stage 4 infected pressure ulcer of the heel extending to the mus...
Figure 9.2 A healed ulcer of the heel. Callus formation is evident over the s...
Figure 9.4 Plastic reconstruction of the heel after removal of a melanoma. Pr...
Figure 9.5 A painful corn under the heel of an obese 70‐year‐old lady with lo...
Figure 9.6 Painful superficial skin cracks on the lateral aspect of the heel....
Figure 9.7 A painful skin crack is seen on the medial aspect of the heel. Ery...
Figure 9.8 A painless, infected neuro‐ischemic heel ulcer that had been prece...
Figure 9.9 A painless, infected (neuro‐ischemic) heel ulcer with superficial ...
Figure 9.10 A heel ulcer with a black eschar is seen on the lateral aspect of...
Figure 9.11 An unstageable skin ulcer on the lateral aspect of the heel. Afte...
Figure 9.13 Painless neuro‐ischemic heel ulcers in a heavy‐smoking diabetic p...
Figure 9.14 Wet gangrene of a heel ulcer. Sharp debridement determines the de...
Figure 9.15 Dry gangrene of the right hallux of the patient whose foot is see...
Figure 9.16 Calcification of the popliteal artery of the patient whose foot i...
Figure 9.17 Case 9.1: A deep irregular cut with macerated borders and massive...
Figure 9.18 Case 9.1: A neuropathic ulcer of the heel one month after the ini...
Figure 9.20 Case 9.1: A chronic neuropathic ulcer of the heel is actually the...
Figure 9.21 Case 9.1: A plain radiograph of a heel ulcer. The infusion of lip...
Figure 9.22 Case 9.1: A chronic neuropathic ulcer of the heel that was actual...
Figure 9.23 Stages of pressure ulcers See text for details.
Figure 9.24 An unstageable pressure ulcer. Removal of the eschar revealed a s...
Figure 9.27 An unstageable heel pressure ulcer. Removal of the eschar reveale...
Figure 9.28 Case 9.2: Stage 2 pressure ulcers.
Figure 9.29 Case 9.2: Stage 2 pressure ulcers covered with Debrisan beadlets ...
Figure 9.30 Case 9.2: Stage 3 pressure ulcers. A fissure to the adipose tissu...
Figure 9.31 Case 9.2: Unstageable pressure ulcers.
Figure 9.32 Case 9.3: A stage 3 pressure ulcer on the left heel. Exposure of ...
Figure 9.33 A heel protector ring, which keeps the heel suspended and complet...
Figure 9.34 A calf support device, which provides a larger resting surface, t...
Chapter 10
Figure 10.1 A thermometer for measuring skin temperature using infrared radia...
Figure 10.2 A patient with acute Charcot arthropathy of the midfoot, with hyp...
Figure 10.3 Upper picture: The right foot of a patient with Charcot arthropat...
Figure 10.4 Involvement of the first, second and third metatarsophalangeal jo...
Figure 10.5 A total‐contact cast placed on a patient with acute Charcot neuro...
Figure 10.6 A special custom‐made total‐contact cast for a patient with Charc...
Figure 10.7 Another special custom‐made total‐contact cast for a patient with...
Figure 10.8 The special custom‐made total‐contact cast for Charcot arthropath...
Figure 10.9 A special brace for ankle–foot joints.
Figure 10.10 Special ankle–foot orthoses.
Figure 10.11 Armpit support crutches.
Figure 10.12 Elbow support crutches.
Figure 10.13 A walker.
Figure 10.14 The feet of a patient with bilateral Charcot neuro‐osteoarthropa...
Figure 10.15 The right foot of the patient in Figure 10.14.
Figure 10.16 The feet of the patient with bilateral Charcot neuro‐osteoarthro...
Figure 10.17 One year later, the right foot of the patient shown in Figure 10...
Figure 10.18 The left foot of the patient shown in Figure 10.15, with a persi...
