Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration (original) (raw)
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Role of neuropathy and high foot pressures in diabetic foot ulceration
Diabetes Care, 1998
OBJECTIVE -High plantar foot pressures in association with peripheral neuropathy have been ascertained to be important risk factors for ulceration in the diabetic foot. Most studies investigating these parameters have been limited by their size and the homogeneity of study subjects. The objective of this study was therefore to ascertain the risk of ulceration associated with high foot pressures and peripheral neuropathy in a large and diverse diabetic population.
Painful neuropathy and foot ulceration in diabetic patients
Diabetes Care, 1993
OBJECTIVE-To examine the prevalence of painful symptoms in neuropathic patients with or without foot ulceration. It has been suggested that there are two clinical presentations of sensory diabetic neuropathy with little overlap: painful (acute or chronic) and painless with recurrent foot ulceration.
Choosing a Practical Screening Instrument to Identify Patients at Risk for Diabetic Foot Ulceration
Archives of Internal Medicine, 1998
To evaluate the sensitivity and specificity of 3 sensory perception testing instruments to screen for risk of diabetic foot ulceration. Methods: This case-control study prospectively measured the degree of peripheral sensory neuropathy in diabetic patients with and without foot ulcers. We enrolled 115 age-matched diabetic patients (40% male) with a casecontrol ratio of approximately 1:3 (30 cases and 85 controls) from a tertiary care diabetic foot specialty clinic. Cases were defined as individuals who had an existing foot ulceration or a history of a recently (Ͻ4 weeks) healed foot ulceration. Controls were defined as subjects with no foot ulceration history. Using receiver operating characteristic analysis, we evaluated the sensitivity and specificity of 2 commonly used neuropathy assessment tools (vibration perception threshold testing and the Semmes-Weinstein 10-g monofilament wire system) and a 4-question verbal neuropathy score to evaluate for presence of foot ulceration. Results: A vibration perception threshold test using 25 V and lack of perception at 4 or more sites using the Semmes-Weinstein 10-g monofilament wire system had a significantly higher specificity than the neuropathy score used. The neuropathy score was most sensitive when 1 or more answers were affirmative. When modalities were combined, particularly the monofilament wire system plus vibration perception threshold testing and the neuropathy score plus the monofilament wire system, there was a substantial increase in specificity with little or no diminution in sensitivity. Conclusions: The early detection of peripheral neuropathy or loss of "protective sensation" is paramount to instituting a structured treatment plan to prevent lower extremity amputation. The results of our study suggest that all 3 sensory perception testing instruments are sensitive in identifying patients at risk for ulceration. Combining modalities appears to increase specificity with very little or no diminution in sensitivity.
2018
Plantar pressure is critical in the onset of neuropathic foot ulcers. However, risk classifications do not consider it as a stratification parameter. Whether plantar pressure distribution affects ulcer-risk was investigated. Patients from a research study (n. 134) and from a clinical environment (n. 83) were classified into ulcer-risk groups according to the International Working Group on the Diabetic Foot guidelines. Pressure distribution was acquired during gait (Pedar-X System), and assessed for hindfoot, midfoot, forefoot and toes (1way- and 2way-ANOVAs, p < 0.05). Pressure distribution changed with polyneuropathy even in the low-risk groups: median p = 0.048 (0.001-0.223). Risk classification correlated poorly with pressure distribution: median p = 0.686 (0.374-0.828). BMI, age and walking speed influenced most parameters and rendered the studies almost impossible to compare (2-way ANOVA factor A > 0.05). Pressure-time integral, the only comparable parameter between the t...
Diabetic Medicine, 1994
The prevalence of peripheral neuropathy, peripheral vascular disease, and foot ulceration in Type 2 diabetic patients in the community were determined in a community-based study. Eight hundred and eleven subjects (404 male, 407 female, mean age 65.4 (range 34-90) years, diabetes duration 7.4 (0-50) years) from 37 general practices in three UK cities were studied. Neuropathy was diagnosed clinically using modified neuropathy disability scores which were ascertained using structured interviews and clinical examinations by one observer in each city. Peripheral vascular disease was diagnosed if a history of revascularization was present or L 2 foot pulses were absent. History of current or previous foot ulceration was recorded. The prevalence of neuropathy was 41.6 % (95 % confidence limits 38.344.9 %) and the prevalence of PVD, 11 % (9.1-13.7 %). Fortyeight percent of neuropathic patients reported significant neuropathic symptoms. Fortythree patients (5.3 % (3.8-6.8 %)) had current or past foot ulcers; 20 of these were pure neuropathic ulcers, 13 neuroischaemic, 5 pure vascular, and 5 were unclassified. Multiple logistic regression showed history of amputation, neuropathy disability score, and peripheral vascular disease to be significantly associated with foot ulceration after adjusting for age and diabetes duration. A substantial proportion of Type 2 diabetic patients, often elderly patients who do not attend hospitals, suffered from peripheral neuropathy and peripheral vascular disease. These patients are at risk of foot ulceration and may benefit from preventive footcare.