Instruments of Choice for Assessment and Monitoring Diabetic Foot: A Systematic Review

Fernández-Torres, Raúl; Ruiz-Muñoz, María; Pérez-Panero, Alberto J.; García-Romero, Jerónimo; Gónzalez-Sánchez, Manuel

doi:10.3390/jcm9020602

Cited by 11 publications

(7 citation statements)

References 65 publications

(78 reference statements)

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“…The evaluation of Doppler arterial waveforms, combined with ankle systolic pressure and systolic ankle-brachial index (ABI), are the most common bedside tests to diagnose PAD in diabetic patients. 18 As reported in recent systematic review, 18 the detection of triphasic tibial waveforms has the best performance value for excluding a diagnosis of PAD 17,[19][20][21] ; on the contrary, an abnormal waveform finding (with a variable definition among different studies) has a poor positive predictive value ( Figure 1).…”

Section: Us In Df Risk Screeningmentioning

confidence: 85%

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Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit

Pieruzzi

Napoli

Goretti

et al. 2020

The International Journal of Lower Extremity Wounds

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Ultrasound (US) is a noninvasive and versatile technology that in recent years found acceptance in almost all the medical specialties, with diagnostic and interventional applications. In the diabetic foot syndrome (DFS), US found specific indications mainly in the screening, quantification, and follow-up of the vascular component of the pathology, but also in the study of the deformities and structural modifications induced by neuropathy and in the diagnosis and surgical management of infections, especially those that induce anatomical changes, like abscesses and fasciitis. This review will summarize all these application of US, giving special attention to the vascular aspects, and on the predominant role that US gained in recent times to guide the indication to revascularization, on the new standardized approach to the study of the arterial tree of the limb and the foot, the so-called duplex ultrasound arterial mapping, which significantly increased the utilization of US to plan the revascularizations in this complex pathology. Outside the vascular fields, the diagnosis of neuropathy and infection and the intraoperative use of US in the surgical management of abscesses and fasciitis will be discussed, leaving the last part to the new and interesting applications of US in the management of DFU, a field that is still in evolution, offering new possibilities to the health care professionals involved in the management of these chronic wounds. The variety of applications both in diagnostic and operative fields makes US a rather versatile technology—a toolkit—that should have a special place among those at reach of the specialists of DFS care.

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Section: Us In Df Risk Screeningmentioning

confidence: 85%

Section: Ultrasound In the Ischemic Diabetic Footmentioning

confidence: 99%

Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit

Pieruzzi

Napoli

Goretti

et al. 2020

The International Journal of Lower Extremity Wounds

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“…Therefore, multiphasic screening—where one or more tools for assessing the signs and symptoms of diabetic peripheral neuropathy are used concurrently or sequentially—may detect a greater proportion of deficits, thereby aiding clinical decision-making. Through the multiphasic approach, both small and large nerve fiber function can be evaluated using objective measures of diabetic peripheral neuropathy [ 79 ]. In resource-limited settings, a practical combination of assessments could be focused medical history, Michigan Neuropathy Screening Instrument (MNSI), and a simple point-of-care test such as Neuropad.…”

Section: Resultsmentioning

confidence: 99%

Screening for diabetic peripheral neuropathy in resource-limited settings

Nkonge

2023

Diabetol Metab Syndr

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Background Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. Main body Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. Conclusions Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.

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“…22 In order to standardise the assessment of DFUs, photographs were taken of the affected foot and these were used for grading using previously described methods. 23,24 All three assessors classified all ulcers based on one system and then with the next system. The photographs were taken using both a Silhouette star camera (The SilhouetteStar, Aranz Medical Ltd.) and an iPhone XR (iOS 12.0 software, Apple Inc.).…”

Section: Methodsmentioning

confidence: 99%

Repeatability, Completion Time, and Predictive Ability of Four Diabetes-Related Foot Ulcer Classification Systems

Alahakoon

Fernando

Galappaththy

et al. 2021

J Diabetes Sci Technol

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Introduction: The inter and intra-observer reproducibility of measuring the Wound Ischemia foot Infection (WIfI) score is unknown. The aims of this study were to compare the reproducibility, completion times and ability to predict 30-day amputation of the WIfI, University of Texas Wound Classification System (UTWCS), Site, Ischemia, Neuropathy, Bacterial Infection and Depth (SINBAD) and Wagner classifications systems using photographs of diabetes-related foot ulcers. Methods: Three trained observers independently scored the diabetes-related foot ulcers of 45 participants on two separate occasions using photographs. The inter- and intra-observer reproducibility were calculated using Krippendorff’s α. The completion times were compared with Kruskal-Wallis and Dunn’s post-hoc tests. The ability of the scores to predict 30-day amputation rates were assessed using receiver operator characteristic curves and area under the curves. Results: There was excellent intra-observer agreement (α >0.900) and substantial agreement between observers (α=0.788) in WIfI scoring. There was moderate, substantial, or excellent agreement within the three observers (α>0.599 in all instances except one) and fair or moderate agreement between observers (α of UTWCS=0.306, α of SINBAD=0.516, α of Wagner=0.374) for the other three classification systems. The WIfI score took significantly longer ( P<.001) to complete compared to the other three scores (medians and inter quartile ranges of the WIfI, UTWCS, SINBAD, and Wagner being 1.00 [0.88-1.00], 0.75 [0.50-0.75], 0.50 [0.50-0.50], and 0.25 [0.25-0.50] minutes). None of the classifications were predictive of 30-day amputation ( P>.05 in all instances). Conclusion: The WIfI score can be completed with substantial agreement between trained observers but was not predictive of 30-day amputation.

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Instruments of Choice for Assessment and Monitoring Diabetic Foot: A Systematic Review

Cited by 11 publications

References 65 publications

Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit

Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit

Screening for diabetic peripheral neuropathy in resource-limited settings

Repeatability, Completion Time, and Predictive Ability of Four Diabetes-Related Foot Ulcer Classification Systems

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