Figure 10.19 A patient with bilateral Charcot feet and ulcers on the right se...
Figure 10.20 X‐ray of the right foot of the patient shown in Figure 10.19, wi...
Figure 10.21 X‐ray of the left foot of the patient shown in Figure 10.19, sho...
Figure 10.22 A half‐shoe ambulatory cast has been placed on the right foot of...
Figure 10.23 The right foot of the patient shown in Figure 10.19 one year lat...
Figure 10.24 The left foot of the patient shown in Figure 10.19 one year late...
Figure 10.25 Dorsal aspect of the right foot of a 62‐year old male depicting ...
Figure 10.26 Plantar aspect of the right foot of the patient showing flatteni...
Figure 10.27 X‐ray of the right foot of the patient shown in Figures 10.25 an...
Figure 10.28 Plantar aspect of the right foot of the patient shown in Figure ...
Figure 10.29 Lateral view of the foot showing the persistent deformity with f...
Figure 10.30 Photograph of both ankles of an 82‐year old male with diabetes o...
Figure 10.31 X‐ray of both ankle joints of the patient in Figure 10.30. Notic...
Figure 10.32 Three‐phase scintigram with Tc99m of the patient shown in Figure...
Figure 10.33 Photograph of the left ankle of the patient in Figure 10.30, sho...
Figure 10.34 Photograph of the left ankle of the patient in Figure 10.30, sho...
Figure 10.35 X‐ray of the left ankle joint of the patient shown in Figure 10....
Figure 10.36 The left foot of a diabetic patient with a neuropathic ulcer und...
Figure 10.37 Both feet of the patient in Figure 10.35 showing Charcot foot on...
Figure 10.38 X‐ray of the right foot of the patient shown in Figure 10.36, re...
Figure 10.39 X‐ray of the left foot of the patient shown in Figure 10.36, rev...
Figure 10.40 The right foot of the patient shown in Figure 10.36, one month l...
Figure 10.41 The feet of the patient shown in Figure 10.36, nine months later...
Figure 10.42 The right foot of a patient with an ulcer at the base of the fif...
Figure 10.43 The right foot of the patient shown in Figure 10.36, two months ...
Figure 10.44 A diabetic patient with a widened right foot with a rocker‐botto...
Figure 10.45 The right foot of the patient shown in Figure 10.41 viewed from ...
Figure 10.46 X‐ray of the right foot of the patient shown in Figure 10.41, si...
Figure 10.47 The right foot of a female diabetic patient with Charcot foot an...
Figure 10.48 The right foot of the patient shown in Figure 10.44, four months...
Figure 10.49 The foot of the patient shown in Figure 10.44, seven months late...
Figure 10.50 The foot of the patient shown in Figure 10.44, eight months late...
Figure 10.51 The right foot of a 61‐year‐old woman with a chronic Charcot foo...
Figure 10.52 Persistence of the ulcers of the patient shown in Figure 10.48, ...
Figure 10.53 One month later, the ulcer shown in Figure 10.51 is still persis...
Figure 10.54 Plain X‐ray of the right foot of the patient shown in Figure 10....
Figure 10.55 Photograph of the right foot of a 55‐year old male. Notice the e...
Figure 10.56 X‐ray of the right foot of the patient in Figure 10.54 showing e...
Figure 10.57 MRI examination of the right foot of the patient shown in Figure...
Figure 10.58 MRI examination of the right foot of the same patient after intr...
Figure 10.59 Dorsal aspect of the right foot of the patient shown in Figure 1...
Figure 10.60 Plantar aspect of the right foot of the patient shown in Figure ...
Figure 10.61 X‐ray of the right foot of the patient in Figure 10.58 showing p...
Chapter 11
Figure 11.1 A clinically diagnosed infection of the big toe, should alert for...
Figure 11.2 Surgical debridement of the ulcer of Figure 11.1 revealed a deep ...
Figure 11.3 Accumulation of pus is revealed under a callus. Infectious materi...
