List of Contributors |
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xv | |
Preface |
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xix | |
Introduction |
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xxi | |
1 Epidemiology and Economic Impact of Foot Ulcers |
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1 | (16) |
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1 | (1) |
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1.2 Diabetic Foot Ulcer (DFU) Definition |
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1 | (1) |
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2 | (1) |
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1.4 DFU Incidence and Prevalence |
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3 | (2) |
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5 | (1) |
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1.6 Risk Factors for Diabetic Foot Ulcers and Lower Extremity Amputation |
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6 | (1) |
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1.7 Diabetic Foot Ulcer Outcomes |
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7 | (2) |
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1.8 Economic Considerations |
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9 | (1) |
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10 | (7) |
2 Cost of Diabetic Foot Disease in England |
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17 | (14) |
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17 | (1) |
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17 | (3) |
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20 | (2) |
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22 | (1) |
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2.5 Establishing Healthcare Priorities |
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22 | (3) |
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25 | (1) |
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26 | (5) |
3 Epidemiology of Amputation and the Influence of Ethnicity |
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31 | (12) |
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3.1 Why Study the Epidemiology of LEA? |
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31 | (1) |
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3.2 LEA Incidence Study Design: The Risk of Bias |
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32 | (1) |
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3.3 LEA Risk Assessment Study Design |
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32 | (1) |
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33 | (1) |
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3.5 Incidence Rates of LEA |
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34 | (1) |
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3.6 International and Regional Differences |
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34 | (1) |
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3.7 Time Trends in LEA Rates |
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34 | (1) |
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3.8 Ethnic Differences in Diabetes-Related LEA |
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35 | (1) |
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3.9 Ethnic Differences in Diabetes-Related LEA Risk |
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35 | (3) |
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38 | (1) |
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38 | (5) |
4a The Diabetic Foot Worldwide: India |
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43 | (4) |
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43 | (1) |
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4a.2 Epidemiology of Diabetes in India |
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43 | (1) |
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4a.3 Socio Economic Burden Due to Diabetes |
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43 | (1) |
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4a.4 Common Risk Factors for Amputation in India |
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43 | (1) |
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4a.5 Diagnosing High Risk Feet in Developing Countries |
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44 | (1) |
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4a.6 Comparison in Risk Factors between India and the Western World |
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44 | (1) |
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4a.7 DFI as a Cause for Declining Kidney Function |
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44 | (1) |
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4a.8 Helping People with Amputation Cope Up with the Disability |
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44 | (1) |
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45 | (2) |
4b The Diabetic Foot Worldwide: Pakistan |
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47 | (4) |
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47 | (1) |
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4b.2 Concept of Multidisciplinary Diabetic Foot Care Team (MDFCT) |
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47 | (1) |
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4b.3 Nationwide Diabetic Foot Programme (Step by Step4SbS1) |
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48 | (1) |
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4b.4 Footwear for Every Diabetic (FED) |
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48 | (1) |
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4b.5 Further Steps Ahead of SbS |
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49 | (1) |
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49 | (2) |
4c The Diabetic Foot Worldwide: Sub-Saharan Africa |
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51 | (10) |
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51 | (1) |
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4c.2 Pathophysiology of Foot Ulcers |
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52 | (1) |
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4c.3 Peripheral Neuropathy (PN) |
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52 | (1) |
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4c.4 Peripheral Arterial Diseases (PAD) |
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53 | (1) |
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4c.5 Foot Ulceration in SSA |
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54 | (1) |
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55 | (1) |
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56 | (1) |
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56 | (1) |
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56 | (2) |
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58 | (1) |
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58 | (3) |
4d Burden of Diabetic Foot Disease in Brazil |
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61 | (6) |
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64 | (3) |
4e Diabetic Foot in Romania and Eastern Europe |
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67 | (8) |
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67 | (1) |
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67 | (1) |
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4e.3 Diabetic Foot in Romania |
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67 | (3) |
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4e.4 Diabetic Foot in Eastern Europe |
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70 | (1) |
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71 | (1) |
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71 | (4) |
4f Diabetic Foot Worldwide: Pacific Region |
