Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492011000600001
Jornal Vascular Brasileiro
Scientific Article

Atenção integral ao portador de pé diabético

Jackson Silveira Caiafa; Aldemar Araujo Castro; Cícero Fidelis; Vanessa Prado Santos; Erasmo Simão da Silva; Cid J. Sitrângulo Jr.

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Resumo

São apresentadas, nessa separata, as principais orientações sobre a atenção às complicações do pé diabético. A neuropatia, com suas diversas apresentações que acometem os membros inferiores dos diabéticos, as lesões da doença arterial obstrutiva periférica (DAOP), as múltiplas apresentações da infecção do pé diabético, e, principalmente, os cuidados preventivos que possam impedir o estabelecimento ou a evolução dessas complicações são tratados de forma sistemática e simplificada, visando a atenção integral desses doentes. Especial cuidado é dado às orientações diferenciadas para os diversos níveis de atenção nos serviços públicos de saúde, porta de entrada virtual de 80% dos infelizes portadores dessa complicação. São aqui apresentados modelos de atenção e sugeridos protocolos que podem contribuir para a efetiva redução do número de amputações, internações e óbitos de diabéticos com complicações nos membros inferiores.

Palavras-chave

Pé diabético, Neuropatia diabética, Doença vascular periférica, Amputação, Prevenção & controle

References

Faber DC, Faber JS. Office-based screening, prevention, and management of diabetic foot disorders. Prim Care. 2007;34(4):873-85.

Diagnóstico precoce do Pé Diabético. 2007:116-119.

Ragnarson T, Apelqvist J. Health-economic consequences of diabetic foot lesions. Clin Infect Dis. 2004;39(2).

Campbell LV, Graham AR, Kidd RM, Molloy HF, O'Rourke SR, Colagiuri S. The lower limb in people with diabetes: Position statement of the Australian Diabetes Society. EMJA. 2000;173:369-72.

Caiafa JS, Canongia PM. Atenção integral ao paciente com pé diabético: um modelo descentralizado de atuação no Rio de Janeiro. J Vasc Br. 2003;2(1):75-8.

Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26(5):1553-79.

Armstrong DG, Harkless LB. Outcomes of preventive care in a diabetic foot specialty clinic. J Foot Ankle Surg. 1998;37:460-6.

Van Gils CC, Wheeler LA, Melltrom M, Brinton EA, Mason S, Wheeler CG. Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients. The Operation Desert Foot experience. Diabetes Care. 1999;22(5):678-83.

Consenso Sobre Diabetes: Diagnóstico e Classificação dos Diabetes Mellitus Tipo II. 2001.

de Heus-van Putten MA, Schaper NC, Bakker K. The clinical examination of the diabetic foot in daily practise. Diabetic Med. 1996;13(^s55).

Implementation of the St Vincent Declaration: The Care of Diabetic Patients in Scotland. Management of Diabetic Foot Disease. 1997.

Kozak GP, Giurini JM. Diabetic Neurophaties: Lower Extremities. Management of diabetic foot problems. 1995:43-52.

Thomaz JB, Herdy CDC, Bracaglio SB, Abílio FM, Oliveira JCP, Thomaz YCM, Lima MV. Pé Diabético. Ars Curandi. 1996:61-103.

Campell DR, Freeman DV, Kozak GP. Guidelines in the Examination of the Diabetic Leg and Foot. Management of diabetic foot problems. 1995:10-5.

Obrosova IG. Increased sorbitol pathway activity generates oxidative stress in tissue sites for diabetic complications. Antioxid Redox Signal. 2005;7(11):1543-52.

Pedrosa HC, Nery ES, Sena FV, Novaes C, Feldkircher TC, Dias MSO, Leme LAP, Miziara M, Assis MA, Kaluma C. O Desafio do Projeto Salvando o Pé Diabético. Terapêutica em Diabetes: Boletim Médico do Centro B-D de Educação em Diabetes. 1998;19.

Steed DL, Attinger C, Colaizzi T. Guidelines for the treatment of diabetic ulcers. Wound Rep Reg. 2006;14:680-92.

Liatis S, Marinou K, Tentolouris N, Pagoni S, Katsilambros N. Usefulness of a new indicator test for the diagnosis of peripheral and autonomic neuropathy in patients with diabetes mellitus. Diabet Med. 2007;24(12):1375-80.

Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg. 1996;35:528-31.

Boulton AJ. The pathogenesis of diabetic foot problems: an overview. Diabet Med. 1996;13(^s12).

Edelson GW, Armstrong DG, Lavery LA, Caicco G. The acutely infected diabetic foot is not adequately evaluated in a inpatient setting. Arch Intern Med. 1996;156:2373-5.

