Davidson JK, Alogna M, Goldsmith M, et al: “Assessment of Program Effectiveness at Grady Memorial Hospital-Atlanta,” in Educating Diabetic Patients, ed by G Steiner, PA Lawrence, p 329, Springer Publishing Co, New York. ,1981. .
Edmonds ME, Blundell MP, Morris ME, et al: Improved survival of the diabetic foot: the role of a specialized foot clinic. .Q J Med 60::763. ,1986. .
Holstein P, Ellitsgaard N, Olsen BB, et al: Decreasing incidence of major amputations in people with diabetes. .Diabetologia 43::844. ,2000. .
Krishnan S, Nash F, Baker N, et al: Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit. .Diabetes Care 31::99. ,2008. .
Larsson J, Apelqvist J, Agardh CD, et al: Decreasing incidence of major amputation in diabetic patients: a consequence of a multidisciplinary foot care team approach?. Diabet Med 12::770. ,1995. .
Litzelman DK, Slemenda CW, Langefeld CD, et al: Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus: a randomized, controlled trial. .Ann Intern Med 119::36. ,1993. .
Rayman G, Krishnan ST, Baker NR, et al: Are we underestimating diabetes-related lower-extremity amputation rates? results and benefits of the first prospective study. .Diabetes Care 27::1892. ,2004. .
Schofield CJ, Yu N, Jain AS, et al: Decreasing amputation rates in patients with diabetes: a population-based study. .Diabet Med 26::773. ,2009. .
Trautner C, Haastert B, Mauckner P, et al: Reduced incidence of lower-limb amputations in the diabetic population of a German city, 1990–2005: results of the Leverkusen Amputation Reduction Study (LARS). .Diabetes Care 30::2633. ,2007. .
van Houtum WH, Rauwerda JA, Ruwaard D, et al: Reduction in diabetes-related lower-extremity amputations in The Netherlands: 1991–2000. .Diabetes Care 27::1042. ,2004. .
Driver VR, Madsen J, Goodman RA: Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model. .Diabetes Care 28::248. ,2005. .
Van Gils CC, Wheeler LA, Mellstrom M, et al: Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients: the Operation Desert Foot experience. .Diabetes Care 22::678. ,1999. .
Holloway LM: A Fast Pace Forward: Chronicles of American Podiatry, Pennsylvania College of Podiatric Medicine, Philadelphia. ,1987. .
Lewi MJ, ed: The Textbook of Chiropody, The School of Chiropody NY, New York. ,1914. .
Bliss M: The Discovery of Insulin, University of Chicago Press, Chicago. ,1982. .
Sanders L J, American Diabetes Association: The Philatelic History of Diabetes: In Search of a Cure, American Diabetes Association, Alexandria, VA. ,2001. .
Joslin EP: The menace of diabetic gangrene. .N Engl J Med 211::16. ,1934. .
McKittrick LS, McKittrick JB, Risley TS: Transmetatarsal amputation for infection or gangrene in patients with diabetes mellitus. .Ann Surg 130::826. ,1949. .
McKittrick JB, Root HF, Wheelock FC Jr: Evaluation of the transmetatarsal amputation in patients with diabetes mellitus. .Surgery 41::184. ,1957. .
Gibbons GW, Wheelock FC Jr, Hoar CS Jr, et al: Predicting success of forefoot amputations in diabetics by noninvasive testing. .Arch Surg 114::1034. ,1979. .
Gibbons GW, Wheelock FC Jr, Siembieda C, et al: Noninvasive prediction of amputation level in diabetic patients. .Arch Surg 114::1253. ,1979. .
Wheelock FC Jr: Problems of the diabetic foot: arterial reconstruction: femoral, popliteal tibial, peroneal. .Diabetes Educ 8::19. ,1982. .
LoGerfo FW, Coffman JD: Current concepts: vascular and microvascular disease of the foot in diabetes: implications for foot care. .N Engl J Med 311::1615. ,1984. .
Gibbons GW, Marcaccio EJ Jr, Burgess AM, et al: Improved quality of diabetic foot care, 1984 vs 1990: reduced length of stay and costs, insufficient reimbursement. .Arch Surg 128::576. ,1993. .
LoGerfo FW, Gibbons GW, Pomposelli FB Jr, et al: Trends in the care of the diabetic foot: expanded role of arterial reconstruction. .Arch Surg 127::617. ,1992. .
