Diabetic Foot A Comprehensive Guide for Clinicians
Diabetic Foot A Comprehensive Guide for Clinicians
Editors
Felix Jebasingh K
MBBS MD DM (Endo) DNB (Endo) MNAMS PGDMLE (Med Law)
Associate Professor Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore, Tamil Nadu, India
Nihal Thomas
MBBS MD MNAMS DNB (Endo) FRACP (Endo) FRCP (Edin) FRCP (Glasg) FRCP (Lond) FACP PhD (Copenhagen)
Professor and Head, Unit-1 Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore, Tamil Nadu, India
Foreword
Andrew JM Boulton

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Diabetic Foot: A Comprehensive Guide for Clinicians / Felix Jebasingh K, Nihal Thomas
First Edition : 2023
9789354655456
Printed at
To our special friend and colleague, the late Professor (Dr) Sunil Agarwal, who supported us immensely, as far back as the year 2009. He endorsed us during the formation of the integrated diabetes foot clinic at CMC Vellore, from its initial days.
Editors
- Felix Jebasingh K MBBS MD DM (Endo) DNB (Endo) MNAMS PGDMLE (Med Law)
- Associate Professor
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Nihal Thomas MBBS MD MNAMS DNB (Endo) FRACP (Endo) FRCP (Edin)
- FRCP (Glasg) FRCP (Lond) FACP PhD (Copenhagen)
- Professor and Head, Unit-1
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
Associate Editors
- Bobeena Rachel Chandy MBBS MD (PMR) DNB
- Professor
- Department of Physical Medicine and Rehabilitation
- Christian Medical College
- Vellore, Tamil Nadu, India
- Pranay Gaikwad DNB MNAMS DMAS FMAS
- Professor and Head, Unit-1
- Department of Surgery: General Head and Neck Surgery
- Christian Medical College
- Vellore, Tamil Nadu, India
- Anand John Samuel G BE (Mech) M Phil (HHSM) MBA (HSM)
- Superintendenting Engineer, Prosthetic and Orthotic Services
- Department of Physical Medicine and Rehabilitation
- Christian Medical College
- Vellore, Tamil Nadu, India
- Kripa Elizabeth Cherian MBBS MD DM (Endo) DNB (Endo)
- Associate Professor, Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Bharathi K BSc (N)
- Charge Nurse and Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College
- Vellore, Tamil Nadu, India
- Flory Christina I BSc (N)
- Charge Nurse and Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College
- Vellore, Tamil Nadu, India
- Mathews Edatharayil Kurian MBBS
- Research Officer, Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
Contributing Authors
- Albert Abhinay Kota MB BS MS DNB
- MRCS MCh
- Associate Professor
- Department of Vascular Surgery
- Christian Medical College
- Vellore, Tamil Nadu, India
- Anand John Samuel G BE (Mech) M Phil (Hospital and Health System Management) MBA (Health Services Management)
- Superintendenting Engineer, Prosthetic and Orthotic Services
- Department of Physical Medicine and Rehabilitation
- Christian Medical College
- Vellore, Tamil Nadu, India
- Bharathi K BSc (N)
- Charge Nurse and Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Bobeena Rachel Chandy MBBS MD (PMR) DNB
- Professor
- Department of Physical Medicine and Rehabilitation
- Christian Medical College
- Vellore, Tamil Nadu, India
- B Vinod Jacob DPO ISPO Cat II
- Prosthetist and Orthotist
- Department of Physical Medicine and Rehabilitation
- Christian Medical College
- Vellore, Tamil Nadu, India
- Ezhilarasi V BSc (N)
- Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Felix Jebasingh K MBBS MD DM (Endo)
- DNB (Endo) MNAMS PGDMLE (Med Law)
- Associate Professor
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Flory Christina I BSc (N)
- Charge Nurse and Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Gourav Sannyasi MBBS MD (PMR)
- Senior Resident, Department of Physical Medicine and Rehabilitation
- Christian Medical College
- Vellore, Tamil Nadu, India
- Ida Nirmal BSc (N) MSc (N) ET (Enterostomal Therapist)
- Professor and Nurse Manager
- Colorectal Unit, College of Nursing
- Christian Medical College
- Vellore, Tamil Nadu, India
- Ilakkiya J RN
- Diabetes Educator, Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Jinson Paul MBBS MD DM (Endo)
- Assistant Professor
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Johns T Johnson MBBS MD (Gen Med)
- Senior Resident, Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Kelita George MBBS Postgraduate Fellowship in Diabetes
- PG Resident
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Kripa Elizabeth Cherian MBBS MD
- DM (Endo) DNB (Endo)
- Associate Professor
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Naveen Cherian Thomas MBBS MD (PMR)
- Assistant Professor
- Department of Physical Medicine and Rehabilitation
- Christian Medical College
- Vellore, Tamil Nadu, India
- Nihal Thomas MBBS MD MNAMS DNB (Endo) FRACP (Endo) FRCP (Edin) FRCP (Glasg)
- FRCP (Lond) FACP PhD (Copenhagen)
- Professor and Head, Unit-1
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Pranay Gaikwad DNB MNAMS DMAS FMAS
- Professor and Head, Unit-1
- Department of Surgery: General Head and Neck Surgery
- Christian Medical College
- Vellore, Tamil Nadu, India
- Ruth Volena D BSc (N)
- Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Sandeep Kumar Agarwal MBBS MD DM (Endo)
- Assistant Professor
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Shirly Jennifer N BSc (N)
- Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Shivendra Verma MBBS MD DM (Endo)
- Senior Resident
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Sunil Agarwal (Late) MBBS MS
- Former Professor and Head
- Department of Vascular Surgery
- Christian Medical College
- Vellore, Tamil Nadu, India
- Sunitha R BSc (N)
- Diabetes Educator
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Vasanth Mark Samuel MBBS MS MRCS
- Associate Professor, Unit-1
- Department of Surgery
- Christian Medical College
- Vellore, Tamil Nadu, India
- Venkata Sandeep MBBS MD (Gen Med)
- Senior Resident
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Vennela Devarapalli MBBS MD (Gen Med) PDF (Diabetology)
- PG Resident
- Department of Endocrinology, Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
