Caroline A. Abbott
Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK

Zulfiqarali G. Abbas
Internal Medicine, Abbas Medical Centre, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

David G. Armstrong
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA

Samir H. Assaad‐Khalil
Department of Internal Medicine, Unit of Diabetology, Lipidology & Metabolism, Diabetes Foot Care Centre, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Abdul Basit
Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan

Neal R. Barshes
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, TX, USA

Andrew J.M. Boulton
Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK; University of Miami, Miami, FL, USA

Edward J. Boyko
VA Puget Sound Healthcare System and the University of Washington, Seattle, WA, USA

S. A. Bus
Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

Avneesh Chhabra
Radiology & Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA;
Adjunct faculty‐Johns Hopkins University, Baltimore, MD, USA; Walton Centre of Neurosciences, Manchester, UK

G. Dovell
Bristol Bath and Weston Vascular Network, Bristol, UK;
Bristol Centre for Surgical Research, University of Bristol, Bristol, UK

Michael E. Edmonds
Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK

Frances L. Game
University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK

Norina Alinta Gâvan
Association for Podiatry, Cluj-Napoca, Romania

Geoffrey C. Gurtner
Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

R.J. Hinchliffe
Bristol Bath and Weston Vascular Network, Bristol, UK;
Bristol Centre for Surgical Research, University of Bristol, Bristol, UK

Joon Pio (Jp) Hong
Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Seoul, Korea

William J. Jeffcoate
Nottingham University Hospitals NHS Trust, Nottingham, UK

Marion Kerr
Insight Health Economics, London, UK

Merrine Klakeel
University of Texas Southwestern Medical Center, Dallas, TX, USA

Shigeo Kono
WHO‐collaborating Centre for Diabetes Treatment and Education, National Hospital Organization, Kyoto Medical Center, Japan

Karen Kowalske
University of Texas Southwestern Medical Center, Dallas, TX, USA

Javier La Fontaine
Department of Orthopaedic Surgery and Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

Lawrence Lavery
Department of Plastic Surgery, Orthopaedic Surgery, and Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA

Peter A. Lazzarini
Allied Health Research Collaborative, The Prince Charles Hospital, and School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia

Benjamin A. Lipsky
Department of Medicine, University of Washington, Seattle, WA USA;
Green Templeton College, University of Oxford, Oxford, UK

George Liu
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

Joseph L. Mills
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, TX, USA

Misaki M. Kiguchi
Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC, USA

Matilde Monteiro‐Soares
MEDCIDS and CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal

Bijan Najafi
Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

Hermelinda C. Pedrosa
Brazilian Society of Diabetes – Government Relations Advisor 2020‐202, Endocrinology Unit/FEPECS Research and Diabetic Foot Center, Brasilia, Brazil; Worldwide Initiatives for Diabetes Education

N.L. Petrova
Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK

Michael S. Pinzur
Orthopaedic Surgery, Loyola University Health System, Maywood, IL, USA

Gerry Rayman
The Diabetes Centre, Ipswich Hospital Ipswich, UK; University of East Anglia Norwich, UK; University of Suffolk, Ipswich, UK

Katherine M. Raspovic
Department of Orthopaedic Surgery and Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

Neil D. Reeves
Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK

Javier Aragón‐Sánchez
Surgery and Diabetic Foot Unit Department La Paloma Hospital Las Palmas de Gran Canaria Spain

Adam P. Schiff
Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA

Dinesh Selvarajah
Senior Lecturer in Diabetes and Honorary Consultant Physician University of Sheffield, Sheffield, UK

Gordon Sloan
Clinical Research Fellow University of Sheffield, Sheffield, UK

Hyunsuk Peter Suh
Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Seoul, Korea

Solomon Tesfaye
Consultant Diabetologist and Honorary Professor of Diabetic Medicine, University of Sheffield, Sheffield, UK

J.S. Ulbrecht
Department of BioBehavioral Health and Medicine, Pennsylvania State University, University Park, PA, USA;
Mount Nittany Health, State College, PA, USA