Figure 11.4 A neuropathic ulcer penetrating to the fifth metatarsal and causi...
Figure 11.6 An infected neuropathic ulcer over the first metatarsal head two ...
Figure 11.7 A sequestrum obtained from a neuropathic ulcer of a patient with ...
Figure 11.8 Distal onychomycosis of the nails of the great toes.
Figure 11.9 Onychomycosis of the nail of the great toe. Fungal invasion occur...
Figure 11.13 Apoptosis of the nails of all toes due to onychomycosis.
Figure 11.14 The anatomy of a nail. The eponychium (cuticle) is situated betw...
Figure 11.15 Acute painful paronychia after minor trauma due to a pedicure. C...
Figure 11.16 Acute paronychia due to friction from unfit shoes.
Figure 11.17 Untreated chronic paronychia of the hallux, complicated by an ac...
Figure 11.18 Nail‐patella syndrome. Underdeveloped and discolored, split, rid...
Figure 11.20 Nail‐patella syndrome. Toenails of a cousin of the gentleman of ...
Figure 11.21 Superficial forefoot ulcers due to an ill‐fitting shoe. PEDIS 2....
Figure 11.22 Tinea pedis. PEDIS 2.
Figure 11.23 An interdigital fungal infection complicated by a combination of...
Figure 11.24 A fungal infection complicating kissing ulcers of the first and ...
Figure 11.25 Maceration of the forefoot due to improper dressing of and signi...
Figure 11.26 Osteomyelitis of the first metatarsal head, complicated by funga...
Figure 11.27 A phlegmon of a Charcot foot, caused by a spread of infection fr...
Figure 11.28 Progression of a treated phlegmon of the dorsum of the foot, whi...
Figure 11.29 Treatment of a phlegmon of the foot, PEDIS 4 with first ray ampu...
Figure 11.30 A phlegmon of the midfoot before and after intensive treatment w...
Figure 11.31 An abscess of the medial and central plantar compartments. The i...
Figure 11.32 The four fascial compartments of the foot: (a) medial compartmen...
Figure 11.33 Infection of the head of the fourth metatarsal (after an amputat...
Figure 11.34 A central plantar compartment abscess. A staphylococcal infectio...
Figure 11.35 A healed abscess of the left foot, 10 months after presentation ...
Figure 11.36 A neuro‐ischemic ulcer on the medial aspect of the hallux showed...
Figure 11.37 A neuropathic ulcer exposing the metatarsophalangeal joint (caus...
Figure 11.38 A neuropathic ulcer with extensive callosity is shown under the ...
Figure 11.39 A plain radiograph of septic arthritis and osteomyelitis of the ...
Figure 11.40 A sausage‐toe disfigurement caused by bone edema and osteomyelit...
Figure 11.41 A sausage‐like toe indicates osteomyelitis. PEDIS 3.
Figure 11.43 Osteomyelitis of the first phalanx of the fourth toe (radiograph...
Figure 11.44 A chronic neuro‐ischemic ulcer on the medial aspect of the first...
Figure 11.45 Healed osteomyelitis of the first toe. Surgical debridement of t...
Figure 11.46 A small neuropathic ulcer is present under the first metatarsal ...
Figure 11.47 A neuropathic ulcer is seen under the first metatarsal head of t...
Figure 11.49 Osteomyelitis of the first metatarsal head thwarts healing of th...
Figure 11.50 An acute infection of a neuropathic ulcer characterized by macer...
Figure 11.51 A three‐phase bone scan (
99 m
Tc‐MDP TPBS) of the feet of t...
Figure 11.52 A three‐phase bone scan (
99 m
Tc‐MDP TPBS) of the feet of t...
Figure 11.53 An infected neuropathic ulcer at the base of the third toe (afte...
Figure 11.54 A neuropathic ulcer under the first right metatarsal head (after...
Figure 11.55 A technetium‐hexamethylpropylene amine oxime (
99 m
Tc‐HMPAO...