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75 | (4) |
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76 | (3) |
4g The Diabetic Foot Worldwide: Middle East |
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79 | (6) |
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4g.1 The Burden of Diabetic Foot Disease (DFD) in the Middle East (ME) |
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79 | (1) |
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4g.2 Specific Regional Barriers to Healthy Feet and Foot Care |
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80 | (1) |
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81 | (1) |
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81 | (1) |
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4g.5 Foot Care, Education and Awareness |
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81 | (1) |
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82 | (3) |
4h The Diabetic Foot Worldwide: Australasia |
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85 | (4) |
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85 | (1) |
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85 | (1) |
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86 | (1) |
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86 | (1) |
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87 | (1) |
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87 | (2) |
5 Diabetic Neuropathy |
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89 | (16) |
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89 | (1) |
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89 | (2) |
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5.3 Symmetrical Neuropathies |
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91 | (4) |
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5.4 Asymmetrical Neuropathies |
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95 | (2) |
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5.5 Pathogenesis of Distal Symmetrical Neuropathy |
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97 | (1) |
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5.6 Management of Diabetic Neuropathy |
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98 | (3) |
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101 | (4) |
6 The Pathway to Ulceration: Aetiopathogenesis and Screening |
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105 | (20) |
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105 | (1) |
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6.2 Peripheral Arterial Disease (PAD) |
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106 | (1) |
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107 | (2) |
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6.4 Neuropathy: The Major Contributory Factor in Ulceration |
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109 | (1) |
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6.5 Other Risk Factors for Foot Ulceration |
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109 | (2) |
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6.6 Assessment of Foot Ulcer Risk |
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111 | (5) |
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6.7 The Pathway to Ulceration |
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116 | (2) |
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6.8 Mechanical Factors and Neuropathic Foot Ulceration |
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118 | (2) |
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6.9 The Patient with Sensory Loss |
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120 | (1) |
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120 | (5) |
7 Biomechanics of the Diabetic Foot for the Uninitiated |
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125 | (14) |
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125 | (1) |
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7.2 The Concept of Pressure and its Measurement |
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125 | (1) |
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7.3 The Role of Elevated Plantar Pressure in Foot Ulceration |
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126 | (2) |
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7.4 Mechanisms of Elevated Plantar Pressure |
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128 | (2) |
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7.5 Foot Biomechanics in Treating a Plantar Foot Ulcer |
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130 | (2) |
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7.6 Biomechanical Issues in Preventing a Foot Ulcer |
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132 | (1) |
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133 | (1) |
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134 | (5) |
8 Psychological and Behavioural Aspects of Diabetic Foot Ulceration |
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139 | (14) |
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8.1 The Role of Psychological and Behavioural Factors in DFU Development |
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139 | (3) |
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8.2 The Role of Psychological and Behavioural Factors in DFU Healing |
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142 | (4) |
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8.3 The Impact of DFUs on Patients' Health Status and QoL |
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146 | (1) |
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8.4 Measuring QoL in DFU Patients: Generic, DFU-Specific or Combined Approach? |
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147 | (1) |
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148 | (5) |
9 What Role for the Plain Radiograph of the Diabetic Foot? |
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153 | (16) |
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Richard William Whitehouse |
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153 | (4) |
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157 | (9) |
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166 | (1) |
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167 | (2) |
10 Advanced Cross-Sectional Radiology-Ultrasound, Computed Tomography and Magnetic Resonance Imaging of the Diabetic Foot |
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169 | (18) |
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169 | (1) |
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10.2 Pathophysiology of Diabetic Foot Disease |
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170 | (13) |
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183 | (4) |
11 Gait and Exercise Training in Diabetic Peripheral Neuropathy |
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187 | (14) |
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187 | (1) |
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11.2 Gait Characteristics of People with Diabetes |
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187 | (1) |
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11.3 Muscle Forces and the Biomechanics of Gait in Diabetes |
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188 | (2) |
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11.4 Biomechanical Strategies to Alter Gait in Diabetic Peripheral Neuropathy |
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190 | (3) |
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11.5 Falls and Diabetic Peripheral Neuropathy |
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193 | (1) |
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11.6 Biomechanical Factors Leading to Increased Fall Risk |
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193 | (1) |
