Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000070.xml
Download PDF
Semin Musculoskelet Radiol 2022; 26(06): 717-729
DOI: 10.1055/s-0042-1760219
DOI: 10.1055/s-0042-1760219
Review Article
Presurgical Perspective and Postsurgical Evaluation of the Diabetic Foot
Authors
Abstract
Management of the diabetic foot is complex and challenging, requiring a multidisciplinary approach. Imaging plays an important role in the decision-making process regarding surgery. This article discusses the presurgical perspective and postsurgical evaluation of the diabetic foot.
Publication History
Article published online:
15 February 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1
Sun H,
Saeedi P,
Karuranga S.
et al.
IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates
for 2021 and projections for 2045. Diabetes Res Clin Pract 2022; 183: 109119
Reference Ris Wihthout Link
- 2 van Netten JJ, Bus SA, Apelqvist J. et al; International Working Group on the Diabetic Foot. Definitions and criteria for diabetic foot disease. Diabetes Metab Res Rev 2020; 36 (Suppl 1): e3268
- 3 Ndosi M, Wright-Hughes A, Brown S. et al. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. Diabet Med 2018; 35 (01) 78-88
- 4 Walker EA, Beaman FD, Wessell DE. et al; Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® Suspected Osteomyelitis of the Foot in Patients With Diabetes Mellitus. J Am Coll Radiol 2019; 16 (11S): S440-S450
- 5 Senneville EM, Lipsky BA, van Asten SAV, Peters EJ. Diagnosing diabetic foot osteomyelitis. Diabetes Metab Res Rev 2020; 36 (Suppl 1): e3250
- 6 Lipsky BA, Senneville É, Abbas ZG. et al; International Working Group on the Diabetic Foot (IWGDF). Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36 (Suppl 1): e3280
- 7 Frykberg RG, Wukich DK, Kavarthapu V, Zgonis T, Dalla Paola L. Board of the Association of Diabetic Foot Surgeons. Surgery for the diabetic foot: a key component of care. Diabetes Metab Res Rev 2020; 36 (Suppl 1): e3251
- 8 Hester T, Stewart CJ, Cavale N. Limb salvage for the diabetic foot. In: Edmonds ME, Sumpio BE, eds. Limb Salvage of the Diabetic Foot: An Interdisciplinary Approach. Cham, Switzerland: Springer; 2019: 123-132
- 9 Patel SR. Local random flaps for the diabetic foot. Clin Podiatr Med Surg 2022; 39 (02) 321-330
- 10 Ramanujam CL, Zgonis T. Use of local flaps for soft-tissue closure in diabetic foot wounds: a systematic review. Foot Ankle Spec 2019; 12 (03) 286-293
- 11 Bekeny JC, Kotha VS, Zolper EG. et al. Surgical coverage of diabetic feet. Decker Medicine. Plastic Surgery. 2019; November 4. Accessed November 1, 2022 at: www.researchgate.net/publication/343969148_Surgical_Coverage_of_Diabetic_Feet
- 12 Parrett BM, Talbot SG, Pribaz JJ, Lee BT. A review of local and regional flaps for distal leg reconstruction. J Reconstr Microsurg 2009; 25 (07) 445-455
- 13 Györi E, Fast A, Resch A, Rath T, Radtke C. Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps. Eur Surg 2022; 54 (01) 44-49
- 14 Teh J, Berendt T, Lipsky BA. Rational Imaging. Investigating suspected bone infection in the diabetic foot. BMJ 2009; 339: b4690
- 15 Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis 2008; 47 (04) 519-527
- 16 Eckman MH, Greenfield S, Mackey WC. et al. Foot infections in diabetic patients. Decision and cost-effectiveness analyses. JAMA 1995; 273 (09) 712-720
- 17 Llewellyn A, Kraft J, Holton C, Harden M, Simmonds M. Imaging for detection of osteomyelitis in people with diabetic foot ulcers: a systematic review and meta-analysis. Eur J Radiol 2020; 131: 109215
