scholarly journals Patient awareness of loss of protective sensation in the diabetic foot: an opportunity for risk reduction?

2011 ◽  
Vol 4 (S1) ◽  
Author(s):  
Sylvia McAra
Keyword(s):  
Risk Reduction ◽  
Diabetic Foot ◽  
Patient Awareness ◽  
Protective Sensation ◽  
Loss Of Protective Sensation

Improved Sensitivity in Patients with Peripheral Neuropathy

2005 ◽  
Vol 95 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Salvatore L. DeLellis ◽  
Dale H. Carnegie ◽  
Thomas J. Burke
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Medical Records ◽  
Significant Clinical Improvement ◽  
The Mean ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Foot Sensation

The medical records of 1,047 patients (mean age, 73 years) with established peripheral neuropathy were examined to determine whether treatment with monochromatic infrared photo energy was associated with increased foot sensitivity to the 5.07 Semmes-Weinstein monofilament. The peripheral neuropathy in 790 of these patients (75%) was due to diabetes mellitus. Before treatment with monochromatic infrared photo energy, of the ten tested sites (five on each foot), a mean ± SD of 7.9 ± 2.4 sites were insensitive to the 5.07 Semmes-Weinstein monofilament, and 1,033 patients exhibited loss of protective sensation. After treatment, the mean ± SD number of insensate sites on both feet was 2.3 ± 2.4, an improvement of 71%. Only 453 of 1,033 patients (43.9%) continued to have loss of protective sensation after treatment. Therefore, monochromatic infrared photo energy treatment seems to be associated with significant clinical improvement in foot sensation in patients, primarily Medicare aged, with peripheral neuropathy. Because insensitivity to the 5.07 Semmes-Weinstein monofilament has been reported to be a major risk factor for diabetic foot wounds, the use of monochromatic infrared photo energy may be associated with a reduced incidence of diabetic foot wounds and amputations. (J Am Podiatr Med Assoc 95(2): 143–147, 2005)

Preferred Offloading Modalities for Management of Diabetic Foot Ulcers in Private Clinical Settings: A Survey of Australian Podiatrists

2021 ◽  
Author(s):  
Adriaan Erasmus ◽  
Michael Melek ◽  
Malia Ho
Keyword(s):  
Diabetic Foot ◽  
Online Survey ◽  
Management Strategies ◽  
Ease Of Use ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Therapeutic Footwear ◽  
Human Research Ethics ◽  
Protective Sensation ◽  
Loss Of Protective Sensation

Abstract Background Diabetic peripheral neuropathy is a common complication of diabetes mellitus. Neuropathy predisposes patients to diabetic foot ulcers (DFU) due to the loss of protective sensation and associated deformities. Management of foot ulcers are multifactorial, but pressure offloading can be considered as one of the most important aspects of management. According to IWGDF Guidelines, non-removable knee-high offloading devices are recommended as the 1st line of treatment for these ulcers. However, this is a very underutilised treatment modality. This study aimed to evaluate the practitioner preferred offloading modalities and reasons for their preference. Methods This project was approved by the university’s human research ethics committee. An online survey was distributed amongst Australian podiatrist via an industry related social media group. The survey collected simple demographical information, management strategies, preferred offloading modalities for the management of diabetic foot ulcers and reasons for their preferred method. Results Sixty-three podiatrists completed the survey with the majority practicing in private clinics. All practitioners treat diabetic foot ulcers regularly with most participants treating up to ten ulcer cases per week and 14% of participants treating more than 20 ulcers per week. Contrary to the IWGDF guidelines, standard therapeutic footwear was the most preferred method of management for the treatment of diabetic foot ulcers, with ease of use reported as the main reason for practitioners using this modality. Non-compliance to the use of non-removable knee-high offloading devices include perceived patient non-compliance and poor tolerance. Conclusion This study shows that practitioners’ offloading strategies do not adhere to the IWGDF guidelines. The reasons for not adhering to the guidelines seems to be a clinical practicality rather than evidence-based practice. Reasons for choosing a management strategy is multi-factorial (not just reducing plantar pressures). Further studies may be required to evaluate the effectiveness of therapeutic footwear in ulcer healing, taking into consideration other factors such as practitioner and patient preference, clinical practicality, and access to support. Based on the findings, this study provides suggestions on how to overcome the barriers that prevent podiatrist from adhering to the recommendations of the IWGDF when selecting offloading devices in general clinical practice.