Figure 11.56 Case 11.2: swelling of the right forefoot due to osteomyelitis o...
Figure 11.57 Case 11.2: swelling of the forefoot due to osteomyelitis of the ...
Figure 11.58 Case 11.2: A radiograph of septic arthritis and osteomyelitis of...
Figure 11.59 Case 11.2: Sagittal magnetic resonance imaging T1‐ (upper panel)...
Figure 11.60 Case 11.2: T1‐ (upper panel) and T2 fat sat (lower panel) weight...
Figure 11.61 Case 11.2: T1‐ (upper panel) and T2‐ (lower panel) weighted coro...
Figure 11.62 Case 11.3: A plain radiograph of a left ankle after an ankle str...
Figure 11.63 Case 11.3: A plain radiograph of an acute neuro‐osteoarthropathi...
Figure 11.64 Case 11.3: Cellulitis of the front aspect of the swollen neuro‐o...
Figure 11.65 Case 11.3: Chronic neuropathic osteoarthropathy (Charcot joint) ...
Figure 11.66 Case 11.3: A hindfoot radiograph showing chronic neuropathic ost...
Figure 11.67 Case 11.3: A magnetic resonance imaging T1‐weighted image showin...
Figure 11.68 Case 11.3: A magnetic resonance imaging T2 image showing enhance...
Figure 11.69 Case 11.3: A magnetic resonance imaging STIR image. Pathology is...
Figure 11.70 Case 11.3: A magnetic resonance imaging T1‐weighted image post g...
Chapter 12
Figure 12.1 The indicator plaster Neuropad is applied to the patient's foot. ...
Figure 12.2 The indicator plaster Neuropad is applied to the foot of the pati...
Figure 12.3 High‐heel shoes worn by a female patient in the diabetic foot cli...
Figure 12.4 Shoe terms.
Figure 12.5 A shoe with enough room at the toe box to prevent friction and pr...
Figure 12.6 A ready‐made shoe for a patient with Charcot neuro‐osteoarthropat...
Figure 12.7 A ready‐made insole for a diabetic patient's custom‐made shoe.
Figure 12.8 Special socks for a diabetic patient. Note that they have no seam...
Figure 12.9 A custom‐made insole for a diabetic patient's shoe. Notice the sp...
Figure 12.10 The upper side of a three‐layer custom‐made insole, used to off‐...
Figure 12.11 The lower side of the insole shown in Figure 12.10.
Figure 12.12 A custom‐made insole for a patient with amputation of two toes. ...
Figure 12.13 A ready‐made shoe with a hard, rocker‐bottom outsole. Note that ...
Figure 12.14 The shoe depicted in Figure 12.13, shown during walking. Note th...
Figure 12.15 Skin exfoliation and hematomas on the toes due to the use of imp...
Figure 12.16 Ulcers on the tips of both first toes, as a result of constant f...
Figure 12.17 A further ulceration on the dorsal surface on the left foot of p...
Chapter 13
Figure 13.1 A neuropathic ulcer under the hallux before debridement.
Figure 13.2 The ulcer of the patient in Figure 13.1 after sharp (surgical) de...
Figure 13.3 A deep neuropathic ulcer under the first metatarsal head covered ...
Figure 13.4 The ulcer of the patient in Figure 13.3 after surgical debridemen...
Figure 13.5 A neuropathic ulcer under the first metatarsal head covered by gr...
Figure 13.7 A neuropathic ulcer under the fifth metatarsal head before debrid...
Figure 13.8 The ulcer of the patient in Figure 13.7 after surgical debridemen...
Figure 13.9 An ischemic ulcer at the heel. The ulcer could not be debrided wi...
Figure 13.11 The result after debridement of the ulcer in Figure 13.9.
Figure 13.12 A neuro‐ischemic ulcer of the heel. Enzymatic debridement is ind...
Figure 13.13 A large neuro‐ischemic ulcer on the plantar area of the foot. Th...