- 18 Martín Noguerol T, Luna Alcalá A, Beltrán LS, Gómez Cabrera M, Broncano Cabrero J, Vilanova JC. Advanced MR imaging techniques for differentiation of neuropathic arthropathy and osteomyelitis in the diabetic foot. Radiographics 2017; 37 (04) 1161-1180
- 19 Abdel Razek AAK, Samir S. Diagnostic performance of diffusion-weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot. Eur J Radiol 2017; 89: 221-225
- 20 Morrison WB, Schweitzer ME, Batte WG, Radack DP, Russel KM. Osteomyelitis of the foot: relative importance of primary and secondary MR imaging signs. Radiology 1998; 207 (03) 625-632
- 21 Ledermann HP, Morrison WB, Schweitzer ME. MR image analysis of pedal osteomyelitis: distribution, patterns of spread, and frequency of associated ulceration and septic arthritis. Radiology 2002; 223 (03) 747-755
- 22 Morrison WB, Schweitzer ME, Bock GW. et al. Diagnosis of osteomyelitis: utility of fat-suppressed contrast-enhanced MR imaging. Radiology 1993; 189 (01) 251-257
- 23 Ledermann HP, Morrison WB, Schweitzer ME, Raikin SM. Tendon involvement in pedal infection: MR analysis of frequency, distribution, and spread of infection. AJR Am J Roentgenol 2002; 179 (04) 939-947
- 24 Ledermann HP, Schweitzer ME, Morrison WB. Nonenhancing tissue on MR imaging of pedal infection: characterization of necrotic tissue and associated limitations for diagnosis of osteomyelitis and abscess. AJR Am J Roentgenol 2002; 178 (01) 215-222
- 25 Donovan A, Schweitzer ME. Current concepts in imaging diabetic pedal osteomyelitis. Radiol Clin North Am 2008; 46 (06) 1105-1124 , vii
- 26 Butalia S, Palda VA, Sargeant RJ, Detsky AS, Mourad O. Does this patient with diabetes have osteomyelitis of the lower extremity?. JAMA 2008; 299 (07) 806-813
- 27 La Fontaine J, Bhavan K, Jupiter D, Lavery LA, Chhabra A. Magnetic resonance imaging of diabetic foot osteomyelitis: imaging accuracy in biopsy-proven disease. J Foot Ankle Surg 2021; 60 (01) 17-20
- 28 Poirier JY, Garin E, Derrien C. et al. Diagnosis of osteomyelitis in the diabetic foot with a 99mTc-HMPAO leucocyte scintigraphy combined with a 99mTc-MDP bone scintigraphy. Diabetes Metab 2002; 28 (6 Pt 1): 485-490
- 29 Lauri C, Glaudemans AWJM, Campagna G. et al. Comparison of white blood cell scintigraphy, FDG PET/CT and MRI in suspected diabetic foot infection: results of a large retrospective multicenter study. J Clin Med 2020; 9 (06) 1645
- 30 Lepäntalo M, Biancari F, Tukiainen E. Never amputate without consultation of a vascular surgeon. Diabetes Metab Res Rev 2000; 16 (Suppl 1): S27-S32
- 31 Oh TS, Lee HS, Hong JP. Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg 2013; 66 (02) 243-250
- 32 Briggs SE, Banis Jr JC, Kaebnick H, Silverberg B, Acland RD. Distal revascularization and microvascular free tissue transfer: an alternative to amputation in ischemic lesions of the lower extremity. J Vasc Surg 1985; 2 (06) 806-811
- 33 Wang Z, Hasan R, Firwana B. et al. A systematic review and meta-analysis of tests to predict wound healing in diabetic foot. J Vasc Surg 2016;63(2, Suppl): 29S–36S, e1–e2
- 34 Hinchliffe RJ, Forsythe RO, Apelqvist J. et al; International Working Group on the Diabetic Foot (IWGDF). Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36 (Suppl 1): e3276
- 35 Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJW. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA 2009; 301 (04) 415-424
- 36 Verma M, Pandey NN, Singh V, Jagia P. A meta-analysis of the diagnostic performance of quiescent-interval-single-shot magnetic resonance angiography in peripheral arterial disease. Eur Radiol 2022; 32 (04) 2393-2403
- 37 Trieb K. The Charcot foot: pathophysiology, diagnosis and classification. Bone Joint J 2016; 98-B (09) 1155-1159
