Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes
Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes
and an OR 1.1-7.8. This study also found that PVD, foot ulcers, former amputationand treatment with insulin were independent risk factors (Adler et al, 1999). As partof this ongoing Seattle Foot Study 749 people were followed with monofilamenttesting for a median of 3.7 years. These study participants had a mean age of 63.2years, were 98% mean and 93.6% had had Type 2 diabetes for a mean duration of11.4 years. Insensitivity to the monofilament remained an independent risk factor forfoot ulcer with a RR of 2.2 (CI 1.5-3.1) (Boyko et al, 1999).Kastenbauer et al (2001) reported predictors for foot ulceration in a prospective studyof people (aged
Apelqvist et al (1990) studied a cohort of 314 consecutive people with diabetesreferred to a Swedish department of medicine because of foot ulcers. The studyparticipants had a mean age of 64±17 and duration of diabetes of 17±12 years and96% had sensory and muscular disturbances of neuropathy. Neuropathy was morecommon in those progressing to amputation than in those who did not. However,consistent with other studies, additional precipitating factors were again found in 84%of subjects, such as wearing ill fitting shoes or acute mechanical trauma.In a case-control study, Masson et al (1989) found that among people with diabetes(n= 38) or with rheumatoid arthritis (n=37) who presented with similar forefootdeformity. 32% of the diabetic group had a history of plantar ulceration comparedwith none of the rheumatoid group (p10 kg/cm 2 )was very common in both groups (61.0 v 51.0%, respectively, p=NS). However, thediabetic group had more severe neuropathy (85.0 v 35.0% with absent ankle reflexes,p
- Page 1: National Evidence Based Guidelinesf
- Page 4: Research OfficersMs Linda SmithPodi
- Page 7 and 8: 2.2 Issues for Foot Problems in Typ
- Page 9: • Aim to achieve the best possibl
- Page 12 and 13: Background - Peripheral Neuropathy
- Page 14 and 15: proportion of subjects with a durat
- Page 18 and 19: Summary - Peripheral Neuropathy as
- Page 20 and 21: Section 2: Diabetes Foot ProblemsIs
- Page 22 and 23: predicting risk of amputation, 2.9
- Page 24 and 25: Summary - Peripheral Vascular Disea
- Page 26 and 27: Section 3: Diabetes Foot ProblemsIs
- Page 28 and 29: Evidence - Foot Deformity and Previ
- Page 30 and 31: people with both LJM and neuropathy
- Page 32 and 33: Summary - Foot Deformity and Previo
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- Page 36 and 37: Also in the Seattle study, 67 peopl
- Page 38 and 39: Summary - Ulcer as a Risk Factor fo
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- Page 42 and 43: The other frequently reported metho
- Page 44 and 45: side; and 82% having the same resul
- Page 46 and 47: Evidence Table: Section 5Detection
- Page 48 and 49: Background - Clinical Detection of
- Page 50 and 51: pulse was bilaterally absent in 1.8
- Page 52 and 53: Evidence Table: Section 6AuthorClin
- Page 54 and 55: Background - Frequency of Foot Exam
- Page 56 and 57: Summary - Frequency of Foot Examina
- Page 58 and 59: Section 8: Diabetes Foot ProblemsIs
- Page 60 and 61: Behaviour assessment scores, measur
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<strong>and</strong> an OR 1.1-7.8. This study also found that PVD, foot ulcers, former amputation<strong>and</strong> treatment with <strong>in</strong>sul<strong>in</strong> were <strong>in</strong>dependent risk factors (Adler et al, 1999). As part<strong>of</strong> this ongo<strong>in</strong>g Seattle <strong>Foot</strong> Study 749 people were followed with mon<strong>of</strong>ilamenttest<strong>in</strong>g for a median <strong>of</strong> 3.7 years. These study participants had a mean age <strong>of</strong> 63.2years, were 98% mean <strong>and</strong> 93.6% had had <strong>Type</strong> 2 diabetes for a mean duration <strong>of</strong>11.4 years. Insensitivity to the mon<strong>of</strong>ilament rema<strong>in</strong>ed an <strong>in</strong>dependent risk factor forfoot ulcer with a RR <strong>of</strong> 2.2 (CI 1.5-3.1) (Boyko et al, 1999).Kastenbauer et al (2001) reported predictors for foot ulceration <strong>in</strong> a prospective study<strong>of</strong> people (aged
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