Figure 13.14 A hydrocolloid dressing is indicated for this ulcer, which has m...
Figure 13.15 A hydrocolloid dressing can be used in this patient with a dry n...
Figure 13.16 A sloughy infected ulcer of the heel. This ulcer could be dresse...
Figure 13.17 An infected sloughy ulcer of the great toe with bone exposure an...
Figure 13.18 An extensive plantar infected ulcer. After debridement, this ulc...
Figure 13.19 Total‐contact cast.
Figure 13.20 Ulcer debridement.
Figure 13.21 An ulcer covering using an absorbent adhesive dressing.
Figure 13.22 Moisture and pressure between the toes should be reduced using g...
Figure 13.23 Adherent foam is placed around the toes for their protection, an...
Figure 13.24 The stockinette should be fold over the toes dorsally and taped ...
Figure 13.25 A cut on the anterior aspect of the ankle should be made in orde...
Figure 13.26 The cut is taped in place on the anterior aspect of the ankle.
Figure 13.27 Felt padding for the protection of bony prominences.
Figure 13.28 The application of adherent felt for protection of the ulcer are...
Figure 13.29 Minimal padding using orthopedic protective padding.
Figure 13.30 Plaster cast material to conform to the contour of the foot and ...
Figure 13.31 A double rubber heel can be placed on the plantar aspect of the ...
Figure 13.32 An open‐toe total‐contact cast.
Figure 13.33 An open‐toe total‐contact cast.
Figure 13.34 A removable cast walker – 1.
Figure 13.36 A removable cast walker – 3.
Figure 13.37 An instant total‐contact cast.
Figure 13.38 A half‐shoe for off‐loading the forefoot – 1.
Figure 13.39 A half‐shoe for off‐loading the forefoot – 2.
Figure 13.40 A half‐shoe for off‐loading the rearfoot – 1.
Figure 13.41 A half‐shoe for off‐loading the rearfoot – 2.
Figure 13.42 Therapeutic shoes. Note the “rocker‐bottom” shape of the sole fo...
Figure 13.43 Therapeutic shoes. These are indicated to protect the dorsal asp...
Figure 13.44 A patient with a refractory ulcer despite proper off‐loading and...
Figure 13.45 The result after four weekly applications of platelet‐rich plasm...
Figure 13.46 A patient newly diagnosed with type 2 diabetes with an extensive...
Figure 13.49 Excellent results for the patient in Figure 13.46 after treatmen...
Figure 13.50 The patient in Figure 13.49, two months later: the ulcer has alm...
Figure 13.51 A non‐healing ulcer of the heel.
Figure 13.52 The result two months after the application of Hyalograft 3D and...
Figure 13.53 A patient with renal failure on hemodialysis developed this ulce...
Figure 13.54 The ulcer in Figure 13.53 was covered with AlloDerm.
Figure 13.55 One month later, the result for the ulcer in Figure 13.54 was sa...
Figure 13.56 The patient from Figure 13.46 at presentation. He had a severe f...
Figure 13.61 Healthy granulation tissue covers the wound area. At this time, ...
Figure 13.62 A multiplace chamber to treat multiple individuals with hyperbar...
Figure 13.63 The outer aspect of the multiplace chamber.
Chapter 14
Figure 14.1 Wet gangrene, an indication for a wider amputation.
Figure 14.2 The flexor
hallucis brevis
(
HB
) attaches to the tendon of the pro...
Figure 14.4 X‐ray showing amputation of the distal and preservation of the pr...
Figure 14.5 Callus formation over the third metatarsal head due to great toe ...
Figure 14.6 Hallux valgus deformity after second toe amputation.
Figure 14.8 A hallux valgus deformity after second toe removal.
Figure 14.9 Correction of hallux valgus after completion of the second ray am...
Figure 14.10 Rays of foot amputation: the lateral or calcaneal ray (in blue),...
Guide
Cover
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