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

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Section 4: Diabetes Foot ProblemsIssueIs a current or previous ulcer a risk factor for amputation?RecommendationPeople with diabetes and a current foot ulcer are at high risk for amputation andpreventative interventions to lower that risk should be instituted promptlyPeople with diabetes and a history of a healed previous diabetic foot ulcer should berecognised as having a life long increased risk of recurrent ulceration and amputationEvidence Statements• A healed diabetic foot ulcer is an indicator of high risk for recurrent ulceration andamputationEvidence Level III-2• A current ulcer is a high risk indicator for amputationEvidence Level III-234
Background - Ulcer as a Risk Factor for AmputationObservational studies suggest that 6-43% of people with diabetes who have a footulcer eventually progress to amputation (Bild et al, 1989; Apelqvist et al, 1994;Larsson et al, 1995; Moss et al, 1996). Retrospective studies suggest that lowerextremity ulcers precede 71-85% of first (Reiber et al, 1992; Larsson et al, 1995;Moss et al, 1996) or second amputation (Larsson et al, 1998). While the presence of acurrent ulcer leads to an increased risk of amputation, it is important to know the levelof risk and whether a healed ulcer is also a risk factor in the assessment of the feet of aperson with diabetes for ongoing monitoring and preventative intervention. It hasbeen observed that the most likely site for plantar ulceration in neuropathic feet is atthe location of a previous ulcer (Sims et al, 1988).While sophisticated measurements are sometimes used to assess the high risk foot, thehistory of an ulcer or the detection of a current ulcer by physical examination are bothrisk factors capable of detection by all primary care health professionals. Preventativeaction can then be instituted in an easily identified high risk group (Apelqvist et al,1993).Evidence - Ulcer as a Risk Factor for AmputationA healed diabetic foot ulcer is an indicator of high risk for recurrent ulcerationand amputationA UK prospective study followed 63 neuropathic people (median age 62 years andmedian duration of diabetes 17 years) with plantar callus and high plantar footpressures. After 22 months follow-up previous ulceration proved to be the highest riskfactor for the development of a new foot ulcer with a RR of 56.8 (p=0.00001) (Murrayet al, 1996).A 14 year prospective study followed 984 diabetic individuals (mean age 64.4 yearsand a duration of diabetes 10.9 years) from a population based cohort fromWisconsin, US. A history of foot ulceration was associated with the highest OR of3.56 (CI 1.84-6.89, p≤0.0005) for amputation in a multivariate logistic regressionmodel. Male gender was also a risk factor (OR 2.66 [CI 1.49-4.76], p
Page 1: National Evidence Based Guidelinesf
Page 4: Research OfficersMs Linda SmithPodi
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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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