Diabetic foot primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2], Anahita Deylamsalehi, M.D.[3]

Overview

Foot ulcers can be prevented by frequent physical examinations, proper glycemic control, good foot hygiene, diabetic socks and shoes, and by avoiding injury. Studies recommend annual screening for every diabetic patient older than 15 years old by the physician and more frequent for patients who are at risk (such as neuropathy). A careful examinations should consist peripheral neuropathy assessment, which should be done by checking ankle reflexes, vibration and sensation. A study showed the importance of using a 10-g Semmes-Weinstein monofilament with a 10 fold risk elevation of foot ulcer development and 17 fold increase in amputation rate within a 32-month follow up in patients who had abnormal 10-g Semmes-Weinstein monofilament examinations.

Primary Prevention

Foot ulcers can be prevented by frequent physical examinations, good foot hygiene, diabetic socks and shoes, and by avoiding injury. The following are some of the important steps for primary prevention of diabetic foot:[1][2][3][4][5][6][7][8]

Clinical Trials

Randomized controlled trials of interventions to prevent complications of diabetic foot.[15] [9] [16] [17]
Trial Patients Intervention Comparison Outcome Results Comment
Intervention Control
Litzelman[9]
1993
395 patients
• General medicine practice
Patient and provider education Usual care • Any foot lesion
• Serious foot lesions at one year
Not reported • 11%
• 2.9%

• Insignificant
• Significant reduction
Lincoln[17]
2008
172 patients
• Prior ulceration
• Specialist clinic
Targeted, one-to-one education Usual care Re-ulceration at
• 1 year
2 years
• 30%
• 41%
• 20%
• 41%
• Insignificant
• Insignificant
McCabe[16]
1998
2002 patients
• High-risk
• General diabetic clinic
Screening and referral to foot-care clinic if they had prior ulcer, low ankle–brachial index (<0.75), or foot deformities Usual care • Ulceration within 2 years
• Amputation rates
• 2%
• 0.1%
4%
1.2%
• Insignificant
• Significant
Reiber[15]
2002
400 patients
• Prior ulceration
• Excluded severe deformity
Therapeutic shoes Usual footwear Re-ulceration 15% 17% Insignificant difference

Video: Diabetic Foot Care

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References

  1. Armstrong DG, Boulton AJM, Bus SA (2017). "Diabetic Foot Ulcers and Their Recurrence". N Engl J Med. 376 (24): 2367–2375. doi:10.1056/NEJMra1615439. PMID 28614678.
  2. Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S; et al. (1998). "1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association". CMAJ. 159 Suppl 8: S1–29. PMC 1255890. PMID 9834731.
  3. Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM (1998). "Preventive foot care in people with diabetes". Diabetes Care. 21 (12): 2161–77. doi:10.2337/diacare.21.12.2161. PMID 9839111.
  4. Rith-Najarian SJ, Stolusky T, Gohdes DM (1992). "Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria". Diabetes Care. 15 (10): 1386–9. doi:10.2337/diacare.15.10.1386. PMID 1425105.
  5. Mueller MJ (1996). "Identifying patients with diabetes mellitus who are at risk for lower-extremity complications: use of Semmes-Weinstein monofilaments". Phys Ther. 76 (1): 68–71. doi:10.1093/ptj/76.1.68. PMID 8545495.
  6. McGill M, Molyneaux L, Spencer R, Heng LF, Yue DK (1999). "Possible sources of discrepancies in the use of the Semmes-Weinstein monofilament. Impact on prevalence of insensate foot and workload requirements". Diabetes Care. 22 (4): 598–602. doi:10.2337/diacare.22.4.598. PMID 10189538.
  7. Croxson, S. (2002). "Diabetes in the elderly: problems of care and service provision". Diabetic Medicine. 19: 66–72. doi:10.1046/j.1464-5491.19.s4.12.x. ISSN 0742-3071.
  8. Stumvoll, Michael; Goldstein, Barry J; van Haeften, Timon W (2005). "Type 2 diabetes: principles of pathogenesis and therapy". The Lancet. 365 (9467): 1333–1346. doi:10.1016/S0140-6736(05)61032-X. ISSN 0140-6736.
  9. 9.0 9.1 9.2 Litzelman D, Slemenda C, Langefeld C, Hays L, Welch M, Bild D, Ford E, Vinicor F (1993). "Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial". Ann Intern Med. 119 (1): 36–41. PMID 8498761.
  10. Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F; et al. (2006). "Exercise training can modify the natural history of diabetic peripheral neuropathy". J Diabetes Complications. 20 (4): 216–23. doi:10.1016/j.jdiacomp.2005.07.005. PMID 16798472.
  11. Hunt D. "Foot ulcers and amputations in diabetes". Clin Evid: 455–62. PMID 16620415. Text " based on September 2005 search" ignored (help)
  12. "Scope: Management of type 2 diabetes: prevention and management of foot problems (update)" (PDF). Clinical Guidelines and Evidence Review for Type 2 Diabetes: Prevention and Management of Foot Problems. National Institute for Health and Clinical Excellence. 20 February 2003. Retrieved 2007-12-04.
  13. Spencer S. "Pressure relieving interventions for preventing and treating diabetic foot ulcers". Cochrane Database Syst Rev: CD002302. doi:10.1002/14651858.CD002302. PMID 10908550.
  14. Uccioli L, Faglia E, Monticone G, Favales F, Durola L, Aldeghi A, Quarantiello A, Calia P, Menzinger G (1995). "Manufactured shoes in the prevention of diabetic foot ulcers". Diabetes Care. 18 (10): 1376–8. PMID 8721941.
  15. 15.0 15.1 15.2 Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C; et al. (2002). "Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial". JAMA. 287 (19): 2552–8. PMID 12020336.
  16. 16.0 16.1 McCabe CJ, Stevenson RC, Dolan AM (1998). "Evaluation of a diabetic foot screening and protection programme". Diabet Med. 15 (1): 80–4. doi:10.1002/(SICI)1096-9136(199801)15:1<80::AID-DIA517>3.0.CO;2-K. PMID 9472868.
  17. 17.0 17.1 Lincoln NB, Radford KA, Game FL, Jeffcoate WJ (2008). "Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial". Diabetologia. 51 (11): 1954–61. doi:10.1007/s00125-008-1110-0. PMID 18758747.