The Pathway to Foot Ulceration in Diabetes

Boulton, Andrew J.M.

doi:10.1016/j.mcna.2013.03.007

Cited by 183 publications

(143 citation statements)

References 54 publications

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“…10,11,16 Importantly, the proportion of patients with diabetes melli tus who are at increased risk of foot ulceration, such as elderly patients (>65 years of age) with type 2 diabetes mellitus, might be >50%. 1,16 Although one group of investigators have reported that the number of nontraumatic amputations in people with diabetes mellitus increased in the 5year period up to 2008, 17 since then, a marked variation in the inci dence of amputation across different regions of the UK has been reported. 18 By contrast, a considerable reduc tion in the incidence of lower extremity amputations in people with diabetes mellitus during a similar period of time was reported in Scotland.…”

Section: Epidemiologymentioning

confidence: 99%

“…[45][46][47] Callus formation, which is a consequence of raised pressure on the foot and sympathetic autonomic neuro pathy, is strongly associated with increased risk of foot ulceration. 1 Peripheral oedema, which can compro mise local blood flow, has also been associated with an increased risk of foot complications in patients with diabetes mellitus. 48 In a prospective study of risk factors for diabetic foot ulceration, neuropathy, deformity and trauma were the most frequently occurring factors implicated in the development of foot ulcers.…”

Section: Microvascular Complicationsmentioning

confidence: 99%

“…An esti mated 2-3% of patients with diabetes mellitus are thought to have an active foot ulcer and the lifetime risk of develop ing a foot ulcer for these patients could be as high as 25%. 1,2 Consequently, the financial and health burdens of diabetic foot disease is substantial and in 2010-2011 was estimated to cost the National Health Service in the UK at least UK£580 million, which represents ~0.6% of the national health expenditure in that period of time. 3 More than half of this cost was estimated to be spent on care of ulcerations in the community, but the cost of inpatient care for foot ulcers and other foot complications in patients with diabetes mellitus is estimated at >£219 million in the UK.…”

Section: Introductionmentioning

confidence: 99%

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Preventing and treating foot complications associated with diabetes mellitus

2015

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Diabetes mellitus is associated with a series of macrovascular and microvascular changes that can manifest as a wide range of complications. Foot ulcerations affect ∼2-4% of patients with diabetes mellitus. Risk factors for foot lesions include peripheral and autonomic neuropathy, vascular disease and previous foot ulceration, as well as other microvascular complications, such as retinopathy and end-stage renal disease. Ulceration is the result of a combination of components that together lead to tissue breakdown. The most frequently occurring causal pathways to the development of foot ulcers include peripheral neuropathy and vascular disease, foot deformity or trauma. Peripheral vascular disease is often not diagnosed in patients with diabetes mellitus until tissue loss is evident, usually in the form of a nonhealing ulcer. Identification of patients with diabetes mellitus who are at high risk of ulceration is important and can be achieved via annual foot screening with subsequent multidisciplinary foot-care interventions. Understanding the factors that place patients with diabetes mellitus at high risk of ulceration, together with an appreciation of the links between different aspects of the disease process, is essential to the prevention and management of diabetic foot complications.

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Section: Epidemiologymentioning

confidence: 99%

Section: Microvascular Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preventing and treating foot complications associated with diabetes mellitus

2015

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“…The fourth extremely important risk factor is increased plantar pressure. 6 Sympathetic autonomic neuropathy in the lower limb results not only in reduced sweating and therefore dry skin that is prone to crack and fissure, but also to increase blood flow in the absence of large vessel peripheral vascular disease. This latter abnormality is a consequence of an increase in arteriovenous shunting and results from a warm foot with distended dorsal foot veins, both useful physical signs of an "at risk" foot.…”

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confidence: 99%

Diabetic Foot Risk Assessment and Foot Care Among Patients Attending Tertiary Care Hospital in Central India

Chaurasia¹,

Valame²

2017

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BACKGROUND India currently leads the world with largest number of diabetic subjects, earning the ignominy of being the "Diabetes capital of the world." Diabetic foot ulcer is a rising health problem, being the most important cause of non-traumatic foot ischaemia. Ulceration, infection, gangrene and lower extremity amputation are complications often encountered in diabetics. Not all foot complications can be prevented, but it is possible to dramatically reduce their incidence through appropriate management and prevention programs. The aim of this study is to evaluate risk of development of diabetic foot among diabetics and to identify high risk features through Epidemiological variables, biochemical parameters and clinical findings of Ankle-Brachial Index, Monofilament testing and Durometer analysis. Settings and Design-Cross-sectional study with educational intervention on 350 Diabetics attending Outpatient Department of Medicine at a tertiary care hospital in Central India. MATERIALS AND METHODSDiabetic Foot Risk Assessment questionnaire will be filled out by patients. Clinical assessment of their feet using Monofilament, Ankle Brachial Index and Durometer analysis of footwear along with Epidemiological Profile and Biochemical Parameters shall be correlated with their risk profile. Statistical Analysis-Data analysis was done by calculating the p-value using the Chi-Square test using Microsoft Excel version 2016 (MS Office 365 Home). RESULTSOf 350 subjects 227 (64.86%) had moderate risk of developing diabetic foot, while 87 (24.86%) had high risk. Advanced age, rural lifestyle, low literacy, high body mass index, poor blood glucose control, longer duration of diabetes and addictions were significantly associated with a higher risk of developing diabetic foot. Ankle-Brachial Index, Monofilament Test and Durometer evaluation proved to be simple, cost-effective outpatient methods to evaluate risk profile. CONCLUSIONFoot care assessment and inculcation of good foot care practices should be done at the outset of diagnosis of diabetes. Simple outpatient tests are sensitive enough to detect risk of developing diabetic foot. This approach may help reduce the incidence of diabetic foot.

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“…An indicator of ongoing infection with cellulitis and potential septicemia is the leucocyte count. However, a normal leucocyte count can be reported in advanced septicemia and thus a normal leucocyte count can be misleading [31]. Diabetic peripheral neuropathy enhances the risk of DFUs due to the loss of cutaneous sensation as the patients become vulnerable to trivial trauma that goes unnoticed [32].…”

Section: Discussionmentioning

confidence: 99%