Frykberg RG, Arora S, Pomposelli FB Jr, et al: Functional outcome in the elderly following lower extremity amputation. .J Foot Ankle Surg 37::181. ,1998. .
Rosenblum BI, Pomposelli FB Jr, Giurini JM, et al: Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes: a 5-year experience. .Diabetes Care 17::983. ,1994. .
Pomposelli FB, Kansal N, Hamdan AD, et al: A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases. .J Vasc Surg 37::307. ,2003. .
Brand PW: Third Annual Roger Pecoraro, MD Lecture: the biomechanics of ulceration. Paper presented at: American Diabetes Association 55th Annual Meeting and Scientific Sessions, Atlanta, Georgia, June 11. ,1995. .
Brand PWP: “Repetitive Stress in the Development of Diabetic Foot Ulcers,” in The Diabetic Foot, 4th Ed, ed by ME Levin, LW O’Neal, p xi, Mosby, St Louis. ,1988. .
Birke JA, Horswell R, Patout CA Jr, et al: The impact of a staged management approach to diabetes foot care in the Louisiana public hospital system. .J La State Med Soc 155::37. ,2003. .
Birke JA, Novick A, Patout CA, et al: Healing rates of plantar ulcers in leprosy and diabetes. .Lepr Rev 63::365. ,1992. .
Dorgan MB, Birke JA, Moretto JA, et al: Performing foot screening for diabetic patients. .Am J Nurs 95::32. ,1995. .
Duffy JC, Patout CA Jr: Management of the insensitive foot in diabetes: lessons learned from Hansen’s disease. .Mil Med 155::575. ,1990. .
Patout CA Jr, Birke JA, Horswell R, et al: Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population. .Diabetes Care 23::1339. ,2000. .
Patout CA Jr, Birke JA, Wilbright WA, et al: A decision pathway for the staged management of foot problems in diabetes mellitus. .Arch Phys Med Rehabil 82::1724. ,2001. .
Birke JA, Sims DS: Plantar sensory threshold in the ulcerative foot. .Lepr Rev 57::261. ,1986. .
Wagner FW Jr: The dysvascular foot: a system for diagnosis and treatment. .Foot Ankle 2::64. ,1981. .
American Diabetes Association: Consensus Development Conference on Diabetic Foot Wound Care: 7–8 April 1999, Boston, Massachusetts. .Diabetes Care 22::1354. ,1999. .
American Diabetes Association: Peripheral arterial disease in people with diabetes. .Diabetes Care 26::3333. ,2003. .
Mayfield JA, Reiber GE, Sanders L J, et al: Preventive foot care in people with diabetes. .Diabetes Care 21::2161. ,1998. .
Levin ME, O’Neal LW, eds: The Diabetic Foot, 1st Ed, CV Mosby Co, St Louis. ,1973. .
Bowker JH, Pfeifer MA, eds: Levin and O’Neal’s The Diabetic Foot, 7th Ed, Mosby Elsevier, Philadelphia. ,2008. .
Armstrong DG, Abu-Rumman PL, Nixon BP, et al: Continuous activity monitoring in persons at high risk for diabetes-related lower-extremity amputation. .JAPMA 91::451. ,2001. .
Armstrong DG, Lavery LA, Harkless LB: Validation of a diabetic wound classification system: the contribution of depth, infection, and ischemia to risk of amputation. .Diabetes Care 21::855. ,1998. .
Armstrong DG, Lavery LA, Wunderlich RP: Risk factors for diabetic foot ulceration: a logical approach to treatment. .J Wound Ostomy Continence Nurs 25::123. ,1998. .
Armstrong DG, Peters EJ: Classification of wounds of the diabetic foot. .Curr Diab Rep 1::233. ,2001. .
Lavery LA, Armstrong DG, Harkless LB: Classification of diabetic foot wounds. .J Foot Ankle Surg 35::528. ,1996. .
Lavery LA, Armstrong DG, Murdoch DP, et al: Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system. .Clin Infect Dis 44::562. ,2007. .
Lavery LA, Higgins KR, Lanctot DR, et al: Home monitoring of foot skin temperatures to prevent ulceration. .Diabetes Care 27::2642. ,2004. .
Lavery LA, Higgins KR, Lanctot DR, et al: Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool. .Diabetes Care 30::14. ,2007. .
Smith DG, Stuck RM, Ketner L, et al: Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis: an amputation of the back of the foot. .J Bone Joint Surg Am 74::571. ,1992. .
