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Previous Volume 351:48-55 July 1, 2004 Number 1 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.

A 58-year-old man with type 2 diabetes mellitus has an asymptomatic plantar ulcer on the left foot that remains unhealed after four months. The ulcer measures 2 cm by 1 cm and is surrounded by callus under the first metatarsal head (Figure 1). Neurologic examination reveals loss of sensation of light touch, pinprick, and vibration below the midcalf level bilaterally . . . [Full Text of this Article]

The Clinical Problem

Strategies and Evidence

Diagnosis

            Ulcer Assessment

            Infection of the Ulcer

            Osteomyelitis

Management

            Diabetes and General Care

            Preparation of the Wound Bed

            Removal of Pressure

            Dressings

            Treatment of Infection

Adjunctive Treatments

            Growth Factors

            Tissue-Engineered Skin

Delivery of Care

Areas of Uncertainty

Prevention

Therapy

Guidelines

Conclusions and Recommendations

Source Information

From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine (A.J.M.B., L.V.), and the Departments of Dermatology and Cutaneous Surgery (R.S.K.), Epidemiology and Public Health (R.S.K.), and Psychology (L.V.), University of Miami School of Medicine, Miami; the Veterans Affairs Medical Center, Miami (R.S.K.); and the Department of Academic Medicine, Manchester Royal Infirmary, Manchester, United Kingdom (A.J.M.B., L.V.).

Address reprint requests to Dr. Boulton at the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Miami School of Medicine, P.O. Box 016960 (D-110), Miami, FL 33101, or at aboulton@med.miami.edu.

Related Letters:

Neuropathic Diabetic Foot Ulcers
Chang H. R., Aksenov I. V., Boulton A. J.M., Kirsner R. S., Vileikyte L.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:1694-1695, Oct 14, 2004. Correspondence

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