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

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Summary - Foot Deformity and Previous Amputation as RiskFactors for Ulceration and Amputation• Previous amputation is a risk factor for ulceration and further amputation and isassociated with a 68% mortality rate after 5 years• In the presence of diabetic neuropathy, limited joint mobility and bonydeformities increase the risk of ulceration• Deformity increases the risk of ulceration by at least 3 fold• The deformity caused by previous amputation also increases the risk of ulcerationby at least 3 fold• Callus is common in people with diabetes and in the presence of neuropathyincreases the risk of ulceration32
Evidence Table: Section 3AuthorDeformity as a risk factor for ulceration and amputationLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingAbbott C (2002)(Adults – UK)III-2 Cohort High High + HighAbouaesha F (2001)(Adults – UK)III Cross-sectional Medium High + MediumAdler AI (1999)(Adults – US)III-2 Cohort High High + HighBoyko EJ (1999)(Adults – US)III-2 Cohort High High + HighFernando JS (1991)(Adults – UK)III-2 Cross-sectional Medium High + HighKumar S (1994)(Adults – UK)III-2 Cross-sectional Medium High + HighLarsson J (1998)(Adults – Sweden)III-2 Cohort High High + HighLavery LA (1998)(Adults – US)III-2 Case-control High High + HighLavery LA (2003a)(Adults – US)III-2 Cohort Medium High + HighMasson EA (1989)(Adults – UK)III-2 Case-control High High + HighMayfield JA (1996)(Adults – US: GilaIII-2 Case-control High High + LowRiver Indians)Murray HJ (1996)(Adults – UK)III-2 Cohort Medium High + HighPataky Z (2002)(Adults – Switzerland)III-2 Case-control Medium High + HighPitei DL (1999)(Adults – Denmark)III-2 Case-control Medium High + HighQuebedeaux TL (1996)(Adults – US)III-2 Case-control High High + HighReiber GE (1999)(Adults – US; UK)III-2 Cohort Medium High + HighRith-Najarian S (1992)(Adults -US: Red Lake III-2 Cohort High High + LowChippewa Indians)Uccioli L (1995)(Adults – Italy)II RCT High High + HighFor magnitude rating:+deformity is a risk factor for ulceration and amputation. High = clinically important & statistically significant; Medium = smallclinical importance & statistically significant; Low = no statistically significant effect.Criteria for Quality and Relevance ratings are detailed in Appendix 933
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 28 and 29: Evidence - Foot Deformity and Previ
Page 30 and 31: people with both LJM and neuropathy
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
Page 78 and 79: Comparisons of in-shoe foot pressur
Page 80 and 81: 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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