It is a pleasure and honor for me to write the foreword to this excellent book edited by Felix Jebasingh and Nihal Thomas from the Department of Endocrinology, Diabetes and Metabolism at the Christian Medical College, Vellore, Tamil Nadu, India. I cannot think of a more appropriate setting for all the authors who have contributed to this most interesting and up-to-date book, which should be standard reading for those with an interest in looking after people with diabetes. This very practical book is beautifully illustrated, and interspersed between the chapters, one finds the short biographies of leaders in the field of the diabetic foot from India and worldwide; some of those giants in the area of diabetic foot care are from India, and are still working despite being retired. Those from overseas are physicians and surgeons who have contributed so much to our understanding of the pathogenesis, management, and indeed prevention of diabetic foot problems. Most notable amongst these are Jean-Martin Charcot, after whom the neuroarthropathy seen in diabetic patients with neuropathy was first described, and Paul Brand, the surgeon who was born in the hills to the west of Madras (now Chennai) and who worked for many years at CMC Vellore, and it was Brand who instructed us in the management of the neuropathic foot in both leprosy and diabetes. Many young physicians reading this book may not be aware of the major contribution that Brand made to the treatment of the insensitive foot but he will be best remembered for his quotation that “pain is God's greatest gift to mankind” and for promoting the use of total contact casts in the management of neuropathic foot ulcers.
The editors have gathered a team of true experts in this area and I recommend this book to anybody with an interest in the diagnosis, management, surgical treatment, and indeed prevention of diabetic foot ulcers. Included in this book in a logical order are the anatomy and biomechanics of the foot followed by chapters on causal pathways, neuropathy, peripheral arterial disease, and then infections of the diabetic foot. Finally, there are chapters on routine podiatric care and other therapies including surgery. I am particularly happy to see that the editors have seen it appropriate to include a final chapter on “Recent advances in diabetic foot management.” In modern medicine, any textbook is rapidly out of date in terms of recent developments. The editors of this book have appropriately tried to update this book with last minute developments.
I am sure that all those who read it will benefit greatly from this text and I again thank Jebasingh and Thomas for gathering together such an expert team.
Andrew JM Boulton MD DSc FICP FRCP FACP
Professor of Medicine, University of Manchester,
Division of Diabetes, Endocrinology and Gastroenterology
Consultant Physician, Manchester Royal Infirmary, Manchester, United Kingdom
Visiting Professor of Medicine, University of Miami, Miami, Florida, USA
President, International Diabetes Federation
Past-President, European Association for the Study of Diabetes
PREFACE
Disease of the foot resulting from diabetes is an often serious, yet overlooked complication. The burden of uncontrolled diabetes, causing peripheral neuropathy and diabetes foot in India, is alarming. This book aims to provide a comprehensive overview of the foot in diabetes, its management, and would not have been possible without the collective efforts of our team.
The legacy of Paul Brand who initiated the work in 1948 in handling the foot in leprosy has left us with a lamp that lights the way for the management of the foot in diabetes. Dr Ashish Macaden and his colleagues, from the department of physical medicine and rehabilitation, provided immense support in setting up a foundation and helped us to develop a conceptual framework for the integrated diabetes foot clinic.
Dr Felix who spearheads the integrated diabetes foot clinic and whose ideation led to the fruition of this book, his brainchild. Mr Anand Samuel of the department of prosthetics and orthotics led a world class unit to work hand in glove to generate high quality prosthetics without hesitation, all while maintaining a high output. Dr Mathews helped rejuvenate this manuscript through its various phases and created poetry with a prosaic background, on the diabetes foot. Professor Suranjan Bhattacharjee, with his enlightening presence and ability to think out of the box under the most intriguing circumstances, was instrumental in expanding the scope of our work to the CMC Vellore, Chittoor campus. Our Diabetes Educators, whose competence has gone beyond imaginable boundaries, have raised the bar way ahead of the quantum of natural excellence; their presence and contribution to the system penetrate the normal perceptions of imagination.
We hope that our creation adds significantly to your practice in the field, and provides you with the same sense of fulfillment we achieved, in writing it.
Nihal Thomas
ACKNOWLEDGMENTS
The multidisciplinary overlap between several clinical and nonclinical units is a strong feature of endocrinology. This book would not have been possible but for the strong academic links that the Department of Endocrinology shares with several other departments at CMC Vellore. The enthusiasm and dedication of all our colleagues in the departments of vascular surgery, general surgery, and physical medicine and rehabilitation, prosthetics and orthotics in keeping the ship steady over the years and helping in deciphering complex clinical problems as a team. The care for patients is foundational for such a significant output.
We would like to thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, especially grateful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), and also a note of thanks to Dr Richa Saxena (Associate Director, Professional Publishing), Ms Himani Pandey (Development Editor), Ms Seema Dogra (Cover Visualizer) and the entire Production Team at Jaypee Brothers, for managing this project well.
Felix Jebasingh K
Nihal Thomas