Campbell RR, Hawkins SJ, Maddison PJ, Reckless JP. Limited joint mobility in diabetes mellitus. Ann Rheum Dis. 1985;44:93-7.

Fernando DJ, Masson EA, Veves A, Boulton AJ. Relationship of limited joint motility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care. 1991;14:8-11.

Sanders LJ, Frykberg LJ. Charcot Foot. The Diabetic Foot. 1993:149-180.

Frykberg RG, Kozak GP. The Diabetic Charcot Foot. Management of diabetic foot problems. 1995:10-5.

Armstrong DG, Lavery LA, Harkless LB. Treatment based classification system for assessment and care of diabetic feet. Journal of the American Podiatric Medical Association. 1996;86:311-6.

Levin ME. Diabetic Foot Wounds: Pathogenesis and Management. Advances in Wound Care. 1977;10:24-30.

Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical Criteria for Screening Patients at High Risk for Diabetic Foot Ulceration. Archives International Medicine. 1998;158:157-62.

International Consensus on the Diabetic Foot. 1999.

Guy RJ, Clark CA, Malcolm PN, Watkins PJ. Evaluation of thermal and vibration sensation in diabetic neuropathy. Diabetologia. 1985;28:131-7.

Practical Guidelines on the Management and the prevention of the Diabetic Foot Based upon the International Consensus on the Diabetic Foot. 1999.

Armstrong DG, Lavery AL, Wunderlich RP. Risk Factors for Diabetic Foot Ulceration: A Logical Approach to Treatment. Journal Wound Ostomy Continence Nurse. 1998;25:123-8.

Rajbhandari SM, Jenkins RC, Davies C, S, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45:1085-96.

Cole BE. Diabetic peripheral neuropathic pain: recognition and management. Pain Med. 2007;85(^s2).

Boulton AJM, Malik RA. Diabetic Neuropathy. Med Clin North Am. 1998;82:909- 29.

Illa I. Diagnosis and Management of Diabetic Peripheral Neuropathy. European Neurology. 1999;41(^s1).

Boulton AJM, Malik RA, Arezzo JC, Sosenko JM. Diabetic Somatic Neuropathies. Diabetes Care. 2004;27(6):1458-86.

Tandan R, Lewis GA, Krusinski PB, Badger GB, Fries TJ. Topical capsaicin in painful diabetic neuropathy. Controlled study with long-term follow-up. Diabetes Care. 1992;15:8-14.

Ziegler D. Diagnosis and management of diabetic peripheral neuropathy. Diabetic Med. 1996;13(^s348).

Nicolucci A, Carinci F, Graepel JG, Hohman TC, Ferris F, Lachin JM. The efficacy of tolrestat in the treatment of diabetic peripheral neuropathy. A meta-analysis of individual patient data. DiabetesCare. 1996;19:1091-6.

Ametov AS, Barinov A, Dyck PJ, Hermann R, Kozlova N, Litchy WJ, Low PA, Nehrdich D, Novosadova M, O'Brien PC, Reljanovic M, Samigullin R, Schuette K, Strokov I, Tritschler HJ, Wessel K, Yakhno N, Ziegler D. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care. 2003;26:770-6.

Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med. 2004;21:114-21.

Ziegler D, Ametov A, Barinov A, Dyck PJ, Gurieva I, Low PA, Munzel U, Yakhno N, Raz I, Novosadova M, Maus J, Samigullin R. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29:2365-70.

Ziegler D, Low PA, Boulton AJ, Vinik AI, Freeman R, Samigullin R, Tritschler H, Munzel U, Maus J, Schuette k, Dyck PJ. Effect of 4-Year Antioxidant Treatment with alpha-Lipoic Acid in Diabetic Polyneuropathy: The NATHAN 1 Trial. (Abstract). Diabetes. 2007;56.

Cornblath DR, Vinik A, Feldman E, Freeman R, Boulton AJ. Surgical descompression for diabetic sensorimotor polyneuropathy. Diabetes Care. 2007;30:421-2.

Santos VP, Silveira DR, Caffaro RA. Risk factors for primary major amputation in diabetic patients. São Paulo Med J. 2006;124:660-70.

Malone JM, Snyder M, Anderson G, Bernhard VM, Holloway GA, Bunt TJ. Prevention of amputation by diabetic education. Am J Surg. 1989;158:520-4.

Raines JK, Darling C, Buth Jacob, Brewster DC, Austen WG. Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities. Surgery. 1976;79:21-8.

Takolander R, Rauwerda JA. The use of non-invasive vascular assessment in diabetic patients with foot lesions. Diabetic Med. 1996;13(^s1).

