The acutely infected diabetic foot is not adequately evaluated in an inpatient setting

OBJECTIVE To evaluate the standard of evaluation and treatment of the infected diabetic foot ulceration at a 551-bed university teaching institution. DESIGN A retrospective review of a 4-year consecutive sample (1991-1994). POPULATION Two hundred fifty-five patients who were admitted to a hospital for care of an infected diabetic foot ulceration. Patients were subdivided into the following 4 dichotomous variables: (1) whether the patient underwent a lower-extremity amputation, (2) whether the patient was admitted once or multiple times, (3) whether the patient underwent intraoperative debridement, and (4) whether the patient was admitted to medical or surgical services. RESULTS All groups that were evaluated had undergone a less than adequate foot examination. Of the admitted patients, 31.4% did not have their pedal pulses documented; 59.7% of the admitted patients were not evaluated for the presence or absence of protective sensation. Nearly 90% of the wounds were not evaluated for involvement of underlying structures, and foot radiographs were not performed in 32.9% of the patients. There were more blood cultures ordered (62.0%) than wound cultures (51.4%). CONCLUSION The results of this study highlight the need for a systematic, detailed lower-extremity examination for every diabetic patient who is admitted to a hospital, particularly those who are admitted with a primary diagnosis that involves a foot complication.

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Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration

Journal of Diabetes Science and Technology ◽

10.1177/1932296815584796 ◽

2015 ◽

Vol 9 (4) ◽

pp. 873-880 ◽

Cited By ~ 5

Author(s):

Timothy M. Rankin ◽

John D. Miller ◽

Angelika C. Gruessner ◽

D. Scott Nickerson

Keyword(s):

Cost Saving ◽

Lower Extremity ◽

Diabetic Foot ◽

Foot Ulceration ◽

Nerve Decompression

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

Current Diabetes Reviews ◽

10.2174/1573399814666180816165848 ◽

2019 ◽

Vol 15 (3) ◽

pp. 224-232 ◽

Cited By ~ 2

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>

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Health-related quality of life in patients with diabetic foot ulceration: study protocol for adaptation and validation of patient-reported outcome measurements (PROMs) in Dutch-speaking patients

BMJ Open ◽

10.1136/bmjopen-2019-034491 ◽

2019 ◽

Vol 9 (12) ◽

pp. e034491 ◽

Cited By ~ 1

Author(s):

Wahid Rezaie ◽

Flora Lusendi ◽

Kris Doggen ◽

Giovanni Matricali ◽

Frank Nobels

Keyword(s):

Quality Of Life ◽

Lower Extremity ◽

Diabetic Foot ◽

Patient Reported Outcome ◽

Health Related Quality ◽

Foot Ulceration ◽

Patient Reported ◽

Related Quality ◽

Health Related

IntroductionDiabetic foot ulceration (DFU) is a common late-stage complication of diabetes with a large impact on health status and quality of life. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients’ views on their well-being. The DFU Scale Short Form (DFS-SF) is a validated disease-specific PROM for measuring health-related quality of life among DFU patients. The Lower Extremity Functional Scale (LEFS) is another PROM that can be used to measure physical functioning in patients with lower extremity disorders. The LEFS is not yet validated for DFU. Both instruments are not validated in the Dutch language. The purpose of this study is to culturally adapt and validate the DFS-SF and LEFS questionnaires for Belgian Dutch-speaking patients with DFU.Methods and analysisThis study will be conducted as a monocentre observational cohort study in DFU patients presenting at a hospital-based multidisciplinary diabetic foot clinic. Data will be collected from the medical electronic files and from DFS-SF, LEFS and five-level EuroQol five-dimension questionnaires that will be presented to the patients at defined time points. Reproducibility, internal consistency, floor and ceiling effects, construct validity and responsiveness will be assessed for the DFS-SF and LEFS.Ethics and disseminationThe study protocol has been approved by the Medical Ethics Committee of Onze-Lieve-Vrouw Hospital (Aalst, Belgium). The results of the study will be disseminated through peer-reviewed publications and conference presentations.

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Do US Veterans Wear Appropriately Sized Shoes?