Prevalence, Clinical Presentation, and Factors Associated With Diabetic Foot Ulcer in Two Regional Hospitals in Cameroon

2018 ◽  
Vol 17 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Maxime Tindong ◽  
John N. Palle ◽  
Daniel Nebongo ◽  
Leopold Ndemnge Aminde ◽  
Yannick Mboue-Djieka ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Clinical Presentation ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Patients With Diabetes ◽  
Protective Sensation ◽  
Peripheral Arterial ◽  
Loss Of Protective Sensation ◽  
Regional Hospitals

This study aimed to determine the prevalence of diabetic foot ulcer and high risk for ulceration, describe the clinical presentation, and identify factors associated with diabetic foot ulcer in the Southwest regional hospitals of Cameroon. In this cross-sectional study, data were collected using a structured questionnaire administered to consecutive patients with diabetes. Findings from detailed foot examination were recorded. Diabetic foot ulcer was diagnosed according to the International Working Group on Diabetic Foot (IWGDF) definition. Data were analyzed with Stata IC version 12. Of the 203 participants included, 63.1% were females. Age ranged from 26 to 96 years. The median duration of diabetes was 4.0 years (interquartile range 1.0-8.0 years). The prevalence of diabetic foot ulcer was 11.8% (24), of whom 29.2% (7) had high grade (grades 2 to 4), and most of the ulcers 58.3% (14) were located at the plantar region. The prevalence of high risk for ulceration was 21.8% (39). Loss of protective sensation (OR = 3.73, 95% CI = 1.43-9.71; P = .007), and peripheral arterial disease (OR = 3.48, 95% CI = 1.14-10.56; P = .028) were independently associated with diabetic foot. Diabetic foot ulcer is a common complication among patients with diabetes attending these regional hospitals. Loss of protective sensation, and peripheral arterial disease increase the odds of having diabetic foot ulcer, and we suggest them as the main target of interest for prevention.

Reappraising Diabetic Foot Ulcers: A Focus on Mechanisms of Ulceration and Clinical Evaluation

2020 ◽  
pp. 153473462094451
Author(s):  
Paola C. Aldana ◽  
Alexander M. Cartron ◽  
Amor Khachemoune
Keyword(s):  
Diabetic Foot ◽  
Morbidity And Mortality ◽  
Foot Ulcers ◽  
Motor Neuropathy ◽  
Diabetic Foot Ulcers ◽  
Microvascular Changes ◽  
Patient Morbidity ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
The 19Th Century

Diabetic foot ulcers (DFU) are one of the most devastating complications of diabetes as they have significant effects on patient morbidity and mortality. Since their first description in the 19th century, our understanding of DFU has evolved as we uncover the mechanisms that mediate ulceration. In this review, we aim to summarize the various pathways that lead to the development of DFU in order to reappraise physicians’ understanding of these complex wounds. Relevant pathways include the following: (1) neuropathy (motor neuropathy, loss of protective sensation, and autonomic sympathetic dysfunction), (2) vascular disease (arterial ischemia, venous insufficiency, and microvascular changes), and (3) metabolism (signaling and immunological effects of hyperglycemia). We also discuss the clinical presentation of DFU and an evidence-based evaluation to assist clinicians in early identification and classification of these wounds to inform management of DFU. Finally, we summarize complications of DFU caused by the various pathways mediating ulceration and briefly overview DFU management in order to educate physicians about the potential risks if left untreated. A better understanding of the synergistic pathways leading to DFU is essential for clinicians to improve DFU diagnosis, tailor intervention, and mitigate significant patient morbidity and mortality.