Yao ST, Hobbs JT, Irvine WT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Brit J Surg. 1969;56:676-9.

Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31(^s1).

Engelhorn CA, Engelhorn AL, Lourenço MA, Pullig R, Ribas E, Miranda Jr. F, Burrihan E. Acurácia da imagem ultra-sonográfica expandida no diagnóstico das obstruções arteriais do segmento infra-inguinal. J Vasc Br. 2002;1:55-64.

LoGerfo FW, Coffman JD. Current concepts. Vascular and microvascular: disease of foot in diabetes. N Eng J Med. 1984;311(25):1615-9.

Pomposelli FB Jr, Jepsen SJ, Gibbons GW, Campbell DR, Freeman DV, Gaughan BM. A flexible approach to infrapopliteal vein grafts in patients with diabetes mellitus. Arch Surg. 1991;126:724-9.

Levey A S, Coresh J, Balk E. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Ann Intern Med. 2003;139(2):137-49.

Meguid El Nahas A, Bello AK. Chronic Kidney Disease: The Global Challenge. Lancet. 2005;365(9456):331-40.

Salpeter S, Greyber E, Pasternak G, Salpeter E. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus: systematic review and meta-analysis. Arch Intern Med. 2003;163(21):2594-602.

Silva R C, Pardini DP, Kater CE. Síndrome dos ovários policísticos, síndrome metabólica, risco cardiovascular e o papel dos agentes sensibilizadores da insulina. Arq Bras Endocrinol Metab. 2006;50(2):281-90.

Thomsen HS, Morcos SK. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines. Br J Radiol. 2003;76(908):513-8.

Heijenbrok MH, Kock MCJM, Hunik MGM. Lower extremity arterial disease: multidetector CT angiography - meta-analysis. Radiology. 2007;245:433-9.

Catalano C, Fraioli F, Laghi A, Napoli A, Bezzi M, Pediconi F, Danti M, Nofroni I, Passarello R. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology. 2004;231:555-63.

Huber TS, Back MR, Ballinger RJ, Culp WC, Flynn TC, Kubilis PS, Seeger JM. Utility of magnetic resonance arteriography for distal lower extremity revascularization. J Vasc Surg. 1997;26(3):415-24.

Jude EB, Oyibo SO, Chalmers N, Boulton A. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24(8):1433-7.

Dick F, Diehm N, Galimanis A, Husmann M, Schmidli J. Surgical or endovascular revascularization in patients with critical limb ischemia: influence of diabetes mellitus on clinical outcome. J Vasc Surg. 2007;45(4):751-61.

Wölfle KD, Bruijnen H, Loeprecht H, Rümenapf G, Schweiger H, Grabitz K, Sandmann W, Lauterjung L, Largiader JA, Erasmi H, Kasprzak PM, Raithel D, Allenberg JR, Lauber A, Berakovich GM, Kretschmer G, Hepp W, Becker HM. Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and no-diabetic patients: results of a multicentre comparative analysis. Eur J Vasc Endovasc Surg. 2003;25(3):229-34.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Disease. J Vasc Surg. 2007;45(^s5).

Mukherjee D, Lingan PBS, Stanley C, Grossman PM, Moscucci M, Luciano AE, Eagle Kim. Missed opportunities to treat atherosclerosis in patients undergoing peripheral vascular interventions: insights from the University of Michigan peripheral vascular disease quality improvement initiative. Circulation. 2002;106(15):1909-12.

Dawson DL, Cutler BS, Hiatt WR, HobsonII RW, Martin JD, Bortey EB, Forbes WP, Strandness DE. A comparison of cilostazol and pentoxifylline for treating intermittent claudication. Am J Med. 2000;109:523-30.

Pomposelli FB Jr, Marcaccio EJ, Gibbons GW, Campbell DR, Freeman DV, Burgess AM. Dorsalis pedis arterial bypass: durable limb salvage for foot isquemia in patients with diabetes mellitus. J Vasc Surg. 1995;21(3):375-84.

LoGerfo FW, Gibbons GW. Vascular disease of the lower extremities in diabetes mellitus. Endocrinol Metab Clin North Am. 1996;25(12):439-45.

Awad S, Karkos CD, Serrachino-Inglott F, Cooper NJ, Butterfield JS, Ashleigh R, Nasim A. The impact of diabetes on current revascularization practice and clinical outcome in patients with critical lower limb ischaemia. Eur J Vasc Endovasc Surg. 2006;32(1):51-9.

Golledge J, Ferguson K, Sabharwal T, Davles AH, Greenhalgh RM, Powell JT. Outcome of femoropopliteal angioplasty. Ann Surg. 1999;229:146-53.

Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF. BASIL trial participants. Bypass vs angioplasty in severe ischaemia of the leg (BASIL) (multicenter, randomized controlled trial). Lancet. 2005;366(9501):1925-34.

Schillinger M, Sabeti S, Loewe C, Dick P, Amighi J, Mlekusch W, Schager O, Cejna M, Lammer J, Minar E. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879-88.

Daielsson G, Albrechtsson U, Norgren L, Daneisson P, Ribbe E, Thorne J, Zdanowski Z. Percutaneous transluminal angioplasty of crural arteries: Diabetes and other factors influencing outcome. Eur J Vasc Endovasc Surg. 2001;21(5):432-6.

Söder HK, Mannien HI, Jaakkola P, Matsi PJ, Rasanen UT, Kaukanen E, Loponen P, Soimakallio S. Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Interv Radiol. 2000;11(8):1021-31.

van der Zaag ES, Legemate DA, Prins MH, Prins MH, Reekers JA, Jacobs MJ. Angioplasty or bypass for superficial femoral artery disease? A randomized controlled trial. Eur J Vasc Endovasc Surg. 2004;28(2):132-7.

Bühler-Singer S, Hiller D, Albrecht HP, Seidel C, Hornstein OP. Disturbances of cutaneous microcirculation in patients with diabetic legs: additional parameters for a new therapeutic concept. Acta Derm Venereol. 1994;74(4):250-6.

Schaper NC. Early atherogenesis in diabetes mellitus. Diabetic Med. 1996;13(^s23).

Albers M, Romiti M, De Luccia N, Pereira CA. Meta-analysis of popliteal-to-distal vein bypass grafts for critical ischemia. J Vasc Surg. 2006;43(3):498-503.

Gibbons GW, Burgess AM, Guadagnoli E, Pomposelli FB Jr, Freeman DV, Campbell DR. Return to well-being and function after infrainguinal revascularization. J Vasc Surg. 1995;21(^s35).

Frykberg RG, Zgonis T, Amstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schberth JM, Wukich DK, Andersen C, Vanore JV. Diabetic foot disorders: a clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006;45(^s1).

Lipsky BA, Berendt AR, Deery HG, Embil JM, Josephll WS, Krchmer AW, LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS. Diagnosis and treatment of diabetic foot infections. Plast Reconstr Surg. 2006;117(^s212).

Caballero E, Frykberg RG. Diabetic foot infections. J Foot Ankle Surg. 1998;37(3):248-55.

Loeffler RD, Ballard A. Plantar fascial spaces of the foot and a proposed surgical approach. Foot Ankle. 1980;1(1):11-4.

da Silva ES, Tozzi FL. Afecções vasculares: aneurisma, pé diabético, trombose venosa. Manual de Cirurgia do Hospital Universitário. 2002.

Lipsky BA. Osteomyelitis of the Foot in Diabetic Patients. Clin Infect Dis. 1997;25(6):1318-26.

Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995;273(9):721-3.

Tan JS, Friedman NM, Hazelton-Miller C, Flanagan JP, File TM Jr. Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation. Clin Infect Dis. 1996;23(2):286-91.

Fernandes ARC, Aihara AY, Peçanha PC, Natour J. Avaliação por meio de exame radiológico convencional e ressonância magnética do pé diabético. Rev Bras Reumatol. 2003;43:316-23.

Guimarães Maria Carolina, Yamaguchi Claudia Kazue, Aihara André Yui, Hartmann Luiz Guilherme, Pröglhöf Jorge, Fernandes Artur da Rocha Corrêa. Metatarsalgias: differential diagnosis with magnetic resonance imaging. Radiol Bras. 2006;39(4):297-304.

Shults DW, Hunter GC, McIntyre KE, Parent FN, Piotrowski JJ, Bernhard VM. Value of radiographs and bone scans in determining the need for therapy in diabetic patients with foot ulcers. Am J Surg. 1989;158(6):525-30.

Lavery L.A, Sariaya M. Microbiology of Osteomyelitis in Diabetic Foot Infections. J Foot Ankle Surg. 1995;34(1):61-4.

Zuluaga AF, Galvis W, Saldarriaga JG, Agudelo M, Salazar BE, Vesga O. Etiologic diagnosis of chronic osteomyelitis: a prospective study. Arch Int Med. 2006;166(1):95-100.

Seneville E, Lombart A, Beltrand E, Valette M, Legout L, Cazaubiel M, Yazdanpanah Y, Fontaine P. Outcome of diabetic foot osteomyelitis treated nonsurgically. A retrospective cohort study. Diabetes Care. 2008;31(4):637-42.

