Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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Evidence – Foot Deformity and Previous Amputation as RiskFactors for Ulceration and AmputationPrevious amputation is a risk factor for ulceration and further amputationA history of previous lower extremity event (ulceration or amputation) determined byinterview, medical record review and examination, was used to classify risk in aprospective study of 358 American Indians (Rith-Najarian et al, 1992). People in therisk category, including previous amputation had the highest level of risk forulceration (OR 78) and further amputation (rate 180/1000 diabetic person-year). Thetrend for increasing risk of amputation and ulceration with the risk category whichincluded neuropathy, deformity and a history of ulceration or amputation, was highlysignificant (p
Foot deformity is a risk factor for ulceration, especially in people withneuropathyAbbott and coworkers (2002) followed a cohort of 9,710 people in the UK for 2 yearsassessing the final ulceration status of 6,613 people by postal questionnaire. Therewere 219 people who developed a new foot ulcer during the study period with anannual incidence rate of 2.2%. Foot deformity was defined as the presence of 3 ormore of muscle wasting, hammer and claw toes, bony prominences, prominentmetatarsal heads, Charcot arthopathy and limited joint mobility. Foot deformity wasassociated with a RR for foot ulceration of 2.54 (CI 2.04-3.22, 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 16 and 17: and an OR 1.1-7.8. This study also
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 30 and 31: people with both LJM and neuropathy
Page 32 and 33: Summary - Foot Deformity and Previo
Page 36 and 37: Also in the Seattle study, 67 peopl
Page 38 and 39: Summary - Ulcer as a Risk Factor fo
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 60 and 61: Behaviour assessment scores, measur
Page 62 and 63: Mazzuca et al (1986) studies 532 pe
Page 64 and 65: with before the programme, after 1-
Page 66 and 67: Evidence Table: Section 8AuthorEffe
Page 68 and 69: Background - Glycaemic Control and
Page 70 and 71: In a previous Japanese randomised s
Page 72 and 73: Evidence Table: Section 9AuthorGlyc
Page 74 and 75: Background - Footwear to Reduce Ulc
Page 76 and 77: period. In addition people without
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Comparisons of in-shoe foot pressur
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The rate of plantar callus formatio
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Evidence Table: Section 10AuthorFoo
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Background - Foot Clinics and Multi
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A prospective non randomised contro
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Summary - Foot Clinics and Multi-di
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Section 12: Diabetes Foot ProblemsI
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and/or osteomyelitis; III - fore-fo
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Summary - Economic consequences•
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Section 13: Diabetes Foot ProblemsI
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Some ethnic groups are associated w
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Evidence Table: Section 13AuthorSoc
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Calle-Pascual AL, Duran A, Diaz A,
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Jannink MJ, van Dijk H, de Vries J,
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Moss SE, Klein R, Klein BE. The 14-
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Soulier SM, Godsey C, Asay ED, Perr
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Diabetes Foot Problems: General Ref
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McNeely MJ, Boyko EJ, Ahroni JH, St
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Diabetes Foot Problems: Other Refer
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Caputo GM, Cavanagh PR, Ulbrecht JS
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Garbalosa JC, Cavanagh PR, Wu G, Ul
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Lavery LA, Armstrong DG, Wunderlich
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Payne C. Regional variations of dia
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Tovi J, Svanborg E, Nilsson BY, Eng
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Criteria used to determine the suit
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QUESTIONS KEY WORDS NO.ARTICLESIDEN
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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