Evaluation of Risk Factors Associated with Diabetic Foot Ulcers in Saudi Arabia

2019 ◽  
Vol 15 (3) ◽  
pp. 224-232 ◽  
Author(s):  
Mousab Yousef Al-Ayed ◽  
Mutasem Ababneh ◽  
Asirvatham Alwin Robert ◽  
Ahmed Salman ◽  
Abdulghani Al Saeed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Saudi Arabia ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Foot Ulceration ◽  
Factors Associated ◽  
Vascular Insufficiency ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Age Range

<P>Background and Aims: Considering that diabetic foot ulceration is one of the major health issues globally, we aimed to evaluate the risk factors associated with foot ulcers in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 81 T2DM patients (age range: 40-80 years) registered at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia between April and September 2015 were included in this cross-sectional study after purposive selection and assigning of patient numbers. The selected participants were interviewed and examined, and their medical records were reviewed for sensory, vibratory, and painful neuropathies; vascular insufficiency; retinopathy; and dermatological variations. The Wagner’s classification system was employed to evaluate the stage of patients’ foot ulcers. Results: Among the study participants [mean age range: 56.4 ± 6.72 years; 53 males (65.4%)], cases of loss of protective sensation, foot deformity, amputation history, and dermatological abnormalities were notable. The Wagner gradation value of ulcers were grade 0 for 16% study population, grade 1 for 35.8%, grade 2 for 45.7%, grade 3 for 2.5%, and grades 4 and 5 for 0%. Approximately 19% of the patients had a previous case of amputation and 29.6% had nail disease. The most common footwear reported to be used by the patients was sandals shoes (46%). Conclusion: The issues of loss of protective sensation, vascular insufficiency, deformity, previous amputations, and dermatological abnormalities of the lower limbs were found to be most common among the foot ulceration patients. The study findings thus recommend regular foot examination, following basic hygiene habits, encouragement of the use of appropriate footwear, patient education about foot ulcers, and prompt treatment for minor injuries to prevent further ulceration in DM patients.</P>

Do US Veterans Wear Appropriately Sized Shoes?

2006 ◽  
Vol 96 (4) ◽  
pp. 290-292 ◽  
Author(s):  
Brent P. Nixon ◽  
David G. Armstrong ◽  
Christopher Wendell ◽  
Jefferey R. Vazquez ◽  
Zinoviy Rabinovich ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Odds Ratio ◽  
Total Population ◽  
Medical Literature ◽  
Etiologic Factor ◽  
High Risk Population ◽  
Foot Ulceration ◽  
Shoe Size ◽  
Protective Sensation ◽  
Loss Of Protective Sensation

Poorly fitting footwear has frequently been cited as an etiologic factor in the pathway to diabetic foot ulceration. However, we are unaware of any reports in the medical literature specifically measuring shoe size versus foot size in this high-risk population. We assessed the prevalence of poorly fitting footwear in individuals with and without diabetic foot ulceration. We evaluated the shoe size of 440 consecutive patients (94.1% male; mean ± SD age, 67.2 ± 12.5 years) presenting to an interdisciplinary teaching clinic. Of this population, 58.4% were diagnosed as having diabetes, and 6.8% had active diabetic foot ulceration. Only 25.5% of the patients were wearing appropriately sized shoes. Individuals with diabetic foot ulceration were 5.1 times more likely to have poorly fitting shoes than those without a wound (93.3% versus 73.2%; odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–21.9; P = .02). This association was also evident when assessing only the 32.3% of the total population with diabetes and loss of protective sensation (93.3% versus 75.0%; OR, 4.8; 95% CI, 1.1–20.9; P = .04). Poorly fitting shoes seem to be more prevalent in people with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. This implies that appropriate meticulous screening for shoe-foot mismatches may be useful in reducing the risk of lower-extremity ulceration. (J Am Podiatr Med Assoc 96(4): 290–292, 2006)

scholarly journals A Survey of Nurses’ Knowledge Regarding Prevention and Management of Diabetic Foot Ulcer in Bangladesh

2014 ◽  
Vol 4 (1) ◽  
pp. 22-26 ◽  
Author(s):  
S Sharmisthas ◽  
P Wongchan ◽  
S Hathairat
Keyword(s):  
Diabetic Foot ◽  
Callus Formation ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Care Program ◽  
Foot Care ◽  
Multiple Choice Questions ◽  
Patients With Diabetes ◽  
Protective Sensation ◽  
Nurses Knowledge