Gerding D. Foot infections in diabetic patients: the role of anaerobes. Clin Infect Dis. 1995;20(^s283).

Guia de utilização de anti-infecciosos e recomendações para a prevenção de infecções hospitalares. 2005.

Grayson ML, Gibbons GW, Habershaw mGM, Freeman DV, Pomposelli FB. Use of ampicillin/sulbctam versus imipenem/cilastatin in the treatment of limb-threatening foot infection in diabetic patients. Clin Infect Dis. 1994;18(5):683-93.

Abidia A, Laden G, Kuhan G, Wilkinson AR, Renwick PM, Masson EA, McCollun PT. The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind Randomised-controlled trial. Eur J Vasc Endovasc Surg. 2003;25(6):513-8.

Vucrstack JDD, Vainas T, Wuite J, Nelemans P, Neumann MHA, Veraat JCJM. State-of-the-art treatment of chronic leg ulcers: a randomized controlled trial comparing vacuum-assisted closure (VAC) with modern wound dressings. J Vasc Surg. 2006;44(5):1029-38.

. .

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-86.

Armstrong D G, Nguyen HC, Lavery LA. Off-loading the diabetic foot wound: A randomized clinical trial. Diabetes Care. 2001;24(6):1019-22.

Young MJ, Cavanagh PR, Thomas G, Johnson MM, Murray H, Boulton AJM. The effect of callus removal on dynamic foot pressures in diabetic patients. Diabetes Medicine. 1992;9:55-7.

Janisse D. The Therapeutic Shoe Bill: medicare coverage for prescription footwear for diabetic patients. Foot Ankle Int. 2005;26(1):42-5.

Pinzur M, Slovenkai M, Trepman E, Shields N. Diabetes Committee of American Orthopaedic Foot and Ankle Society. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 2005;26:113-9.

Chantelau E, Kushner T, Spraul M. How effective is cushioned therapeutic footwear in protecting diabetic feet? A clinical study. Diabetes Med. 1990;7:355-9.

Chantelau E, Haage P. An audit of cushioned diabetic footwear: relation to patient compliance. Diabetes Méd. 1994;11:114-6.

Uccioli L, Faglia E, Monticone G, Favales F, Durola L, Aldeghi A, Quarantiello A, Calia P, Menzinger G. Manufactured shoes in the prevention of diabetic. Diabetes Care. 1995;18(10):1376-8.

Katz I, Harlan A, Miranda-Polma B, Prieto-Sanchez L, Armstrong D, Bowker J, Mizel M, Boulton A. A randomized trial of two irremovable off-loading devices in management of plantar neuropathic diabetic foot ulcers. Diabetes Care. 2005;28(3):555-9.

Hartsell H, Brand R, Frantz R, Saltzman C. The effects of total contact casting materials on plantar pressures. Foot Ankle Int. 2004;25(2):73-8.

Ha Van G, Siney H, Hartmann-Heurtier A, Jacqueminet S, Greau F, Grimaldi A. Nonremovable, windowed, fiberglass cast boot in the treatment of diabetic plantar ulcers: efficacy, safety and compliance. Diabetes Care. 2003;26:2848-52.

Ulbrecht J, Cavanagh P, Caputo G. Foot problems in diabetes: an overview. Clin Infect Dis. 2004;39(^s73).

Birke JA, Pavich MA, Patout CA, Horswell R. Comparison of forefoot ulcer healing using alternative offloading methods in patients with diabetes mellitus. Adv Skin Wound Care. 2002;15(5):210-5.

Helm P, Walker S, Pullium G. Total contact casting in diabetic patients with neuropathic foot ulcerations. Arch Phys Med Rehabil. 1984;65(11):440-6.

Frykberg RG. Diabetic foot ulcers: current concepts. J Foot Ankle Surg. 1998;37(5):528-31.

Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of Negative Pressure Wound Therapy Using Vacuum Assisted Closure With Advanced Moist Wound Therapy in the Treatment of Diabetic Foot Ulcers: A multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631-6.

Deresh GM, Cohen M. Reconstruction of the diabetic charcot foot incorporating bone grafts. J Foot Ankle Surg. 1996;35(5):474-88.

Petrov O, Pfeifer M, Flood M, Chagares W, Daniele C. Recurrent plantar ulceration following pan metatarsal head resection. J Foot Ankle Surg. 1996;35(6):573-7.

Margolis DJ, Kantor J, Berlin JA. Healing of diabetic neuropathic foot ulcers receiving standard treatment. A meta-analysis. Diabetes Care. 1999;22(5):692-5.

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