Loretta Vileikyte
Department of Medicine, University of Manchester, Manchester, UK;
Division of Endocrinology, Diabetes & Metabolism, University of Miami, Miami, FL, USA;
Dept of Dermatology, University of Miami, Miami, FL, USA

M. Viswanathan
WHO Collaborating Centre for Research, Education and Training in Diabetes, Diabetes Research Centre and M.V. Hospital for Diabetes, Royapuram, Chennai, Tamilnadu, India

Richard William Whitehouse
Manchester Royal Infirmary, Manchester University Hospitals Foundation NHS Trust, Manchester, UK

Edward Y. Woo
Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC, USA

Dane K. Wukich
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

Bob Young
Diabetes UK, London, UK

Much progress has been made in the diagnosis and management of diabetic foot problems since the first edition of this book was published more than three decades ago in 1987. The foot is no longer the “Cinderella” of the late complications of diabetes, and in many areas one could say that the era of anecdote has progressed to the era of evidence‐based practice.

As in the previous editions, we have attempted to provide a concise clinical text, and a number of new topics are included since the 4th edition was published in 2006. These include a global review of diabetic foot problems, new imagining techniques, smart technology, and the use of regenerative medicine and finally providing algorithms for diabetic foot care.

Any medical textbook is necessarily out of date at the time of publication and this certainly includes the diabetic foot. However, in view of a number of key randomized controlled trials that have been published since 2018, these will receive a brief coverage in the Introduction.

We sincerely hope that you find this clinical text of benefit in the management of patients with diabetic foot problems.

Our good friend and author of several contributions in this book, Professor Michael Edmonds, wrote an editorial in 2018 entitled, ‘A renaissance in diabetic foot care: new evidence‐based treatments’ [1]. This renaissance is ongoing, so it was felt that reference should be made to some of the key developments that might not be covered elsewhere in this book. Included in this brief overview will be new evidence‐based therapies including topical therapies and oxygen‐based treatments, infection management, and smart technologies.

A number of well designed, randomised controlled trials (RCTs) were published in 2018. The first proven treatment for neuro‐ischaemic diabetic foot ulcers, sucrose octasulphate dressings, was reported in the Explorer study [2]. In the active group, 48% of wounds were closed after 20 weeks compared to 30% in the control dressing group (p<0.002). In the same journal, Lancet Diabetes Endocrinology, Game and colleagues reported the positive effect of the LeucoPatch device (a disc containing autologous platelets, leucocytes, and fibrin) when applied to the surface of hard‐to‐heal foot ulcers [3]. The addition of a nitric oxide generating medical device to a wound dressing has also been shown to improve healing in an RCT [4].

There has been increasing interest in the use of oxygen‐based therapies in wound healing in recent years. Whereas the latest studies of hyperbaric oxygen have been negative [5,6], there have been interesting developments in the use of devices delivering topical oxygen. There is now evidence that both continuous [7] and cyclical [8] topical wound oxygen therapy may improve wound healing rates.

There has also been a significant increase in studies using placental derived wound products which show promising results but are limited by being unblinded and/or subject to other biases, and the availability and use of these products outside the USA is limited. If high quality RCTs confirm benefit, the widespread availability of placental tissue, and the possibility of less expensive processing methods could make this a cost effective treatment with applicability in lower economy countries [9,10].

In the field of infected foot ulcers, many were surprised to read the result of the OVIVA study [11] which randomized patients with osteomyelitis to oral vs. intravenous antibiotics and showed no superiority of either delivery modality. These observations will certainly challenge the approach to osteomyelitis management in the future. A detailed update review on infection management has been published by the American Diabetes Association in 2020 [12].

Lastly, the area of smart technology in the diabetic foot is progressing rapidly. The efficacy of smart mat technology to predict foot ulceration by monitoring temperature differences between the two feet has been confirmed [13], and RCTs are underway in this area. Similarly, in the field of pressure measurement, an intelligent insole system has been shown to reduce foot ulcer recurrence at plantar sites [14].

