Diabetic neuropathic foot ulcers and amputation

Margolis, David J.; Allen-Taylor, Lynne; Hoffstad, Ole; Berlin, Jesse A.

doi:10.1111/j.1067-1927.2005.130303.x

Cited by 120 publications

(75 citation statements)

References 21 publications

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“…The presence of a foot ulcer increased the risk of LEA nearly six-fold in our patients. Several other studies have reported an independent association between foot ulceration and subsequent LEA [27,31] and the risk of LEA increases with the severity of ulceration [32]. Evidence of PAD (ABI e 0.9) was also an independent predictor of LEA, consistent with the findings of others [27,33].…”

Section: Discussionsupporting

confidence: 86%

Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study

et al. 2006

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Section: Discussionsupporting

confidence: 86%

Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study

et al. 2006

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“…Quando se relacionou amputações e presença, diminuição e ausência dos pulsos pedioso e tibial posterior, ficou confirmado que quando há alteração desses eventos, o paciente pode evoluir para amputação caso não seja submetido a revascularização. Sendo assim, a doença arterial pode ser considerada como um dos principais fatores de risco para ulceração e, consequentemente, para amputação 19 . A palpação dos pulsos arteriais distais é considerada um instrumento de grande valia na triagem para doença oclusiva arterial 5 4,5,8,20,21 .…”

Section: Discussionunclassified

Comparação dos fatores de risco para amputações maiores e menores em pacientes diabéticos de um Programa de Saúde da Família

et al. 2009

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Trabalho de conclusão de graduação médica financiado pela Liga Acadêmica Vascular Prof. Dr. Emil Burihan (LAVA).Não foram declarados conflitos de interesse associados à publicação deste artigo. Artigo submetido em 16.09.08, aceito em 05.05.09. ARTIGO ORIGINAL ResumoContexto: Dentre as maiores causas de internamento hospitalar em pacientes com diabetes melito tipos 1 e 2 estão as complicações do pé diabético, principalmente pelas sequelas, muitas vezes incapacitantes, destacando-se as amputações de membros inferiores. A insuficiência vascular periférica ocorre mais precocemente nesses pacientes. A coexistência de neuropatia, isquemia e imunodeficiência favorece o desenvolvimento de infecções nos membros inferiores, que, se não tratadas adequadamente, podem levar a amputações e até à morte.Objetivos: Comparar os fatores de risco para amputações maiores e menores em pacientes diabéticos de um Programa de Saúde da Família do CAIC Virgem dos Pobres III, em Maceió, AL. Métodos:Foram examinados 93 pacientes com o diagnóstico de diabetes melito, sendo avaliada a realização ou não de amputações de membros inferiores. As variáveis analisadas foram: sexo, idade, tipo do diabetes, pressão arterial, amputação prévia (se maior ou menor), alterações dermatológicas, alterações de pulsos arteriais pedioso e tibial posterior, deformidades e neuropatia, e foram classificadas de acordo com a classificação de Wagner e de Texas.Resultados: Todos os pacientes eram diabéticos tipo 2. Verificou-se que 4,30% dos pacientes evoluíram para amputação de membros inferiores. Não se observou variação significativa da hipertensão, deformidades e neuropatia em relação ao grupo de pacientes que foram amputados. Entretanto, a ausência de detecção dos pulsos distais dos membros inferiores revelou-se bastante significativa com relação ao desfecho de amputação. Conclusão:Deve-se proporcionar aos diabéticos um atendimento ambulatorial adequado para que seja possível prevenir ou minimizar tais complicações.Palavras-chave: Amputação, pé diabético, diabetes melito. AbstractBackground: The main causes of hospital admission in patients with type 1 and 2 diabetes mellitus include diabetic foot complications, which may result in particularly disabling sequelae, such as lower limb amputation. Peripheral vascular insufficiency is a common early occurrence in these patients. The coexistence of neuropathy, ischemia, and immunodeficiency favors the development of infections in the lower limbs, which if not treated properly can lead to amputation and even death.

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“…Recurrence rates among those with successfully treated foot ulcers may be as high as 60% [4]. Foot ulcers are the most important risk factor for lower-extremity amputations [5,6] and are associated with substantial treatment costs [7]. Moreover, foot ulceration impacts negatively on quality of life [8] and, perhaps most strikingly, diabetes patients with a history of foot ulceration have a twofold increased risk for mortality as compared with those without foot ulcers [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Depression predicts first but not recurrent diabetic foot ulcers

et al. 2010

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Aims/hypothesis This study examined the relationship between symptoms of depression and the development of diabetic foot ulcers. Methods Participants were 333 patients (71% male; mean age 62 years; 73% with type 2 diabetes) with diabetic peripheral neuropathy (DPN), but without peripheral vascular disease (PVD). Severity of DPN and the presence of PVD were assessed by clinical examination. Depression, other diabetes complications and foot self-care were assessed by self-report. Cox regression tested whether depression was an independent predictor of foot ulceration over 18 months, whether this relationship was moderated by foot ulcer history, and whether foot self-care mediated this relationship. Results During follow-up, 63 patients developed a foot ulcer. Those with prior foot ulcers had more than four-fold greater risk of subsequent foot ulceration compared with those without a history of foot ulcer. A significant interaction effect showed that depression was significantly related to the development of first but not recurrent foot ulcers. This relationship was independent of biological risk factors. In the final model, each standard deviation increase in depression symptoms was significantly associated with increased risk of developing first foot ulcers (HR 1.68, 95% CI 1.20-2.35), while foot self-care was associated with lower risk (HR 0.61, 95% CI 0.40-0.94). Foot self-care did not mediate the relationship between depression and foot ulceration. Conclusions/interpretation These data suggest that depression is associated with increased risk of first foot ulcers in DPN patients and that this relationship is independent of biological risk factors and foot self-care. Interventions that target depression and foot self-care before the development of foot ulcers may maximise the likelihood of successful prevention of foot ulceration.

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Diabetic neuropathic foot ulcers and amputation

Cited by 120 publications

References 21 publications

Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study

Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study

Comparação dos fatores de risco para amputações maiores e menores em pacientes diabéticos de um Programa de Saúde da Família

Depression predicts first but not recurrent diabetic foot ulcers

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