Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes
Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes
Evidence Table: Section 10AuthorFoot wear and effect on ulceration and amputationLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingArmstrong DG (2001)(Adults – US)II RCT High High U+ HighBusch K (2003)(Adults – Germany)III-2 Cohort High High U+ HighCaravaggi C (2000)(Adults – Italy)II RCT High High U+ HighChantelau E (1994)(Adults – Germany)III-2 Cohort Low High F + HighColagiuri S (1995)(Adults – Australia)II RCT High High C+ HighEdmonds ME (1986)(Adults – UK)III-2 Cohort Low High A+ U+ HighHa Van G (2003)(Adults – France)III-2 Cohort High High F + HighKastenbauer T (1998)(Adults – Austria)III-2 Case-control High High P+ HighLavery LA (1997)(Adults – US)III-2 Case-control High High P+ HighLitzelman DK (1997b)(Adults – US, African III-2 Cohort Low Low LowAmerican)Lobmann R (2001)(Adults – Germany)III-2 Cohort High High P+ HighMason J (1999) I Systematic review High High U+ HighMcCabe CJ (1998)(Adults – UK)II RCT High High U+, A+ HighPerry JE (1995)(Adults – US)III-2 Case-control Medium High P+ HighPraet SFE (2003)(Adults – TheIII-2 Cross-sectional Medium High + HighNetherlands)Raspovic A (2000)(Adults – Australia)III-2 Cross-sectional Medium High P+ HighReiber GE (2002a)(Adults- US)II RCT High Low HighSarnow MR (1994)(Adults – US)III-2 Case-control High High P+ HighSoulier SM (1987)(Adults – US)III-2 Cohort Medium High C+ HighUccioli L (1995)(Adults – Italy)II RCT High High U + HighVeves A (1990)(Adults – UK)III-2 Cohort Medium High P+ HighFor magnitude rating:+indicates that appropriate footwear may reduce the risk of ulceration and amputation; High = clinically important & statisticallysignificant; Medium = small clinical importance & statistically significant; Low = no statistically significant effect.Criteria for Quality and Relevance ratings are detailed in Appendix 9.P= plantar foot pressure; C= callus formation; F= foot lesions; U= ulcer; A= amputations.82
Section 11: Diabetes Foot ProblemsIssueDo specialist foot clinics and multi-disciplinary teams decrease amputation?RecommendationPeople with diabetes who have foot ulcers or with high risk feet should be cared for by amulti-disciplinary service which should include a physician and podiatrist and have readyaccess to a specialist nurse, orthotist and surgeon.Evidence Statements• A multi-disciplinary specialist footcare team can reduce ulceration and amputation inpeople with high risk feetEvidence Level III-2• The multi-disciplinary footcare team commonly includes a physician, podiatrist,specialist nurse, orthotist and surgeonEvidence Level III-283
- Page 32 and 33: Summary - Foot Deformity and Previo
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- Page 36 and 37: Also in the Seattle study, 67 peopl
- Page 38 and 39: Summary - Ulcer as a Risk Factor fo
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- 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 58 and 59: Section 8: Diabetes Foot ProblemsIs
- 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
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- Page 76 and 77: period. In addition people without
- Page 78 and 79: Comparisons of in-shoe foot pressur
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- Page 84 and 85: Background - Foot Clinics and Multi
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- Page 90 and 91: Section 12: Diabetes Foot ProblemsI
- Page 92 and 93: and/or osteomyelitis; III - fore-fo
- Page 94 and 95: Summary - Economic consequences•
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- Page 100 and 101: Evidence Table: Section 13AuthorSoc
- Page 102 and 103: Calle-Pascual AL, Duran A, Diaz A,
- Page 104 and 105: Jannink MJ, van Dijk H, de Vries J,
- Page 106 and 107: Moss SE, Klein R, Klein BE. The 14-
- Page 108 and 109: Soulier SM, Godsey C, Asay ED, Perr
- Page 110 and 111: Diabetes Foot Problems: General Ref
- Page 112 and 113: McNeely MJ, Boyko EJ, Ahroni JH, St
- Page 114 and 115: Diabetes Foot Problems: Other Refer
- Page 116 and 117: Caputo GM, Cavanagh PR, Ulbrecht JS
- Page 118 and 119: Garbalosa JC, Cavanagh PR, Wu G, Ul
- Page 120 and 121: Lavery LA, Armstrong DG, Wunderlich
- Page 122 and 123: Payne C. Regional variations of dia
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Section 11: <strong>Diabetes</strong> <strong>Foot</strong> <strong>Problems</strong>IssueDo specialist foot cl<strong>in</strong>ics <strong>and</strong> multi-discipl<strong>in</strong>ary teams decrease amputation?RecommendationPeople with diabetes who have foot ulcers or with high risk feet should be cared for by amulti-discipl<strong>in</strong>ary service which should <strong>in</strong>clude a physician <strong>and</strong> podiatrist <strong>and</strong> have readyaccess to a specialist nurse, orthotist <strong>and</strong> surgeon.Evidence Statements• A multi-discipl<strong>in</strong>ary specialist footcare team can reduce ulceration <strong>and</strong> amputation <strong>in</strong>people with high risk feetEvidence Level III-2• The multi-discipl<strong>in</strong>ary footcare team commonly <strong>in</strong>cludes a physician, podiatrist,specialist nurse, orthotist <strong>and</strong> surgeonEvidence Level III-283
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