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11.7 Diabetic Peripheral Neuropathy and Balance during Gait |
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194 | (2) |
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11.8 Exercise and Diabetic Peripheral Neuropathy |
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196 | (1) |
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11.9 Effects of Exercise in Patients with Diabetic Peripheral Neuropathy on Gait and Balance |
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197 | (1) |
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11.10 The Case for Resistance Exercise Training |
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198 | (1) |
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198 | (3) |
12 Smart Technology for the Diabetic Foot in Remission |
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201 | (24) |
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201 | (2) |
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12.2 Technologies to Guide the Prescription of Footwear-Related Offloading Treatments |
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203 | (1) |
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12.3 Technologies to Facilitate Triaging those at High Risk of DFU |
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204 | (7) |
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12.4 Technologies to Manage Dose of Physical Activities in People with Diabetes and Insensate Foot |
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211 | (3) |
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12.5 Using Technology to Improve Patient Education for Effective Prevention of Diabetic Foot Ulcers |
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214 | (1) |
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12.6 Mobile Health (mHealth) to Manage Diabetic Foot Ulcers |
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215 | (1) |
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12.7 Internet of Things and Remote Management of Diabetic Foot Ulcers |
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216 | (1) |
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12.8 Technologies to Facilitate Delivering of Therapy at Home and Reduce Risk of DFU |
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217 | (1) |
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218 | (1) |
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219 | (6) |
13 How to Assess the Quality of Clinical Trials for Diabetic Foot Ulcer Therapies |
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225 | (10) |
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225 | (1) |
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13.2 Hierarchy of Evidence |
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226 | (1) |
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13.3 Items to Be Considered in Assessing Trials of Diabetic Foot Ulcer Therapies |
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227 | (1) |
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227 | (1) |
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228 | (1) |
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229 | (1) |
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230 | (1) |
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230 | (1) |
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231 | (1) |
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231 | (2) |
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233 | (2) |
14a Bypass in Diabetic Peripheral Artery Disease |
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235 | (12) |
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14a.1 Identifying Significant PAD Amongst Patients Presenting with Foot Ulcers |
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235 | (2) |
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14a.2 Relative Benefits and Risks: Identifying Patients Who May Benefit from a Leg Bypass Operation |
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237 | (2) |
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14a.3 Evaluating Relevant Vascular Anatomy for Planning a Bypass Operation |
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239 | (2) |
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14a.4 The Operation and Early In-Hospital Recovery |
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241 | (2) |
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14a.5 Follow-Up After a Leg Bypass Operation |
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243 | (1) |
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243 | (4) |
14b Surgery or Endovascular Intervention in Diabetic Peripheral Vascular Disease |
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247 | (12) |
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247 | (1) |
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247 | (1) |
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248 | (2) |
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250 | (1) |
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14b.5 Endovascular Revascularization |
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250 | (3) |
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253 | (1) |
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254 | (1) |
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254 | (1) |
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255 | (4) |
15 Inpatient Diabetic Foot Care: A UK Perspective |
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259 | (6) |
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259 | (1) |
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15.2 The Burden of Inpatient Diabetes |
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260 | (1) |
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15.3 The Burden of Inpatient Diabetic Foot Disease |
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260 | (1) |
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15.4 Recommended Foot Care for Inpatients with Diabetes |
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261 | (1) |
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262 | (1) |
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263 | (2) |
16 Diagnosis and Management of Infection in the Diabetic Foot |
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265 | (22) |
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265 | (1) |
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16.2 Pathophysiology of Infections in Persons with Diabetes Mellitus |
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265 | (1) |
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16.3 Risk Factors for DFI |
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266 | (1) |
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16.4 Clinical Signs and Symptoms |
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266 | (1) |
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267 | (1) |
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268 | (1) |
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269 | (5) |
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16.8 IWGDF Grade 4 (Severe) Infections |
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274 | (1) |
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275 | (5) |
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280 | (7) |
17 Surgical Approach to Diabetic Foot Infections |
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287 | (14) |
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287 | (1) |
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288 | (2) |
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17.3 Initial Surgical Intervention |
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290 | (3) |
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17.4 After Initial Surgical Intervention |
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293 | (1) |
