Preface

Rehabilitation medicine is the final care path to improve quality of life for those who sustain impairment, disability, or handicap after illness. Remarkable development and improvement of diagnostic as well as therapeutic skills in recent times have contributed to increasing survival rates. Consequently it also increases demand for rehabilitation for survivors. For rehabilitation professionals, this text will provide current concepts, practical skills, and further research issues in various areas. The contributors of this text not only describe current knowledge, but also stimulate readers to continue developing better rehabilitation skills. This text is not sufficient to cover every rehabilitation issue in one volume. However, we hope the readers will build up more knowledge upon this first edition.

> **Dr. Chong-Tae Kim**  Department of Rehabilitation and Physical Medicine, University of Pennsylvania, School of Medicine, USA

**1** 

*USA* 

**Diabetic Foot Ulceration and Amputation** 

*2University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences,* 

The number of people with diabetes mellitus (DM) has been conservatively estimated to approximately double by 2030 to a worldwide prevalence of 4.4% at which time 366 million people will have diabetes (Wild et al., 2004). As the number of people with DM rises, so too will the burden of diabetic foot disease, particularly since the factors contributing to ulcer formation such as peripheral neuropathy and vascular disease are already present in 10% of people at the time of diagnosis (Boulton et al., 2005). The risk of an individual with DM developing a foot ulcer some time in his or her lifetime could be as high as 15% and foot ulcers are found in 12% to 25% of diabetics (Singh et al., 2005; Brem et al., 2006). Results from population and community based studies in the UK have shown a 1.3-4.8% prevalence rate of foot ulcers in persons with type 2 DM (Boulton et al., 2005). The annual incidence of foot ulceration is more than 2% among all persons with diabetes and 5% to 7.6% among

The prevalence of diabetes-related complications such as peripheral neuropathy and foot disease will continue to increase in countries such as the United States not only as the prevalence of the disease increases but as longevity of the population with DM improves. Among people with DM, lower extremity disease is the most common source of complications and hospitalization (Boyko et al.). Ghanassia et al (2008) reported a diabetic foot ulcer recurrence rate of 60.9% and an amputation rate of 43.8% in a study of 89 hospitalized subjects (Ghanassia et al., 2008). Almost 50% of nontraumatic lower extremity amputations worldwide occur in people with DM (Global Lower Extremity Amputation Study, 2000). Amputations from complications related to DM place an individual at risk for additional amputation and have a 5 year mortality rate of 39% to 68% (Morris et al., 1998). People with diabetic foot ulcers have a lower health-related quality of life than the general

The pathogenesis of diabetic foot ulceration is multifactorial and the result of a complex interplay of a number of elements including peripheral neuropathy, structural deformities, elevated plantar pressures, limited joint mobility, vascular disease, and various extrinsic sources of trauma such as ill fitting shoe wear or foreign objects in shoes. The peripheral

diabetics with peripheral neuropathy (Abbott et al., 2002; Boulton et al., 2004).

population and diabetics without foot ulcers as well (Ribu et al., 2007).

**2. Pathophysiology of diabetic foot ulceration** 

**1. Introduction** 

*1Veterans Affairs Medical Center, Department of Physical Therapy,* 

Stephanie Burns1 and Yih-Kuen Jan2

*Oklahoma City, Oklahoma,* 