These are surely exciting times in the prevention and treatment of diabetic foot problems and we firmly believe that this new decade will bring many more developments in this rapidly expanding area.

References

1. 1 Edmonds, M.E. (2018). A renaissance in diabetic foot care: new evidence‐based treatments. Lancet Diabet. Endocrinol. 6: 837–838.
2. 2 Edmonds, M., Lázaro‐Martínez, J.L., Alfayate‐Garcia, J.M. et al. (2018). Sucrose octasulfate dressing versus control dressing in patients with neuroischemic diabetic foot ulcers (Explorer): an international, multicentre, double‐blind, randomized controlled trial. Lancet Diabetes Endocrinol. 6: 186–196.
3. 3 Game, F., Jeffcoate, W., Tarnow, L. et al. (2018). LeucoPatch system for the management of hard‐to‐heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer‐masked, randomized controlled trial. Lancet Diabetes Endocrinol. 6: 870–878.
4. 4 Edmonds, M.E., Bodansky, H.J., Boulton, A.J.M. et al. (2018). Multicentre, randomized controlled, observer‐blinded study of a nitric oxide generating treatment in foot ulcers of patients with diabetes: ProNox1 study. Wound Rep. Regen. 26: 228–237.
5. 5 Santema, K.T.B., Stoekenbroek, R.M., Koelemay, M.J.W. et al. (2018). Hyperbaric oxygen therapy in the treatment of ischaemic lower‐extremity ulcers in patients with diabetes: results of the DAMO₂CLES multicentre randomized controlled trial. Diabetes Care 41: 112–119.
6. 6 Löndahl, M. and Boulton, A.J.M. ( 2020) Hyperbaric oxygen: useless or useful? A debate. Diab. Metab. Res. Rev. 2020 (in press).
7. 7 Niederauer, M.Q., Michalek, J.E., Liu, Q. et al. (2018). Continuous diffusion of oxygen improves diabetic foot ulcer healing when compared with a placebo control: a randomized, double‐blind, multicentre study. J. Wound Care 27 (suppl 9): S30–S45.
8. 8 Frykberg, R.G., Franks, P.J., Edmonds, M. et al. (2019). A multinational, multicentre, randomized, double‐blinded, placebo‐controlled trial to evaluate the efficacy of cyclical topical wound oxygen therapy (TWO2) in the treatment of chronic diabetic foot ulcers: the TWO2 study. Diabetes Care 2019, Oct 16, Epub ahead of print.
9. 9 Ananian, C.E., Dhillon, Y.S., Van Gils, C.C. et al. (2018). A multicenter, randomized, single‐blind trial comparing the efficacy of viable cryopreserved placental membrane to human fibroblast‐derived dermal substitute for the treatment of chronic diabetic foot ulcers. Wound Repair Regen. 26: 274–83.
10. 10 Tettelbach, W., Cazzell, S., Sigal, F. et al. (2019). A multicentre prospective randomised controlled comparative parallel study of dehydrated human umbilical cord (EpiCord) allograft for the treatment of diabetic foot ulcers. Int. Wound J. 16: 122–30.
11. 11 Li, H.K., Rombach, I., Zambellas, R. et al. (2019). OVIVA Trial Collaborators. Oral versus intravenous antibiotics for bone and joint infection. N. Engl. J. Med. 380: 425–436.
12. 12 Boulton, A.J.M., Armstrong, D.G., Hardman, M.J. et al. (2020). Diagnosis and management of diabetic foot infections. Arlington (VA). American Diabetes Association.
13. 13 Frykberg, R.G., Gordon, I., Rayzelman, A.M. et al. (2017). Feasibility and efficacy of a smart mat technology to predict development of diabetic plantar ulcers. Diabetes Care 40: 973–980.
14. 14 Abbott, C.A., Chatwin, K.E., Foden, P. et al. (2019). Innovative intelligent insole system reduces diabetic foot ulcer recurrence at plantar sites: prospective, randomized proof‐of‐concept study. Lancet Digital Health 1: e308–318.