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

people with both LJM and neuropathy compared with none in people with LJM but noneuropathy, and only 5% in people with neuropathy but no LJM.Data on foot deformity and risk of amputation are limited. In a case-control study of244 people with diabetes foot deformity was found to have a risk equal to neuropathyand PVD in predicting amputation but the risk increased with increasing number ofrisk factors (Mayfield et al, 1996). After adjusting for demographic factors anddisease severity, and independent of other risk factors, there was a significantassociation between foot deformity and first amputation in a Native American Indianpopulation (OR 3.0, CI 1.02-8.7). This study was a retrospective review of medicalrecords, which could have underestimated the prevalence of significant peripheralneuropathy in the control group.A longitudinal outcome study (Lavery et al, 2003a) evaluated the effectiveness ofdynamic plantar pressure assessment in determining people at high risk forneuropathic ulceration. A total of 1,666 people with diabetes (mean age 69 years)were enrolled in this 2-year study. Lower-extremity screening involved sensory (using10g Semmes-Weinstein monofilament and vibration perception threshold testing) andmusculoskeletal examination, as well vascular status assessment. Based on screeningresults, people were categorised by their risk of diabetic foot complications. 263people (15.8%) either presented with or developed an ulcer during the 24-monthfollow up period. The baseline peak pressure was significantly higher in the ulceratedgroup compared with those who did not develop ulcers (n=1,403) (95.5±26.4 v85.1±27.3 N/cm 2 , p25V)without either PVD or foot ulcer history, Abouaesha et al (2001) found that people30