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>

scholarly journals Risk Factors Associated with Amputation-Free Survival in Patient with Diabetic Foot Ulcers

2014 ◽  
Vol 55 (5) ◽  
pp. 1373 ◽  
Author(s):  
Sung Hun Won ◽  
Chin Youb Chung ◽  
Moon Seok Park ◽  
Taeseung Lee ◽  
Ki Hyuk Sung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Free Survival ◽  
Factors Associated

The Frequency and Risk Factors of Diabetic Foot Ulcer Recurrence Among Jordanian Patients with Diabetes

2020 ◽  
Vol 16 (8) ◽  
pp. 910-915
Author(s):  
Sinan F. Tabanjeh ◽  
Dana Hyassat ◽  
Hashem Jaddou ◽  
Nidal A. Younes ◽  
Asirvatham A. Robert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Public Health Problem ◽  
Foot Ulcers ◽  
Ulcer Recurrence ◽  
Major Public Health Problem ◽  
Historical Cohort ◽  
Foot Ulceration ◽  
Foot Clinic

Background: Diabetic foot is a major public health problem and their complications are an imperative cause of morbidity and mortality in diabetes. Objective: To evaluate the rate of recurrence of foot ulcers post two years of follow-up, including the associated risk factors in the patients attending the diabetic foot clinic at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), Amman, Jordan. Methods: A historical cohort design was adopted for the patients who presented for the first time to the diabetic foot clinic at the NCDEG. Every patient who came to the clinic was reviewed by using his or her medical files with respect to diabetic foot-related complaints. Patients were classified under four categories: (1) Recurrent foot ulcers (2) chronic foot ulcer (3) free of recurrence, and (4) no foot ulcers. Among the four groups, group 1 (recurrent foot ulcers, n=76) and group 3 (free of recurrence, n=54) were included for the analysis. Results: Among the 141 patients who presented to the diabetic foot clinic during the two-year study period, 76 (53.9%) of them experienced ulcer recurrences, 54 (38.3%) were recurrence-free, and 11 (7.8%) had chronic ulceration. The two-year recurrence rate was 58.5%. The presence of deformity and osteomyelitis were the statistically significant independent risk factors for recurrent foot ulceration. Conclusion: This study of recurrences was clearly related to the type and complications of the ulcers rather than to the other variables. Recurrent foot ulceration is linked to the presence of osteomyelitis and/or deformities.

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.

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.

scholarly journals Risk Factors for Diabetic Foot Ulcers in Metreleptin Naïve Patients With Lipodystrophy

2021 ◽  
Author(s):  
Onur Saydam ◽  
Basak Ozgen Saydam ◽  
Suleyman Cem Adiyaman ◽  
Melda Sonmez Ince ◽  
Mehmet Ali Eren ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Partial Lipodystrophy ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract AimPatients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population.MethodsNinety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers).Results Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95%CI: 3.31 - 503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95%CI: 2.97 - 246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95%CI: 1.96 - 90.67, p = 0.008).ConclusionOur study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

Incidence and Risk Factors Associated With Ulcer Recurrence Among Patients With Diabetic Foot Ulcers Treated in a Multidisciplinary Setting

2020 ◽  
Vol 246 ◽  
pp. 243-250 ◽  
Author(s):  
Caitlin W. Hicks ◽  
Joseph K. Canner ◽  
Nestoras Mathioudakis ◽  
Christopher Lippincott ◽  
Ronald L. Sherman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Ulcer Recurrence ◽  
Diabetic Foot Ulcers ◽  
Factors Associated

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)

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