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17.5 Staged Surgical Intervention and Wound Closure |
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294 | (2) |
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296 | (1) |
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17.7 Soft Tissue/Tendon Balancing and Definitive Osseous Surgical Reconstruction |
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296 | (1) |
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17.8 Decision for Proximal Level Amputation |
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297 | (1) |
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298 | (1) |
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298 | (3) |
18 The Evidence Base for the Choice of Dressings in the Management of Diabetic Foot Ulcers |
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301 | (10) |
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301 | (1) |
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302 | (1) |
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18.3 The Definition of a Dressing |
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302 | (1) |
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18.4 The Roles of the Dressing |
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303 | (1) |
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18.5 Basic Aspects of Wound Care |
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304 | (1) |
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18.6 Evidence for Potential Contributions of Dressings and Wound Applications to Improve Wound Healing |
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304 | (2) |
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18.7 Other Therapies which May Modulate Healing of Chronic Wounds |
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306 | (1) |
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307 | (1) |
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308 | (3) |
19 Pathogenesis of Charcot Neuroarthropathy and Acute Management |
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311 | (12) |
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311 | (1) |
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311 | (5) |
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19.3 Acute Management of CN |
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316 | (2) |
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318 | (1) |
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319 | (4) |
20 Surgical Reconstruction of the Charcot Foot |
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323 | (22) |
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323 | (1) |
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20.2 Indications for Surgical Reconstruction |
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323 | (2) |
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20.3 Radiographic Predictors for Ulceration |
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325 | (1) |
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326 | (1) |
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20.5 Preoperative Medical Workup |
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327 | (1) |
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327 | (1) |
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328 | (1) |
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328 | (1) |
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20.9 Procedures/Outcome Studies |
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328 | (6) |
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20.10 Outcomes of Charcot Reconstruction |
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334 | (1) |
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20.11 Summary of Evidence Based Recommendations |
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335 | (1) |
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336 | (9) |
21 Amputation in the Diabetic Foot |
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345 | (18) |
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345 | (1) |
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21.2 Impediments to Rehabilitation in the Diabetic Amputee |
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345 | (1) |
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21.3 The Lower Extremity as an Organ of Weight Bearing |
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346 | (1) |
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21.4 Metabolic Cost of Walking with an Amputation |
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346 | (1) |
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21.5 Limb Salvage vs. Amputation |
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347 | (1) |
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21.6 Amputation Level Selection |
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348 | (1) |
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21.7 The Terminal Organ of Weight Bearing |
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348 | (3) |
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21.8 The Soft Tissue Envelope |
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351 | (1) |
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351 | (1) |
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21.10 Outcomes-Following Amputation |
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352 | (1) |
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21.11 Surgical Amputation Levels |
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352 | (1) |
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21.12 Lesser Toe Amputation |
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353 | (1) |
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353 | (2) |
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355 | (1) |
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21.15 Hindfoot Amputation |
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355 | (1) |
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21.16 Symes's Ankle Disarticulation Amputation |
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356 | (1) |
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21.17 Transtibial Amputation |
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357 | (2) |
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21.18 Knee Disarticulation Amputation |
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359 | (1) |
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21.19 Transfemoral Amputation |
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359 | (1) |
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360 | (1) |
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360 | (3) |
22 Rehabilitation of the Amputee |
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363 | (12) |
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22.1 Lower Limb Amputation and Prosthetics |
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363 | (1) |
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364 | (1) |
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365 | (1) |
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22.4 Transtibial Amputations |
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366 | (3) |
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22.5 Ankle/Foot Components |
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369 | (3) |
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372 | (1) |
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372 | (3) |
23 Surgery for the Diabetic Foot: Prophylactic and Osteomyelitis Surgery - Is there an Evidence Base? |
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375 | (20) |
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23.1 The Role of Surgery Preventing Occurrence and Recurrence of Foot Ulcers |
