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

Summary - Clinical Detection of Peripheral Vascular Disease• Peripheral vascular disease is common in people with Type 2 diabetes and is animportant risk factor for amputation• The presence of symptoms of intermittent claudication has a sensitivity of 50%and a specificity of 87% for peripheral vascular disease determined by an anklearm index ≤0.5• Less than half of people with diabetes and peripheral vascular disease experienceintermittent claudication• The presence of palpable pedal pulses is a good predictor of adequate peripheralcirculation but their absence is only a moderate predictor of peripheral vasculardisease.• Both dorsalis pedis and posterior tibial pulses should be impalpable for thedesignation “absent foot pulses”• A negative history of peripheral vascular disease together with palpableperipheral pulses usually excludes a critical reduction in limb perfusion• History of claudication and palpation of peripheral pulses are reliable in detectingperipheral vascular disease in a routine practice setting• The absence of peripheral pulses has prognostic significance for futureamputation in people with diabetes with and without foot ulceration51