Diabetic foot: Difference between revisions
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==Prevention== | ==Prevention== | ||
"Integrated foot risk scores are more sensitive than individual clinical criteria in predicting future foot ulceration and are likely to be better screening tools." <ref name="pmid21418097">{{cite journal| author=Leese GP, Cochrane L, Mackie AD, Stang D, Brown K, Green V| title=Measuring the accuracy of different ways to identify the 'at-risk' foot in routine clinical practice. | journal=Diabet Med | year= 2011 | volume= 28 | issue= 6 | pages= 747-54 | pmid=21418097 | doi=10.1111/j.1464-5491.2011.03297.x | pmc= | url= }} </ref> | "Integrated foot risk scores are more sensitive than individual clinical criteria in predicting future foot ulceration and are likely to be better screening tools." <ref name="pmid21418097">{{cite journal| author=Leese GP, Cochrane L, Mackie AD, Stang D, Brown K, Green V| title=Measuring the accuracy of different ways to identify the 'at-risk' foot in routine clinical practice. | journal=Diabet Med | year= 2011 | volume= 28 | issue= 6 | pages= 747-54 | pmid=21418097 | doi=10.1111/j.1464-5491.2011.03297.x | pmc= | url= }} </ref> | ||
An example of a foot risk score is the Scottish foot ulcer risk score. Low risk is defined as able to detect at least one pulse per foot, and able to feel 10 g monofilament, and no foot deformity, physical, or visual impairment. The negative predictive value of a 'low-risk score' is 99%. <ref name="pmid16700850">{{cite journal| author=Leese GP, Reid F, Green V, McAlpine R, Cunningham S, Emslie-Smith AM et al.| title=Stratification of foot ulcer risk in patients with diabetes: a population-based study. | journal=Int J Clin Pract | year= 2006 | volume= 60 | issue= 5 | pages= 541-5 | pmid=16700850 | doi=10.1111/j.1368-5031.2006.00899.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16700850 }} </ref> | |||
"Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs" according to a [[meta-analysis]].<ref name="pmid21447666">{{cite journal| author=Arad Y, Fonseca V, Peters A, Vinik A| title=Beyond the Monofilament for the Insensate Diabetic Foot: A systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes. | journal=Diabetes Care | year= 2011 | volume= 34 | issue= 4 | pages= 1041-6 | pmid=21447666 | doi=10.2337/dc10-1666 | pmc=PMC3064020 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21447666 }} </ref> | "Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs" according to a [[meta-analysis]].<ref name="pmid21447666">{{cite journal| author=Arad Y, Fonseca V, Peters A, Vinik A| title=Beyond the Monofilament for the Insensate Diabetic Foot: A systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes. | journal=Diabetes Care | year= 2011 | volume= 34 | issue= 4 | pages= 1041-6 | pmid=21447666 | doi=10.2337/dc10-1666 | pmc=PMC3064020 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21447666 }} </ref> | ||
Revision as of 09:59, 18 July 2011
The diabetic foot is "common foot problems in persons with diabetes mellitus, caused by any combination of factors such as diabetic neuropathies; peripheral vascular diseases; and infection. With the loss of sensation and poor circulation, injuries and infections often lead to severe foot ulceration, gangrene and amputation."[1]
Diagnosis
The signs of underlying osteomyelitis are "an ulcer area larger than 2 cm2, a positive probe-to-bone test result, an erythrocyte sedimentation rate of more than 70 mm/h, and an abnormal plain radiograph" according to a systematic review by the Rational Clinical Examination.[2] A normal magnetic resonance imaging makes osteomyelitis unlikely.