Journal of the American Podiatric Medical Association ◽

10.7547/0960290 ◽

2006 ◽

Vol 96 (4) ◽

pp. 290-292 ◽

Cited By ~ 25

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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RISK FACTORS FOR DIABETIC FOOT AND LOWER LIMB AMPUTATION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i9.538 ◽

2019 ◽

Vol 3 (9) ◽

Author(s):

Dr. Uday Prakash ◽

Dr. Kumar Durgeshwar ◽

Dr.R.K. Das ◽

Dr. Lalji Chaudhary

Keyword(s):

Risk Factors ◽

Peripheral Arterial Disease ◽

Lower Extremity ◽

Diabetic Foot ◽

Arterial Disease ◽

Major Amputation ◽

Cardiac Diseases ◽

Foot Ulceration ◽

Duration Of Diabetes ◽

Peripheral Arterial

Introduction: Diabetic foot syndrome (DFS) is the major cause of hospitalization for diabetes-related complications. Protective sensation loss and impaired vision increase the susceptibility for minor feet trauma, which results in diabetic foot ulceration with or without subsequent infection. Peripheral arterial disease is a major cause of impaired ulcer, wound healing and gangrenous diabetic foot. The most important intervention to prevent diabetic foot ulceration and its consequences is early recognition of high-risk patients and their risk factors and referral to appropriate medical departments. There are various risk factors for major lower extremity amputations related to diabetic foot, which includes microvascular diseases, infections, long duration of diabetes, poor glycemic control, peripheral arterial disease, old age and associated cardiovascular comorbidities. Material and Methods: This study was done on the review of medical records of consecutive type 2 diabetic patients. Admitted patients were treated and managed according to the standard protocol of the hospital. History, clinical and physical examination were carried out on each patient. Ulcer characteristics like infection and depth of the ulcer, site of ulcer were assessed. Associated diabetic neuropathy and peripheral arterial disease was assessed by a clinical method. Age, sex, body mass index (BMI), smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases were recorded. The glycated haemoglobin level (HbA1c) were recorded. Results: A total of 128 patients with diabetic foot were included in the study of which 76(59.4%) were male and 52(40.6%) were female. Of the 76 male 6 (4.7%) had major amputation and out of 52 female 4(3.1%) had major amputation, thus total number of major amputations were 10(7.8%). Statistically significant difference was observed in HbA1C and duration of diabetes group in amputation. High HbA1C and more duration of diabetes was associated with the higher number of amputation. The rate of amputation was much higher among patients hypertension, smoking, cardiac diseases and stroke. Conclusion: Poor glycemic controls and duration of diabetes are the important independent risk factors for diabetes-related major lower extremity amputations. Keywords: DFS, BMI, smkoing, DM

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Is a Left-to-Right >2.2°C Difference a Valid Measurement to Predict Diabetic Foot Ulceration in People with Diabetes and a History of Diabetic Foot Ulceration?

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211062719 ◽

2021 ◽

pp. 153473462110627

Author(s):

Jill Featherston ◽

Anke M. Wijlens ◽

Jaap J. van Netten

Keyword(s):

High Risk ◽

Construct Validity ◽

Diabetic Foot ◽

Environmental Temperature ◽

Time Of Day ◽

Warning Sign ◽

Activity Time ◽

Foot Ulceration ◽

Walking Activity ◽

Protective Sensation

Monitoring foot skin temperatures at home have been shown to be effective at preventing the occurrence of diabetic foot ulcers. In this study, the construct validity of using >2.2°C difference between contralateral areas on the foot as a warning sign of imminent ulceration is explored. Thirty participants with diabetes at high risk of ulceration (loss of protective sensation and previous ulceration and/or amputation) monitored their foot temperatures at six sites, four times a day for six days using a handheld infrared thermometer. Walking activity, time of day, and environmental temperature were also monitored and correlated with foot temperatures. We found that contralateral mean skin temperature difference was 0.78°C at baseline. At single sites, left-to-right temperature differences exceeding the threshold were found in 9.6% of measurements ( n = 365), which reduced to 0.4% when individually corrected and confirmed the next day. No correlation was found between contralateral temperature differences and activity, time of day, and environmental temperature. We conclude that using a >2.2°C difference is invalid as a single measurement in people at high risk of ulceration, but the construct validity is appropriate if both individual corrections and next day confirmation are applied.

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