Preulcerous Risk Situation in Diabetic Foot Syndrome: Proposal for a Simple Ulcer Prevention Score

Abstract

Background: Preulcerous risk situations in patients with diabetes are often undiagnosed and care administered too late. Even with regular medical check-ups and status documentation, foot examinations have not been given enough attention. Diagnosing an individual patients’ risk of developing diabetic foot ulcers may increase vigilance for diabetic foot syndrome (DFS), and the appropriate prevention measures matching the risk involved may prevent the emergence of diabetic ulcers. The classical DFS risk factors are well established and have been extensively covered in the literature; however, there is a lack of efficient screening tools that could be used for a rapid assessment of diabetic foot ulcer risk. Methods: A methodical literature search was conducted to assess relevant publications for the preparation of a simple risk score for amputation related to diabetic foot ulcer. We then analyzed the risk factors for predictive value as odds ratios in foot ulcers and/or amputation. We used the available data to deduce a mean value to reflect the authors’ consensus. Results: In view of the current literature on the matter, we have developed a semi-quantitative scoring system using just a few items to allow rapid and visual risk assessment for diabetic foot ulcers alongside recommendations for prevention and a sensible follow-up strategy to match the risk. Conclusion: This relatively simple score enables rapid risk classification for patients that can ease the way for both physicians and patients in gaining an insight into individual risk situations. The score provides more effective preventative measures for high-risk patients against future complications.

Screening for diabetic peripheral neuropathy in resource-limited settings

“…A recently developed semi-quantitative scoring system stratifies patients according to their risk for developing DFU based on minor criteria (foot or nail fungal infection; ill-fitting socks and footwear; lack of visual or cognitive ability for selfcare; glycated hemoglobin > 9%; diabetes duration > 10 years; and male sex), moderate criteria (slight polyneuropathy; pronounced foot deformity; pronounced hyperkeratosis; PAD; and renal insufficiency or dialysis), and major criteria (pronounced polyneuropathy; history of foot ulcer; and history of non-traumatic amputation) [ 111 ]. Validation of this new risk assessment system in diverse patients at risk for DFS is needed to determine how to incorporate the system into future screening practices.…”

Old and Novel Predictors for Cardiovascular Risk in Diabetic Foot Syndrome—A Narrative Review

“…The risk of developing diabetic foot is assessed using nomograms based on the main independent risk factors associated with it such as age, glycosylated hemoglobin, low density lipoprotein cholesterol, total cholesterol, smoking and alcohol consumption [80,89,90]. Several risk scores have been developed for diabetic patients prone to ulcers, which have both preventive and therapeutic roles [91,92].…”