Independent Physiological Predictors of Foot Lesions in Patients With NIDDM

Abstract

Lesions may be preventable with aggressive screening for peripheral neuropathy and abnormal lipids. Also, these results provide empirical support for the commonly held belief that foot lesions prospectively predict future wounds.

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

“…These latter patients might therefore have had more severe disease, although in terms of ulcer stages, no differences were observed between patients who were referred by other specialists and those who were not. In addition, studies with long-term follow-up indicate that diabetic foot ulceration is a recurrent disease [34,35]. Since we excluded patients with a previous ulcer within the 12 months prior to presentation, our cohort does not properly reflect the total population attending the participating clinics.…”

Can Motor Nerve Conduction Velocity Predict Foot Problems in Diabetic Subjects Over a 6-Year Outcome Period?

“…Again the significant predictors of mortality (previous ulcer, creatinine, PPT, VPT, MNCV, TPT, calcification, and TcpO 2 ) are shown in Table 5. Previous foot ulceration is a strong predictor of new foot problems (1,3,13) and was therefore removed from the multivariate Cox's regression analysis as a confounding variable. MNCV was found to be the best predictor of new ulceration (Table 3), and the best predictors for amputation were PPT and medial arterial calcification (Table 4).…”

“…PN affects sensory, motor, and autonomic sections of the peripheral nervous system and can be assessed in a variety of ways (1,5,11,12). Vibration perception threshold (VPT), pressure perception threshold (PPT), temperature perception threshold (TPT), autonomic neuropathy, muscle strength, reflexes, and neuropathy disability score all predict foot ulceration to some degree (1)(2)(3)(4)(5)7,13). In addition, lower-limb amputation (LLA) can be predicted by VPT, PPT, and reflexes (6,8).…”

“…Bioc h e m i c a l , p h y s i o l o g i c a l a n d sociological factors contribute to their development. Such factors include peripheral neuropathy (PN) (1)(2)(3)(4)(5), peripheral vascular disease (PVD) (6 -8), trauma, infection, and poor wound healing (9,10). PN affects sensory, motor, and autonomic sections of the peripheral nervous system and can be assessed in a variety of ways (1,5,11,12).…”

Emergency in Diabetic Foot

“…This condition promotes the protusion of metatarsal heads, resulting in an alterated biomechanics and peak plantar pressure [11]. Sensory abnormalities reduce the perception of pain and trauma during walking with a high risk of ulceration [12][13][14]. Further patients can lose the thermal discrimination with an easy risk of burns [11].…”