Comprehensive Foot Examination and Risk Assessment

Boulton, Andrew J.M.; Armstrong, David G.; Albert, Stephen F.; Frykberg, Robert G.; Hellman, Richard; Kirkman, M. Sue; Lavery, Lawrence A.; LeMaster, Joseph W.; Mills, Joseph L.; Mueller, Michael J.; Sheehan, Peter; Wukich, Dane K.

doi:10.2337/dc08-9021

Cited by 737 publications

(532 citation statements)

References 25 publications

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“…DN, diabetic neuropathy; O, present in the original stratification; R, present in the revised stratification Apelqvist et al [9,14] Peters et al [19] Lavery et al [20] SIGN [6] Leese et al [21] Mayfield et al [22,23] Boulton et al [11,12] as related to foot ulcer development (namely diabetic neuropathy, PVD, foot deformity, and foot ulcer or amputation history) and anyone presenting with any of these conditions was considered to be at high risk [22,23]. In 2008, a modification was proposed.…”

Section: Foot Ulcer Risk Stratification Systems: Data Synthesismentioning

confidence: 99%

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Risk stratification systems for diabetic foot ulcers: a systematic review

et al. 2011

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Aims/hypothesis Several risk stratification systems have been proposed for predicting development of diabetic foot ulcer. However, little has been published that assesses their similarities and disparities, diagnostic accuracy and evidence level. Consequently, we conducted a systematic review of the existing stratification systems. Methods We searched the MEDLINE database for studies (published until April 2010) describing the creation and validation of risk stratification systems for prediction of diabetic foot ulcer development. Results We included 13 studies describing or evaluating the following different risk degree stratification systems: University of Texas; International Working Group on Diabetic Foot; Scottish Intercollegiate Guideline Network (SIGN); American Diabetes Association; and Boyko and colleagues. We confirmed that five variables were included in almost all the systems: diabetic neuropathy, peripheral vascular disease, foot deformity, and previous foot ulcer and amputation. The number of variables included ranged from four to eight and the number of risk groups from two to six. Only four studies reported or allowed the calculation of diagnostic accuracy measures. The SIGN system showed some higher diagnostic accuracy values, particularly positive likelihood ratio, while predictive ability was confirmed through external validation only in the system of Boyko et al. Conclusions/interpretation Foot ulcer risk stratification systems are a much needed tool for screening patients with diabetes. The core variables of various systems are very similar, but the number of included variables in each model and risk groups varied greatly. Overall, the quality of evidence for these systems is low, as little validation of their predictive ability has been done.

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Section: Foot Ulcer Risk Stratification Systems: Data Synthesismentioning

confidence: 99%

“…Therefore, it is crucial to define a standardised and efficient approach to prevention of foot ulceration and consequently amputation [2]. The first step should be the correct identification of degree of risk for foot ulceration in all patients [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Risk stratification systems for diabetic foot ulcers: a systematic review

et al. 2011

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“…This exam should consist of a complete foot inspection including assessment of foot structure and deformity, skin temperature and integrity, the presence of ulcers, vascular status, presence of pedal pulses, and toe and foot amputations ( Grade B; BEL 2 ). For a complete discussion of diabetic foot assessment, refer to the American Diabetes Association (ADA) Foot Care Task Force report, which has been endorsed by the AACE (32). Neurologic testing may include assessment of sensation using 1- and 10-g monofilaments; vibration perception using a 128-Hz tuning fork; ankle reflexes; and touch, pinprick, and warm and cold thermal sensations ( Grade B; BEL 2 ).…”

Section: Executive Summarymentioning

confidence: 99%

American Association of Clinical Endocrinologists and American College of Endocrinology – Clinical Practice Guidelines for Developing A Diabetes Mellitus Comprehensive Care Plan – 2015 — Executive Summary

et al. 2015

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“…This would include a detailed examination of the lower extremity in regard to the cardiovascular, neurological, dermatological, and musculoskeletal systems. This examination has been codified as part of the American Diabetes Association Comprehensive Diabetic Foot Examination [25]. It was further pared down to a basic ‘three-minute foot exam’ for family physicians, nurses, and technicians [11,26–28].…”

Section: Step Four: Screening Clinicsmentioning

confidence: 99%

Building a scalable diabetic limb preservation program: four steps to success

Khan

Shin

Woelfel

et al. 2018

Diabetic Foot & Ankle

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Over the past generation, limb preservation programs and diabetic foot services have begun to proliferate within academic health science centers as well as within health-care systems in general. We describe four key components for a successful program that, developed sequentially with temporal overlap, can allow the program to scale. The first component includes establishment of a ‘hot foot line’ for urgent emergency department/inpatient referral. The second includes development of a wound-healing clinic to address outpatient care through to remission. The third component focuses on the diabetic foot in remission to maximize ulcer-free days following healing. The fourth and final component focuses on implementation of local and widespread screening clinics to identify and triage patients into appropriate therapeutic and surveillance programs for healing, remission, and primary prevention. Along with developing each of these components, we describe discrete methods to quantify success.

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Comprehensive Foot Examination and Risk Assessment

Cited by 737 publications

References 25 publications

Risk stratification systems for diabetic foot ulcers: a systematic review

Risk stratification systems for diabetic foot ulcers: a systematic review

American Association of Clinical Endocrinologists and American College of Endocrinology – Clinical Practice Guidelines for Developing A Diabetes Mellitus Comprehensive Care Plan – 2015 — Executive Summary

Building a scalable diabetic limb preservation program: four steps to success

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