- 38 Korst GS, Ratliff HT, Torian J, Jimoh RO, Jupiter DC. Delayed diagnosis of Charcot foot: a systematic review. J Foot Ankle Surg 2022; 61 (05) 1109-1113
- 39 Chantelau EA, Antoniou S, Zweck B, Haage P. Follow up of MRI bone marrow edema in the treated diabetic Charcot foot—a review of patient charts. Diabet Foot Ankle 2018; 9 (01) 1466611
- 40 Ruotolo V, Di Pietro B, Giurato L. et al. A new natural history of Charcot foot: clinical evolution and final outcome of stage 0 Charcot neuroarthropathy in a tertiary referral diabetic foot clinic. Clin Nucl Med 2013; 38 (07) 506-509
- 41 Tan PL, Teh J. MRI of the diabetic foot: differentiation of infection from neuropathic change. Br J Radiol 2007; 80 (959) 939-948
- 42 Ahmadi ME, Morrison WB, Carrino JA, Schweitzer ME, Raikin SM, Ledermann HP. Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics. Radiology 2006; 238 (02) 622-631
- 43 Loder RT. The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 1988; 232 (232) 210-216
- 44 Chahal J, Stephen DJG, Bulmer B, Daniels T, Kreder HJ. Factors associated with outcome after subtalar arthrodesis. J Orthop Trauma 2006; 20 (08) 555-561
- 45 Flynn JM, Rodriguez-del Rio F, Pizá PA. Closed ankle fractures in the diabetic patient. Foot Ankle Int 2000; 21 (04) 311-319
- 46 Costigan W, Thordarson DB, Debnath UK. Operative management of ankle fractures in patients with diabetes mellitus. Foot Ankle Int 2007; 28 (01) 32-37
- 47 Smitaman EE, Davis M. Hindfoot fractures: injury patterns and relevant imaging findings. Radiographics 2022; 42 (03) 661-682
- 48 Teh J, Firth M, Sharma A, Wilson A, Reznek R, Chan O. Jumpers and fallers: a comparison of the distribution of skeletal injury. Clin Radiol 2003; 58 (06) 482-486
- 49 Sagray BA, Stapleton JJ, Zgonis T. Diabetic calcaneal fractures. Clin Podiatr Med Surg 2013; 30 (01) 111-118
- 50 Toussaint RJ, Lin D, Ehrlichman LK, Ellington JK, Strasser N, Kwon JY. Peroneal tendon displacement accompanying intra-articular calcaneal fractures. J Bone Joint Surg Am 2014; 96 (04) 310-315
- 51 Rosenberg ZS, Feldman F, Singson RD. Intra-articular calcaneal fractures: computed tomographic analysis. Skeletal Radiol 1987; 16 (02) 105-113
- 52 Kathol MH, el-Khoury GY, Moore TE, Marsh JL. Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus. Radiology 1991; 180 (03) 725-729
- 53 Sanders R, Vaupel ZM, Erdogan M, Downes K. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma 2014; 28 (10) 551-563
- 54 Jones CP, Coughlin MJ, Shurnas PS. Prospective CT scan evaluation of hindfoot nonunions treated with revision surgery and low-intensity ultrasound stimulation. Foot Ankle Int 2006; 27 (04) 229-235
- 55 Dorsey ML, Liu PT, Roberts CC, Kile TA. Correlation of arthrodesis stability with degree of joint fusion on MDCT. AJR Am J Roentgenol 2009; 192 (02) 496-499
- 56 Jones JM, Vacketta VG, Philp FH, Catanzariti AR. Radiographic outcomes of isolated subtalar joint arthrodesis with varying fixation technique. J Foot Ankle Surg 2022; 61 (05) 938-943
- 57 Rana B, Patel S. Results of ankle and hind foot arthrodesis in diabetic Charcot neuroarthropathy—a retrospective analysis of 44 patients. J Clin Orthop Trauma 2021; 23: 101637
- 58 Pattisapu N, Bettin CC, Yeoh JC, Sarfani S. Reconstructive surgical management of Charcot neuropathy of the foot and ankle: a retrospective study. Foot Ankle Orthop. 2022; 7 (01) 247
- 59 Pradana AS, Mustamsir E, Mahendra AS, Phatama KY, Hidayat M, Sugiarto MA. Superconstructs in reconstruction surgery of Charcot foot Brodsky 1: a case report. Int J Surg Case Rep 2022; 90: 106670