Pinzur MS, Morrison C, Sage R, et al: Syme’s two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot. .Foot Ankle 11::394. ,1991. .
Edelman D, Sanders L J, Pogach L: Reproducibility and accuracy among primary care providers of a screening examination for foot ulcer risk among diabetic patients. .Prev Med 27::274. ,1998. .
Sanders L J: Diabetes mellitus: prevention of amputation. .JAPMA 84::322. ,1994. .
Sanders L J: Transmetatarsal and midfoot amputations. .Clin Podiatr Med Surg 14::741. ,1997. .
Sanders L J: “Ray and Transmetatarsal Amputations,” in Mastery of Surgery, 5th Ed, ed by JE Fischer, KI Bland, p 2, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia. ,2007. .
Sanders L J, Dunlap G: Transmetatarsal amputation: a successful approach to limb salvage. .JAPMA 82::129. ,1992. .
Pinzur MS, Sage R, Schwaegler P: Ray resection in the dysvascular foot: a retrospective review. .Clin Orthop Relat Res 191::232. ,1984. .
Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .
Reiber GE, Vileikyte L, Boyko EJ, et al: Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. .Diabetes Care 22::157. ,1999. .
Preservation-Amputation Care and Treatment (PACT) Program, Department of Veterans Affairs, Veterans Health Administration, Washington, DC. ,2006. . VHA Directive 2006–050.
Iversen MM, Tell GS, Riise T, et al: History of foot ulcer increases mortality among individuals with diabetes: ten-year follow-up of the Nord-Trondelag Health Study, Norway. .Diabetes Care 32::2193. ,2009. .
Robbins JM, Strauss G, Aron D, et al: Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration?. JAPMA 98::489. ,2008. .
Obituary notices: Robert Daniel Lawrence, M.A., LL.D., M.D., F.R.C.P. .Br Med J 3::621. ,1968. .
Jackson JG: R.D. Lawrence and the formation of the Diabetic Association. .Diabet Med 13::9. ,1996. .
Oakley WG: R.D. Lawrence, M.D., F.R.C.P., 1892–1968. .Diabetes 18::54. ,1969. .
McKeown KC: The history of the diabetic foot. .Diabet Med 12::19. ,1985. .
Catterall RC, Martin MM, Oakley W: Aetiology and management of lesions of the feet in diabetics. .Br Med J 27::953. ,1956. .
Assal J-P, Gfeller R, Ekoe J-M: “Patient Education in Diabetes,” in Recent Trends in Diabetes Research: Symposium, September 22–24, 1981, ed by H Boström, N Ljungstedt Skandiakoncernen, p 276, Almqvist & Wiksell International, Stockholm. ,1982. .
Peter-Riesch B, Assal JP: Teaching diabetic foot care effectively. .JAPMA 87::318. ,1997. .
Thompson FJ, Veves A, Ashe H, et al: A team approach to diabetic foot care: the Manchester experience. .Foot 1::75. ,1991. .
Barbano PR, Aldeghi A, Faglia E, et al: Results of revascularization and amputation of the gangrenous diabetic foot: importance of a multidisciplinary approach [in Italian]. .Minerva Cardioangiol 43::97. ,1995. .
Faglia E, Favales F, Aldeghi A, et al: Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation. .J Diabetes Complications 12::96. ,1998. .
Edmonds M, Foster A: Reduction of major amputations in the diabetic ischaemic foot: a strategy to “take control” with conservative care as well as revascularization. .VASA 58: (suppl):6. ,2001. .
Foster AV, Snowden S, Grenfell A, et al: Reduction of gangrene and amputations in diabetic renal transplant patients: the role of a special foot clinic. .Diabet Med 12::632. ,1995. .
McArthur CS, Sheahan MG, Pomposelli FB Jr, et al: Infrainguinal revascularization after renal transplantation. .J Vasc Surg 37::1181. ,2003. .
Ramdev P, Rayan SS, Sheahan M, et al: A decade experience with infrainguinal revascularization in a dialysis-dependent patient population. .J Vasc Surg 36::969. ,2002. .
Uccioli L, Faglia E, Monticone G, et al: Manufactured shoes in the prevention of diabetic foot ulcers. .Diabetes Care 18::1376. ,1995. .
