Choosing a Practical Screening Instrument to Identify Patients at Risk for Diabetic Foot Ulceration

Armstrong, David G.; Lavery, Lawrence A.; Vela, Steven A.; Quebedeaux, Terri L.; Fleischli, John G.

doi:10.1001/archinte.158.3.289

Cited by 367 publications

(211 citation statements)

References 29 publications

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“…Monofilaments, sometimes known as Semmes-Weinstein monofilaments, were originally used to diagnose sensory loss in leprosy (21). Many prospective studies have confirmed that loss of pressure sensation using the 10-g monofilament is highly predictive of subsequent ulceration (3,21,22). Screening for sensory loss with the 10-g monofilament is in widespread use across the world, and its efficacy in this regard has been confirmed in a number of trials, including the recent Seattle Diabetic Foot Study (4,21,23,24).…”

Section: Neurological Assessmentmentioning

confidence: 99%

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Comprehensive Foot Examination and Risk Assessment

et al. 2008

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Section: Neurological Assessmentmentioning

confidence: 99%

“…This process should initially be demonstrated on a proximal site, and then the mean of three readings is taken over each hallux. A VPT Ͼ25 V is regarded as abnormal and has been shown to be strongly predictive of subsequent foot ulceration (15,22).…”

Section: Neurological Assessmentmentioning

confidence: 99%

Comprehensive Foot Examination and Risk Assessment

et al. 2008

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“…The 10-g SW-MF is tested on the plantar surface of the hallux and centrally at the heel. The ability to sense the SW-MF correctly in six trials at both locations is defined as normal; the inability to sense the SW-MF correctly in one of six trials is defined as mildly disturbed (score 1 point), and the inability to sense the SW-MF correctly more than one time is defined as disturbed and scores 2 points (11,12).…”

Section: Ndf/cbo Guidelinesmentioning

confidence: 99%

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Meijer

Smit²,

Lefrandt³

et al. 2005

Diabetes Care

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OBJECTIVE—Several national and international scoring systems are used to diagnose diabetic polyneuropathy (PNP). The variety in these scores and the lack of data on validity and predictive value has led to a comparison and validation of the scores with clinical standards for PNP to determine the most powerful measurement for screening. RESEARCH DESIGN AND METHODS—Three matched groups were selected: 24 diabetic patients with neuropathic foot ulcers, 24 diabetic patients without PNP or ulcers, and 21 control subjects without diabetes. In all participants the scores from the International Consensus on the Diabetic Foot (ICDF) and the Dutch Nederlandse Diabetes Federatie-Centraal Beleids Orgaan (NDF/CBO) were tested. The Diabetic Neuropathy Symptom score, the Diabetic Neuropathy Examination score, Heart Rate Variability, the Nerve Conduction Sum score, and a San Antonio Consensus sum score were obtained as clinical standards. Reproducibility was tested in a separate study (13 patients). RESULTS—The construct validity and discriminative power of the ICDF and NDF/CBO scores were comparable, although monofilaments (NDF/CBO) scored lower. The predictive value was good for all scores, with the best results being obtained for the tuning fork (NDF/CBO). Reproducibility of the NDF/CBO scores (monofilaments and tuning fork) was high. CONCLUSIONS—The characteristics of the scores of tests recommended by ICDF and NDF/CBO are comparable. The single use of the 128-Hz tuning fork produces results similar to the extended scores of the ICDF and much better than those of monofilaments on validation and for predictive value. For screening we therefore advise the use of the tuning fork alone.

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“…Experiência do Reino Unido revelou que o LPV, a partir de um nível de 25 volts, esteve associado a aumento no risco de úlcera, o que não ocorreu quando percebido com 15 volts ou menos (9). Outros estudos confirmaram o ponto de corte do LPV ≥ 25 volt como preditivo para ulceração do pé (10,11). Cada aumento de 1 volt da LPV no nível basal de percepção do indivíduo associou-se a aumento de 5,6% no risco de úlcera (12).…”

Section: Introductionunclassified

Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

Porciúncula

Rolim

Garofolo

et al. 2007

Arq Bras Endocrinol Metab

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Analysis of Factors Associated with Extremity Ulceration in Diabetic Subjects with Peripheral Neuropathy.Peripheral neuropathy is the main risk factor for foot ulceration in diabetic subjects. This study examined the association of peripheral arterial disease (PAD) with foot ulceration in a sample of diabetic subjects with peripheral neuropathy, and also if inflammatory markers would be associated with this event. We evaluated 32 type 2 diabetic individuals with abnormal 10-g monofilament exam, who were stratified in 2 groups according to history or presence of lower extremities ulcer. The group "with ulcer" (n = 18) included the ones that had active or cicatrized ulcer, or some lower-extremity amputation due to ulcer complications. In addition to the neurological examination and monofilament test, they were submitted to biothesiometry, lower extremity vascular assessment with Doppler, and laboratory determinations. No difference between the groups was found concerning sex distribution, mean age, and duration of diabetes diagnosis. The group with ulcer showed higher mean values of height (1.70 ± 0.06 vs. 1.63 ± 0.11 m, p = 0.044), vibration perception threshold measured in medial malleolli (40.9 ± 13.0 vs. 30.6 ± 12.3 V, p = 0.040) than the group without ulcer. The groups did not differ regarding the mean values of the inflammatory markers. Response to patellae reflex was worse in the group with ulcer (p = 0.047), in which a higher proportion of individuals with abnormal toe-brachial index (p = 0.030) was observed as compared to those without ulcer. We concluded that PAD is associated with the presence of ulcer in neuropathic subjects. The assessment of digital arteries flow in lower limbs (in great toe) contributed to detect such association. Association of diabetic foot ulcers and inflammatory markers was not observed, but cannot be excluded due to limitations of sample size. Prospective studies should examine the sensitivity of the toe-brachial index to identify PAD in diabetic individual at risk of ulceration.

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Choosing a Practical Screening Instrument to Identify Patients at Risk for Diabetic Foot Ulceration

Cited by 367 publications

References 29 publications

Comprehensive Foot Examination and Risk Assessment

Comprehensive Foot Examination and Risk Assessment

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

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