- 60 Sharmin A, Khan MA, Humayra ZU, Shah R, Alam MA, Rahman MA. Challenges of dealing diabetic foot and step wise surgical management. Z H Sikder Women S Medical Coll J. 2020; 2 (02) 7-12
- 61 Morris CD, Potter BK, Athanasian EA, Lewis VO. Extremity amputations: principles, techniques, and recent advances. Instr Course Lect 2015; 64: 105-117
- 62 James SLJ, Davies AM. Post-operative imaging of soft tissue sarcomas. Cancer Imaging 2008; 8 (01) 8-18
- 63 Davies AM, Hall AD, Strouhal PD, Evans N, Grimer RJ. The MR imaging appearances and natural history of seromas following excision of soft tissue tumours. Eur Radiol 2004; 14 (07) 1196-1202
- 64 Subedi N, Heire P, Parmer V. et al. Multimodality imaging review of the post-amputation stump pain. Br J Radiol 2016; 89 (1068): 20160572
- 65 Foisneau-Lottin A, Martinet N, Henrot P, Paysant J, Blum A, André JM. Bursitis, adventitious bursa, localized soft-tissue inflammation, and bone marrow edema in tibial stumps: the contribution of magnetic resonance imaging to the diagnosis and management of mechanical stress complications. Arch Phys Med Rehabil 2003; 84 (05) 770-777
- 66 Ruangchaijatuporn T, Gaetke-Udager K, Jacobson JA, Yablon CM, Morag Y. Ultrasound evaluation of bursae: anatomy and pathological appearances. Skeletal Radiol 2017; 46 (04) 445-462
- 67 Henrot P, Stines J, Walter F, Martinet N, Paysant J, Blum A. Imaging of the painful lower limb stump. Radiographics 2000; 20 (Spec No, suppl_1): S219-S235
- 68 Boutin RD, Pathria MN, Resnick D. Disorders in the stumps of amputee patients: MR imaging. AJR Am J Roentgenol 1998; 171 (02) 497-501
- 69 Atkinson GJ, Lee MY, Mehta MK. Heterotopic ossification in the residual lower limb in an adult nontraumatic amputee patient. Am J Phys Med Rehabil 2010; 89 (03) 245-248
- 70 Freed JH, Hahn H, Menter R, Dillon T. The use of the three-phase bone scan in the early diagnosis of heterotopic ossification (HO) and in the evaluation of Didronel therapy. Paraplegia 1982; 20 (04) 208-216
- 71 Falsetti P, Acciai C, Palilla R, Carpinteri F, Patrizio C, Lenzi L. Bedside ultrasound in early diagnosis of neurogenic heterotopic ossification in patients with acquired brain injury. Clin Neurol Neurosurg 2011; 113 (01) 22-27
- 72 Zochodne DW, Nguyen C. Angiogenesis at the site of neuroma formation in transected peripheral nerve. J Anat 1997; 191 (Pt 1): 23-30
- 73 Chung BM, Lee GY, Kim WT, Kim I, Lee Y, Park SB. MRI features of symptomatic amputation neuromas. Eur Radiol 2021; 31 (10) 7684-7695
- 74 Provost N, Bonaldi VM, Sarazin L, Cho KH, Chhem RK. Amputation stump neuroma: ultrasound features. J Clin Ultrasound 1997; 25 (02) 85-89
- 75 Ernberg LA, Adler RS, Lane J. Ultrasound in the detection and treatment of a painful stump neuroma. Skeletal Radiol 2003; 32 (05) 306-309
- 76 Guo S, Mansour R, Slater DH. Ultrasound-guided continuous radiofrequency ablation of painful residual limb neuroma in individuals with limb amputation—a retrospective case series. Can Prosthetics Orthot J 2019;2(1). Accessed November 1, 2022 at: https://pdfs.semanticscholar.org/0a42/d42b9cdaa1ae1c0bc3ab0b0332e9a2316882.pdf
- 77 Zhang X, Xu Y, Zhou J. et al. Ultrasound-guided alcohol neurolysis and radiofrequency ablation of painful stump neuroma: effective treatments for post-amputation pain. J Pain Res 2017; 10: 295-302
- 78 Fox MG, Bancroft LW, Peterson JJ, Kransdorf MJ, Terkonda SP, O'Connor MI. MRI appearance of myocutaneous flaps commonly used in orthopedic reconstructive surgery. AJR Am J Roentgenol 2006; 187 (03) 800-806
- 79 Poon-Chue A, Menendez L, Gerstner MM, Colletti P, Terk M. MRI evaluation of post-operative seromas in extremity soft tissue sarcomas. Skeletal Radiol 1999; 28 (05) 279-282