Aetiology and Management of Lesions of the Feet in Diabetes

Catterall, R. C. F.; Martin, Malcolm M.; Oakley, Wilfrid

doi:10.1136/bmj.2.4999.953

Cited by 77 publications

(27 citation statements)

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“…The importance of neuropathy in the pathogenesis of foot lesions in diabetic patients has been widely recognised since the report of Oakley, Catterall and Martin [9]. Vascular disease is also acknowledged as a cause of foot problems, but the associations between the two have not been explored.…”

Section: Discussionmentioning

confidence: 99%

“…Assuming that neuropathy is the primary cause [3,9], the co-existence of arterial disease could potentiate the development and persistence of an ulcerated lesion and, in this way, the two processes may be synergistic in their action.…”

Section: Discussionmentioning

confidence: 99%

“…Since the studies of Oakley, Catterall and Martin [9] the importance of neuropathy has been increasingly recognised, so that a recent account of the pathogenesis of these lesions [3] discounts vascular disease as a factor in the development of ulcers of the sole of the foot. The role of vascular changes has not been frequently studied, especially when the arterial supply is apparently normal.…”

mentioning

confidence: 99%

“…Oakley, Catterall and Martin [9] describe and illustrate the lesions they associate with neuropathy. These include perforating ulcers and areas of gangrene on the feet and toes.…”

mentioning

confidence: 99%

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Small and large vessel disease in the development of foot lesions in diabetics

Fair

1975

Diabetologia

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Summary. This paper describes studies undertaken to determine the role of vascular disease in the development of foot lesions in diabetics, particularly those with neuropathy. The ratios of ankle/arm and toe/ankle blood pressure were used as indices of large and small vessel disease respectively. Diabetic patients with lesions had evidence of more large and small vessel disease than patients without lesions. Patients with neuropathic lesions had evidence of more small vessel disease than patients without lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…Oakley, Catterall and Martin [9] describe and illustrate the lesions they associate with neuropathy. These include perforating ulcers and areas of gangrene on the feet and toes.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Small and large vessel disease in the development of foot lesions in diabetics

Fair

1975

Diabetologia

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“…(12)(13)(14)(15)(16)(17)(18). It seems that poor clinical outcomes are generally associated with infection, peripheral vascular disease, and increasing wound depth; it also appears that the progressive cumulative effect of these comorbidities contributes to a greater likelihood of a diabetic foot ulcer leading to a lower-limb amputation.…”

mentioning

confidence: 99%

A Comparison of Two Diabetic Foot Ulcer Classification Systems

et al. 2001

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A Comparison of Two Diabetic Foot Ulcer Classification SystemsThe Wagner and the University of Texas wound classification systemsOBJECTIVE -In this study, the following two ulcer classification systems were applied to new foot ulcers to compare them as predictors of outcome: the Wagner (grade) and the University of Texas (UT) (grade and stage) wound classification systems.RESEARCH DESIGN AND METHODS -Ulcer size, appearance, clinical evidence of infection, ischemia, and neuropathy at presentation were recorded, and patients were followed up until healing or for 6 months.RESULTS -Of 194 patients with new foot ulcers, 67.0% were neuropathic, 26.3% were neuroischemic, 1.0% were ischemic, and 5.7% had no identified underlying factors. Median (interquartile range [IQR]) ulcer size at presentation was 1.5 cm 2 (0.6-4.0). Lower-limb amputations were performed for 15% of ulcers, whereas 65% healed [median (IQR) healing time 5 (3-10) weeks] and 16% were not healed at study termination; 4% of patients died. Wagner grade (P Ͻ 0.0001), and UT grade (P Ͻ 0.0001) and stage (P Ͻ 0.001) showed positive trends with increased number of amputations. For UT stage, the risk of amputation increased with infection both alone (odds ratio [OR] = 11.1, P Ͻ 0.0001) and in combination with ischemia (OR = 14.7, P Ͻ 0.0001), but not significantly with ischemia alone (OR = 4.6, P = 0.09). Healing times were not significantly different for each grade of the Wagner (P = 0.1) or the UT system (P = 0.07), but there was a significant stepwise increase in healing time with each stage of the UT system (P Ͻ 0.05), and stage predicted healing (P Ͻ 0.05).CONCLUSIONS -Increasing stage, regardless of grade, is associated with increased risk of amputation and prolonged ulcer healing time. The UT system' s inclusion of stage makes it a better predictor of outcome.

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