Diabetic foot ulcer is a preventable complication of diabetes. Nurses must have knowledge related to this condition so that education can be given to patients. This study aims to examine the level of nurses’ knowledge regarding prevention and management of diabetic foot ulcer in Bangladesh. A survey involved 218 nurses working at a national, specialized, and well-established institute of diabetic care of Bangladesh. The Nurses’ Knowledge Regarding Prevention and Management of Diabetic Foot Ulcer Questionnaire (NKPMDFUQ) comprising of 40 questions with 20 true/false questions and 20 multiple choice questions was used. It was content validated and tested for internal consistency and stability yielding acceptable levels of reliability. The findings revealed that nurses had very low level of knowledge (M=52.60%, SD=7.86%). The content areas most nurses did not have knowledge were detecting loss of protective sensation of the feet, caring of callus formation, encouraging patients to have activity of daily living in order to self-manage, setting a goal for prevention of amputation, and giving advice to patients that causes of diabetes is the least important element in diabetic foot care program. The findings are beneficial for establishing training courses. Consequently, quality of care for patients with diabetes will be improved. DOI: http://dx.doi.org/10.3329/birdem.v4i1.18549 Birdem Med J 2014; 4(1): 22-26

Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients

2014 ◽  
Vol 3 (1) ◽  
pp. 1-17 ◽  
Author(s):  
V. B. Narayanamurthy ◽  
Richa Poddar ◽  
R. Periyasamy
Keyword(s):  
Pressure Distribution ◽  
Biomechanical Properties ◽  
Distribution Parameter ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Wear Properties ◽  
History Of ◽  
Protective Sensation ◽  
Index Value ◽  
Loss Of Protective Sensation

This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination.A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation.In this study we found newPRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.

The Safety and Effectiveness of the Percutaneous Flexor Tenotomy in Healing Neuropathic Apical Toe Ulcers in the Outpatient Setting

2019 ◽  
Vol 13 (2) ◽  
pp. 123-131
Author(s):  
Simon E. Smith ◽  
Julie Miller
Keyword(s):  
Patient Satisfaction ◽  
Ulcer Healing ◽  
Case Series ◽  
Outpatient Setting ◽  
The Mean ◽  
Prospective Case Series ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Mean Time ◽  
Flexor Tenotomy

Percutaneous flexor tenotomy is a minimally invasive procedure that involves cutting one or both flexor digitorum tendons underneath the toe. It is an alternative to open surgical procedures performed in an operating theatre. This project is a prospective case series investigating the utility, effectiveness, and participant satisfaction of the percutaneous flexor tenotomy when performed in the outpatient setting. People with diabetes, digital flexion deformity, and loss of protective sensation with an apical ulcer or preulcerative lesion presenting to the Austin Health Foot Ulcer Specialist Outpatient Clinic were enrolled in the study. The procedure was performed under sterile technique with an 18-gauge needle or fine scalpel blade. Participants were reviewed weekly until the incision and/ or ulcer healed. Participants were then followed up at 3 and 6 months. Time to ulcer healing, reulceration rate, frequency of complications, and patient satisfaction were recorded. There were 11 toe ulcers and 41 preulcerative lesions. A total of 76 tenotomy procedures were performed on the 23 participants across 35 episodes of care. The mean time to ulcer healing following tenotomy was 10.2 ± 4.3 days. There were no recurrences of ulceration. The infection rate per episode of care was 2.8%. There were 11 toes (14.5%) that sustained a transfer lesion post the index procedure. The mean time to development of a transfer lesion was 95.5 ± 98.1 days. All participants strongly agreed that they were satisfied with the outcome of the procedure. The flexor tenotomy is an effective procedure to expedite the healing of apical toe ulcers in people with loss of protective sensation and flexion digital deformity. It has a low infection rate and high patient satisfaction rate when performed in the outpatient setting. There is a moderate risk of transfer preulcerative lesions to an adjacent digit. Levels of Evidence: Level IV: Prospective case series

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