Calle-Pascual AL, Duran A, Benedi A, et al: Reduction in foot ulcer incidence: relation to compliance with a prophylactic foot care program. .Diabetes Care 24::405. ,2001. .
McCabe CJ, Stevenson RC, Dolan AM: Evaluation of a diabetic foot screening and protection programme. .Diabet Med 15::80. ,1998. .
Donohue M, Fletton J, Tooke JE: “The Exeter Integrated Diabetic Foot Project,” in The Foot in Diabetes, 3rd Ed, ed by AJM Boulton, H Connor, PR Cavanagh, p 87, John Wiley & Sons Ltd, Chichester. ,2000. .
Donohoe ME, Fletton JA, Hook A, et al: Improving foot care for people with diabetes mellitus: a randomized controlled trial of an integrated care approach. .Diabet Med 17::581. ,2000. .
Gershater MA, Londahl M, Nyberg P, et al: Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. .Diabetologia 52::398. ,2009. .
Faglia E, Dalla Paola L, Clerici G, et al: Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. .Eur J Vasc Endovasc Surg 29::620. ,2005. .
El Sakka K, Fassiadis N, Gambhir RP, et al: An integrated care pathway to save the critically ischaemic diabetic foot. .Int J Clin Pract 60::667. ,2006. .
Zayed H, Halawa M, Maillardet L, et al: Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach. .Int J Clin Pract 63::855. ,2009. .
Trautner C, Haastert B, Spraul M, et al: Unchanged incidence of lower-limb amputations in a German City, 1990–1998. .Diabetes Care 24::855. ,2001. .
Canavan RJ, Unwin NC, Kelly WF, et al: Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: continuous longitudinal monitoring using a standard method. .Diabetes Care 31::459. ,2008. .
Cheer K, Shearman C, Jude EB: Managing complications of the diabetic foot. .BMJ 339::b4905. ,2009. .
Anichini R, Zecchini F, Cerretini I, et al: Improvement of diabetic foot care after the implementation of the International Consensus on the Diabetic Foot (ICDF): results of a 5-year prospective study. .Diabetes Res Clin Pract 75::153. ,2007. .
Eskelinen E, Eskelinen A, Alback A, et al: Major amputation incidence decreases both in non-diabetic and in diabetic patients in Helsinki. .Scand J Surg 95::185. ,2006. .
Young MJ, McCardle JE, Randall LE, et al: Improved survival of diabetic foot ulcer patients 1995–2008: possible impact of aggressive cardiovascular risk management. .Diabetes Care 31::2143. ,2008. .
Lincoln NB, Radford KA, Game FL, et al: Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. .Diabetologia 51::1954. ,2008. .
Jeffcoate WJ, Price PE, Phillips CJ, et al: Randomised controlled trial of the use of three dressing preparations in the management of chronic ulceration of the foot in diabetes. .Health Technol Assess 13::1. ,2009. .
Lobmann R, Muller E, Kersken J, et al: The diabetic foot in Germany: analysis of quality in specialised diabetic footcare centres. .Diabetic Foot J 10::68. ,2007. .
This historical perspective highlights some of the pioneers, milestones, teams, and system changes that have had a major impact on management of the diabetic foot during the past 100 years. In 1934, American diabetologist Elliott P. Joslin noted that mortality from diabetic coma had fallen from 60% to 5% after the introduction of insulin, yet deaths from diabetic gangrene of the lower extremity had risen significantly. He believed that diabetic gangrene was preventable. His remedy was a team approach that included foot care, diet, exercise, prompt treatment of foot infections, and specialized surgical care.
The history of the team approach to management of the diabetic foot chronicles the rise of a new health profession—podiatric medicine and surgery—and emergence of the specialty of vascular surgery. The partnership among the diabetologist, vascular surgeon, and podiatric surgeon is a natural one. The complementary skills and knowledge of each can improve limb salvage and functional outcomes. Comprehensive multidisciplinary foot-care programs have been shown to increase quality of care and reduce amputation rates by 36% to 86%. Development of distal revascularization techniques to restore pulsatile blood flow to the foot has also been a major advancement.
Patients with diabetic foot complications are among the most complex and vulnerable of all patient populations. Specialized diabetic foot clinics of the 21st century should be multidisciplinary and equipped to coordinate diagnosis, off-loading, and preventive care; to perform revascularization procedures; to aggressively treat infections; and to manage medical comorbidities. (J Am Podiatr Med Assoc 100(5): 317–334, 2010)