Manufactured Shoes in the Prevention of Diabetic Foot Ulcers

Uccioli, Luigi; Faglia, Ezio; Monticone, Giovanna; Favales, Fabrizio; Durola, Laura; Aldeghi, Antonio; Quarantiello, Antonella; Calia, Patrizia; Menzinger, G.

doi:10.2337/diacare.18.10.1376

Cited by 299 publications

(241 citation statements)

References 9 publications

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“…Estudos apontam que os pontos de alta pressão, calosidades, deformidades nos pés, amputação de dedos, ou mesmo transmetatarsianos, são problemas que podem ser corrigidos com calçados confortáveis ou confeccionados sob medida, coadjuvados com palmilhas (9,(20)(21)25,30,34,37,46) . Estudo prospectivo, realizado em hospital de ensino para avaliar pessoas com diabetes de alto risco, identificou menor recorrência de ulcerações no grupo que havia recebido calçados especialmente confeccionados (55) . Um outro estudo mostrou, também, menor recorrência de úlceras e amputações entre aqueles que usaram calçados terapêuticos e receberam intenso treinamento Pé diabético: estratégias para prevenção educativo (9) .…”

Section: Avaliação Dos Pés E Prevenção De Complicaçõesunclassified

Pé diabético: estratégias para prevenção

Ochoa-Vigo

Pace

2005

Acta paul. enferm.

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Ochoa-Vigo K, Pace AE. Pé diabético: estratégias para prevenção. Acta Paul Enferm 2005; 18(1):100-9.RESUMO: Aproximadamente 50% das amputações não-traumáticas em membros inferiores ocorrem entre pessoas com diabetes. As amputações são precedidas por úlceras, caracterizadas por lesões cutâneas, com perda do epitélio, que podem estender-se até a derme ou chegar a tecidos profundos. As úlceras, geralmente, são acompanhadas de insensibilidade por neuropatia periférica crônica e associadas a pequenos traumas que se originam do uso de calçados inapropriados, dermatoses comuns ou manipulações incorretas dos pés. O objetivo deste estudo é descrever as principais estratégias para avaliar fatores de risco que conduzem ao desenvolvimento de complicações nos membros inferiores entre pessoas com diabetes, bem como considerá-las uma responsabilidade da equipe de assistência primária. É um trabalho de revisão da literatura, com ênfase na avaliação dos pés como medida preventiva fundamental, para identificar, precocemente, as alterações neurológica e vascular periféricas e disfunções biomecânicas. Destaca-se a avaliação dos calçados como fator externo.

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Section: Avaliação Dos Pés E Prevenção De Complicaçõesunclassified

Pé diabético: estratégias para prevenção

Ochoa-Vigo

Pace

2005

Acta paul. enferm.

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“…88 To minimize the risk of trauma, patients should be counseled to avoid walking barefoot, and those with neuropathy should avoid high-impact exercise and should test the temperature of hot water before use. A number of drugs are currently under investigation for the treatment of diabetic neuropathy, including aldose reductase inhibitors (ARIs), which block the conversion of glucose to sorbitol and nerve growth factors.…”

Section: Neuropathy and Foot Carementioning

confidence: 99%

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

et al. 1997

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PURPOSE:To summarize current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of prevention, screening, and treatment, all of which are focused on office practice. METHODS:Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search. MAIN RESULTS:An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. ype II diabetes is a common condition, affecting 2% to 3% of the adult population, and up to 20% to 25% of the elderly population. 1 Type II diabetes typically occurs in patients who are over 30 years old and weigh more than 120% of ideal body weight, and accounts for 90% of all cases of diabetes mellitus diagnosed in the United States. 1 Minorities have a prevalence of type II diabetes mellitus that is 2 to 6 times greater than that of white persons. The morbidity and mortality are higher for minorities than for white persons, and the rate is increasing. 2 The reasons for this disparity remain unclear, but could include differences in disease severity, comorbidities, or access to care.Diabetes has significant associated morbidity. Prevention and treatment of the complications of diabetes mellitus have the potential to improve quality of life and increase life expectancy. 3 The rate of cardiovascular disease is markedly elevated among patients with type II diabetes, leading to an increased mortality rate compared with the general population. 4,5 In addition, microvascular complications, which include retinopathy, nephropathy, and neuropathy, can progress to end-stage outcomes such as blindness, end-stage renal disease (ESRD), and amputation. Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. 9-11 Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice. METHODSA multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest ...

