Diabetic Foot – A Comprehensive Guide for Clinicians

Diabetic Foot – A Comprehensive Guide for Clinicians

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Dr. Felix Jebasingh, MD, PGDMLE (Ethics), DM (Endo), MNAMS, DNB (Endo)
Dr. Nihal Thomas, MD., MNAMS, DNB(Endo), FRACP (Endo), FRCP(Edin), FRCP (Glasg), FRCP (London), FACP, Ph.D (Copenhagen),

First Edition    |     ISBN No.9789354655456     |      Year : 2022      |       Publisher: Jaypee Brothers Medical Publishers



Prof. Dr. Andrew JM Boulton

It is a pleasure and honor for me to write the foreword to this excellent book edited by Jebasingh and Thomas from the Department of Endocrinology, Diabetes and Metabolism at the Christian Medical College, Vellore, Tamil Nadu, India. I cannot think of a more appropriate setting for all the authors who have contributed to this most interesting and up-to-date book, which should be standard reading for those with an interest in looking after people with diabetes. This very practical book is beautifully illustrated, and interspersed between the chapters, one finds the short biographies of leaders in the field of the diabetic foot from India and worldwide: Some of those giants in the area of diabetic foot care are from India, and are still working despite being retired. Those from overseas are physicians and surgeons who have contributed so much to our understanding of the pathogenesis, management, and indeed prevention of diabetic foot problems. Most notable amongst these are Jean-Martin Charcot, after whom the neuroarthropathy seen in diabetic patients with neuropathy was first described, and Paul Brand, the surgeon who was born in the hills to the west of Madras (now Chennai) and who worked for many years at CMC Vellore, and it was Brand who instructed us in the management of the neuropathic foot in both leprosy and diabetes. Many young physicians reading this book may not be aware of the major contribution that Brand made to the treatment of the insensitive foot but he will be best remembered for his quotation that “pain is God’s greatest gift to mankind” and for promoting the use of total contact casts in the management of neuropathic foot ulcers.

The editors have gathered a team of true experts in this area and I recommend this book to anybody with an interest in the diagnosis, management, surgical treatment, and indeed prevention of diabetic foot ulcers. Included in this book in a logical order are the anatomy and biomechanics of the foot followed by chapters on causal pathways, neuropathy, peripheral arterial disease, and then infections of the diabetic foot. Finally, there are chapters on routine podiatric care and other therapies including surgery. I am particularly happy to see that the editors have seen it appropriate to include a final chapter on “Recent advances in diabetic foot management.” In modern medicine, any textbook is rapidly out of date in terms of recent developments. The editors of this book have appropriately tried to update this book with last minute developments.

I am sure that all those who read it will benefit greatly from this text and I again thank Jebasingh and Thomas for gathering together such an expert team.


Professor of Medicine, University of Manchester,
Division of Diabetes, Endocrinology and Gastroenterology
Consultant Physician, Manchester Royal Infirmary, Manchester, United Kingdom
Visiting Professor of Medicine, University of Miami, Miami, Florida, USA
President, International Diabetes Federation
Past-President, European Association for the Study of Diabetes


Disease of the foot resulting from diabetes is an often serious, yet overlooked complication. The burden of uncontrolled diabetes, causing peripheral neuropathy and diabetes foot in India, is alarming. This book aims to provide a comprehensive overview of the foot in diabetes, its management, and would not have been possible without the collective efforts of our team.

The legacy of Paul Brand who initiated the work in 1948 in handling the foot in leprosy has left us with a lamp that lights the way for the management of the foot in diabetes. Dr Ashish MacAden and his colleagues, from the department of physical medicine and rehabilitation, provided immense support in setting up a foundation and helped us to develop a conceptual framework for the integrated diabetes foot clinic.

Dr Felix who spearheads the integrated diabetes foot clinic and whose ideation led to the fruition of this book, his brainchild. Mr Anand Samuel of the department of prosthetics and orthotics led a world class unit to work hand in glove to generate high quality prosthetics without hesitation, all while maintaining a high output. Dr Mathews helped rejuvenate this manuscript through its various phases and created poetry with a prosaic background, on the diabetes foot. Professor Suranjan Bhattacharjee, with his enlightening presence and ability to think out of the box under the most intriguing circumstances, was instrumental in expanding the scope of our work to the CMC Vellore, Chittoor campus. Our Diabetes Educators, whose competence has gone beyond imaginable boundaries, have raised the bar way ahead of the quantum of natural excellence; their presence and contribution to the system penetrate the normal perceptions of imagination.

We hope that our creation adds significantly to your practice in the field, and provides you with the same sense of fulfillment we achieved, in writing it.

Dr. Nihal Thomas

Professor & Head Unit-I,
Department of Endocrinology Diabetes & Metabolism
Christian Medical College, Vellore
Tamil Nadu, India

Chapter NoTopicContributing Authors
Chapter 1Introduction to Diabetic Foot CareSandeep Kumar Agarwal, Bharathi K, Vasanth Mark Samuel, Felix Jebasingh K, Nihal Thomas
Chapter 2Anatomy and Biomechanics of the Diabetic FootBobeena Rachel Chandy, Gourav Sannyasi
Chapter 3Peripheral Neuropathy : Clinical ApproachJinson Paul, Shivendra Verma, Kripa Elizabeth Cherian, Flory Christina I, B Vinod Jacob, Felix Jebasingh K, Nihal Thomas
Chapter 4Diabetic Foot Ulcers: Clinical ApproachJinson Paul, Felix Jebasingh K, Kripa Elizabeth Cherian, Anand John Samuel G, Ruth Volena D, Nihal Thomas
Chapter 5The Charcot Foot: Clinical Features and ManagementVenkata Sandeep, Ilakkiya J, Bharathi K, Anand John Samuel G, Felix Jebasingh K, Nihal Thomas
Chapter 6Osteomyelitis of the Diabetic Foot  Kelita George, Johns T Johnson, Kripa Elizabeth Cherian, Shirly Jennifer N, Felix Jebasingh K, Nihal Thomas
Chapter 7Peripheral Vascular Disease: Clinical ApproachAlbert Abhinay Kota, Sunil Agarwal (Late)
Chapter 8Footwear and Offloading Aids in Diabetic Foot  Bobeena Rachel Chandy, Naveen Cherian Thomas
Chapter 9Callus Removal, Debridement and Foot CareBharathi K, Flory Christina I, Ruth Volena D, Shirly Jennifer N, Ezhilarasi V, Sunitha R, Ilakkiya J, Vennela Devarapalli, Felix Jebasingh K, Nihal Thomas
Chapter 10Negative Pressure Wound Therapy Ida Nirmal, Albert Abhinay Kota, Bharathi K, Felix Jebasingh K
Chapter 11Surgery of the Diabetic Foot  Pranay Gaikwad
Chapter 12Necrotizing Fasciitis in Diabetes Pranay Gaikwad
Chapter 13Recent Advances in Diabetic Foot ManagementSandeep Kumar Agarwal, Felix Jebasingh K, Nihal Thomas