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376 | (1) |
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376 | (1) |
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23.3 Hallux and First Metatarsal Head Procedures |
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377 | (3) |
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380 | (1) |
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23.5 Lesser Metatarsal Heads |
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381 | (2) |
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23.6 Tendon Achilles Lengthening |
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383 | (2) |
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23.7 Curative Surgery for Treating Diabetic Foot Osteomyelitis |
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385 | (1) |
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23.8 Surgery of Forefoot Osteomyelitis |
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386 | (2) |
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23.9 Surgery of Midfoot Osteomyelitis |
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388 | (1) |
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23.10 Surgery of Rear Foot Osteomyelitis |
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388 | (1) |
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389 | (6) |
24 Footwear and Orthoses for People with Diabetes |
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395 | (14) |
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395 | (1) |
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24.2 What is a Therapeutic Shoe for a Person Living with Diabetes? |
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395 | (7) |
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24.3 Who Needs Therapeutic Shoes? |
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402 | (1) |
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24.4 Choosing the Appropriate Footwear for the Patient with LOPS |
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403 | (3) |
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24.5 Summary and Future Trends |
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406 | (1) |
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406 | (3) |
25 The Diabetic Foot in Remission |
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409 | (8) |
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25.1 The Diabetic Foot in Remission |
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409 | (1) |
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25.2 Maintaining Remission |
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410 | (3) |
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413 | (1) |
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414 | (3) |
26 Setting up a Diabetic Foot Clinic |
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417 | (12) |
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26.1 Natural History of the Diabetic Foot |
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417 | (1) |
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26.2 Principles of Care of the Diabetic Foot |
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418 | (1) |
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26.3 Space for the Diabetic Foot Clinic |
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418 | (1) |
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26.4 Personnel for the Diabetic Foot Clinic |
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419 | (3) |
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26.5 Organisation of the Diabetic Foot Clinic |
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422 | (4) |
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426 | (1) |
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426 | (3) |
27 National Audit of Diabetic Foot Care: Continuing Audit Is Essential for the Delivery of Optimal Care of Diabetic Foot Ulcers |
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429 | (10) |
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27.1 Why Should We Document the Outcome of Routine Care? |
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429 | (1) |
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27.2 General Principles of Clinical Audit |
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430 | (3) |
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27.3 National Diabetes Foot Care Audit of England and Wales |
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433 | (4) |
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437 | (2) |
28 Regenerative Medicine and the Diabetic Foot |
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439 | (18) |
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Zachary A. Stern-Buchbinder |
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439 | (1) |
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439 | (3) |
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28.3 Diabetes and Healing Impairment |
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442 | (1) |
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28.4 Diabetes and Vascular Dysfunction |
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443 | (3) |
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28.5 Functional Heterogeneity of Stem Cells |
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446 | (1) |
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28.6 Advances in Regenerative Therapy |
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447 | (2) |
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449 | (1) |
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449 | (8) |
29 Role of the Plastic Surgeon in Diabetic Foot Care |
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457 | (16) |
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457 | (1) |
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29.2 Multidisciplinary Approach and the Spectrum of Care |
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458 | (1) |
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29.3 Reconstruction Algorithm |
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459 | (1) |
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29.4 Debridement (this Is Covered in Detail in another Chapter) |
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460 | (1) |
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29.5 Evaluating and Enhancing the Vascular Status |
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461 | (1) |
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29.6 Skin Grafts and Substitutes |
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462 | (1) |
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463 | (1) |
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464 | (2) |
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466 | (1) |
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467 | (2) |
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469 | (4) |
30a Algorithms for Diabetic Foot Care: Management of the Hot Swollen Foot |
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473 | (8) |
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480 | (1) |
30b Approach to a New Diabetic Foot Ulceration |
|
481 | (14) |
|
|
|
|
481 | (1) |
|
30b.2 Clinical Care for the Management of DFU |
|
|
482 | (3) |
|
|
485 | (5) |
|
30b.4 Structural Care Process in DFU Management |
|
|
490 | (1) |
|
|
491 | (4) |
30c Algorithms for Diabetic Foot Care: Vascular Evaluation |
|
495 | (12) |
|
|
|
|
495 | (1) |
|
30c.2 Methods of Vascular Evaluation - Detecting Peripheral Artery Disease |
|
|
496 | (2) |
|
|
498 | (2) |
|
|
500 | (3) |
|
|
503 | (4) |
30d Algorithms for Diagnosis and Management of Infection in the Diabetic Foot |
|
507 | (8) |
|
|
|
30d.1 Diagnosis of Infection |
|
|
507 | (2) |
|
30d.2 Therapy of Infection |
|
|
509 | (5) |
|
|
514 | (1) |
Index |
|
515 | |