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“…[14]. While the role of specific shoes has been proven in secondary prevention with a significant reduction of relapses in the group treated by therapeutic shoes and customized orthesis [15], its role in primary prevention is still not definitively proven.…”

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confidence: 99%

Prevention of diabetic foot ulceration: new evidences for an old problem

Uccioli

2013

Endocrine

Self Cite

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Diabetic patients have a 15 % lifetime risk of developing a foot ulcer and have a 15 % risk of developing a lower extremity amputation. Amputation is preceded by nonhealing foot wounds in 85 % of cases [1]. The ulcerated diabetic foot may be considered the complication of the peripheral neuropathy (PN) and/or peripheral arterial disease (PAD).Several studies showed that diabetic patients with PN are at risk of foot ulceration and indeed true neuropathic ulceration is found in almost 50 % of the patients with a new foot ulcer according to eurodiale [2]. Those with PAD are at risk of foot amputation and ischemic lesions are found in the other 50 % of patients with foot ulceration. However true ischemic ulcers are observed only in 15 % of cases. The remaining 35 % have both PAD and PN present at the same time: neuroischemic ulcers [2].Many factors may be responsible of the appearance of an ulcer in those patients: intrinsic factors related to the progressive appearance of limited joint mobility, soft tissue stiffness, early and persistent windlass mechanism [3] presence of structural foot deformities as hammer toes, hallux valgus or pes cavus. Metatarsal heads are prominent. This results in increased pressure underneath the metatarsal heads, which will make the plantar forefoot more susceptible to breakdown, also because patients are unaware of this abnormal pressure because of the neuropathy.However, there are also other contributing factors leading to diabetic foot ulcer formation, such as arterial occlusive disease, foot trauma, history of previous amputations, and callus due to the increased plantar pressures caused by abnormal mechanical loading of the foot [4]. A sequence of events has been described in the chain of events that bring to a new foot ulceration: neuropathy is the predisposing condition, trauma is the precipitating factor [5].While neuropathic ulcer may spontaneously heal whenever the offloading is guaranteed, the ischemic one has no chance to heal unless a revascularization, either traditional but even better with peripheral angioplasty [6].A recent study showed that male gender and PN are predictors of diabetic ulcers and amputation, and according to the literature there is an increasing risk of amputation in those patients with both PN and PAD [7].Prevention starts selecting the patients at risk. Very simple tests may be applied. PN may be highlighted by semiquantitative tests such as monofilaments. Different protocol may be utilized with 3-10 points to test, and according to the number of insensitive points the patient is defined as neuropathic or not [8].Another method commonly utilized is the definition of the vibratory perception threshold. In this case, values more than 25 indicate the presence of PN with an increased risk of foot ulceration [9]. Patients with PAD are categorized by using the ankle brachial index (ABI); values \0.9 indicate the presence of PAD with an increased level of gravity when values \0.5 are recorded (critical limb ischemia) [10].Once defined the presence of PN, PA...

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Manufactured Shoes in the Prevention of Diabetic Foot Ulcers

Abstract: The use of specially designed shoes is effective in preventing relapses in diabetic patients with previous ulceration.

Cited by 299 publications

References 9 publications

Pé diabético: estratégias para prevenção

Pé diabético: estratégias para prevenção

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

Prevention of diabetic foot ulceration: new evidences for an old problem

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