The National Institute for Health and Clinical Excellence (NICE) has addressed screening and recommends annually:[3][4]
Physical examination of patients’ feet:
- testing of foot sensation using a 10 g monofilament or vibration
- palpation of foot pulses
- inspection of any foot deformity and footwear
Although NICE and others[5][6] have recommended monofilament testing, its contribution in the major randomized controlled trials is not clear.[7][8]
If screening with the monofilament is done, a three site test of the plantar surfaces of the great toe, the third metatarsal, and the fifth metatarsalsis is adequate according to a systematic review[9] of studies[10]. Another systematic review questions the test accuracy of the monofilament exam.[11]
The role of patient education in preventing ulcers is not clear according to the Cochrane Collaboration. [12]
Prevention
"Integrated foot risk scores are more sensitive than individual clinical criteria in predicting future foot ulceration and are likely to be better screening tools." [13]
An example of a foot risk score is the Scottish foot ulcer risk score. Low risk is defined as able to detect at least one pulse per foot, and able to feel 10 g monofilament, and no foot deformity, physical, or visual impairment. The negative predictive value of a 'low-risk score' is 99%. [14]
"Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs" according to a meta-analysis.[15]
References
- ↑ Anonymous (2024), Diabetic foot (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Sonia Butalia et al., “Does This Patient With Diabetes Have Osteomyelitis of the Lower Extremity?,” JAMA 299, no. 7 (February 20, 2008): 806-813.
- ↑ (2004) CG10 Type 2 diabetes - footcare. National Institute for Health and Clinical Excellence
- ↑ Kaiser Permanente Care Management Institute. Guidelines for the management of adult diabetes in Primary Care. Oakland (CA): Kaiser Permanente Care Management Institute; 2006. 10 p. National Guidelines Clearinghouse
- ↑ Singh N, Armstrong DG, Lipsky BA (2005). "Preventing foot ulcers in patients with diabetes.". JAMA 293 (2): 217-28. DOI:10.1001/jama.293.2.217. PMID 15644549. Research Blogging.
- ↑ Kanji JN, Anglin RE, Hunt DL, Panju A (2010). "Does this patient with diabetes have large-fiber peripheral neuropathy?". JAMA 303 (15): 1526-32. DOI:10.1001/jama.2010.428. PMID 20407062. Research Blogging. Review in: Ann Intern Med. 2010 Oct 19;153(8):JC4-10
- ↑ Litzelman DK, Slemenda CW, Langefeld CD, Hays LM, Welch MA, Bild DE et al. (1993). "Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial.". Ann Intern Med 119 (1): 36-41. PMID 8498761.
- ↑ Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C et al. (2002). "Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial.". JAMA 287 (19): 2552-8. PMID 12020336. [e]
- ↑ 9.0 9.1 Feng Y, Schlösser FJ, Sumpio BE (2009). "The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy.". J Vasc Surg 50 (3): 675-82, 682.e1. DOI:10.1016/j.jvs.2009.05.017. PMID 19595541. Research Blogging.
- ↑ Smieja M, Hunt DL, Edelman D, Etchells E, Cornuz J, Simel DL (1999). "Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research.". J Gen Intern Med 14 (7): 418-24. PMID 10417599. PMC PMC1496604.
- ↑ Dros J, Wewerinke A, Bindels PJ, van Weert HC (2009 Nov-Dec). "Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review.". Ann Fam Med 7 (6): 555-8. DOI:10.1370/afm.1016. PMID 19901316. PMC PMC2775618. Research Blogging.
- ↑ Dorresteijn JA, Kriegsman DM, Assendelft WJ, Valk GD (2010). "Patient education for preventing diabetic foot ulceration.". Cochrane Database Syst Rev (5): CD001488. DOI:10.1002/14651858.CD001488.pub3. PMID 20464718. Research Blogging.
- ↑ Leese GP, Cochrane L, Mackie AD, Stang D, Brown K, Green V (2011). "Measuring the accuracy of different ways to identify the 'at-risk' foot in routine clinical practice.". Diabet Med 28 (6): 747-54. DOI:10.1111/j.1464-5491.2011.03297.x. PMID 21418097. Research Blogging.
- ↑ Leese GP, Reid F, Green V, McAlpine R, Cunningham S, Emslie-Smith AM et al. (2006). "Stratification of foot ulcer risk in patients with diabetes: a population-based study.". Int J Clin Pract 60 (5): 541-5. DOI:10.1111/j.1368-5031.2006.00899.x. PMID 16700850. Research Blogging.
- ↑ Arad Y, Fonseca V, Peters A, Vinik A (2011). "Beyond the Monofilament for the Insensate Diabetic Foot: A systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes.". Diabetes Care 34 (4): 1041-6. DOI:10.2337/dc10-1666. PMID 21447666. PMC PMC3064020. Research Blogging.