John H. Bowker and Michael A. Pfeifer, editors. St. Louis:
Mosby; 2001. 828 pages. $125.00.
At any point in time, 3% to 4% of the diabetic
population will have a foot ulcer, and 15% of the 16 million
Americans with diabetes will have a foot ulcer in their lifetime.
Following the development of a foot ulcer or infection, the risk
of lower-extremity amputation is increased by a factor of eight,
leading to over 50,000 such amputations yearly in the United States
alone. No other disease affects as many organ systems and requires
the interaction of as many medical disciplines. As knowledge has
become available, each medical and surgical discipline has developed
different strategies for tackling this health-care epidemic, but
there has been very little interdisciplinary interaction.
The current edition of this classic text has new editors, who
inherited the responsibility from Levin and O’Neal. Bowker,
an orthopaedic surgeon, and Pfeifer, an endocrinologist, have attempted
to produce a text that will be equally valuable to the endocrinologist
managing a population of diabetic patients, the orthopaedic foot
and ankle surgeon with a practice devoted to the diabetic foot,
and the general surgeon with an interest in limb salvage. In order
to do this, they have sought to build bridges between medical disciplines
by eliminating petty biases and tunnel vision.
The book is divided into five sections and thirty-eight chapters.
The table of contents provides a comprehensive outline for a consensus
conference devoted to the diabetic foot. The text has seventy-three
authors, and the editors were careful to provide sufficient focus
as well as to allocate enough space to create substance as opposed
to summary. All of the authors are sufficiently well versed to provide
a comprehensive summary of their respective topics. The figures
and illustrations are clear and consistent, and they provide valuable
amplification to the text. Political and "turf?" battle
lines have been eliminated.
The sections cover pathophysiology, evaluation, nonsurgical management,
surgical management, and multidisciplinary interaction. The section
on pathophysiology is particularly well structured. The section
on treatment is well focused, in keeping with the text’s
multidisciplinary nature. It provides an up-to-date, thorough review
for every discipline, as well as insights for physicians who generally
act as consultants.
No other text devoted to this disease process, which affects
so many organ systems and requires the input of so many medical
disciplines, accomplishes these tasks as well. If those within each
medical and surgical discipline use this text as a starting point,
the quality of care afforded to this complex, high-morbidity, resource-consuming
patient population will be greatly enhanced. This book belongs in
the library of every practitioner who treats diabetic foot disorders.
It will be a valuable resource for both generalists and specialists.