Risk Factors in the Diabetic Foot

Sims, David S; Cavanagh, Peter R.; Ulbrecht, Jan S.

doi:10.1093/ptj/68.12.1887

Cited by 128 publications

(47 citation statements)

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“…Most of them incorporated neuropathy, bony foot deformity, history of ulceration or amputation, or various combinations of these (10,(23)(24)(25)(26)(27)(28)(29). Three of them also included PVD (10,28,29).…”

Section: Results -Ofmentioning

confidence: 99%

Effectiveness of the Diabetic Foot Risk Classification System of the International Working Group on the Diabetic Foot

Peters

Lavery²

2001

Diabetes Care

254

203

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OBJECTIVE—To evaluate the effectiveness of a diabetic foot risk classification system by the International Working Group on the Diabetic Foot to predict clinical outcomes. RESEARCH DESIGN AND METHODS—A total of 225 diabetic patients were initially evaluated as part of a prospective case-control study at the University of Texas Health Science Center at San Antonio. Complete records were available for 213 patients for follow-up evaluation after 29 months. Upon enrollment, subjects were stratified into four risk groups based on the presence of risk factors according to the consensus of the International Working Group on the Diabetic Foot. Group 0 consisted of subjects without neuropathy, group 1 consisted of patients with neuropathy but without deformity or peripheral vascular disease (PVD), group 2 consisted of subjects with neuropathy and deformity or PVD, and group 3 consisted of patients with a history of foot ulceration or a lower-extremity amputation. RESULTS—Upon enrollment, patients in higher-risk groups had longer duration of diabetes, worse glycemic control, vascular and neuropathic variables, and more systemic complications of diabetes. During 3 years of follow-up, ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in groups 0, 1, 2, and 3, respectively (linear-by-linear association, P < 0.001). All amputations were found in Groups 2 and 3 (3.1 and 20.9%, P < 0.001). CONCLUSIONS—The foot risk classification of the International Working Group on the Diabetic Foot predicts ulceration and amputation and can function as a tool to prevent lower-extremity complications of diabetes.

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Section: Results -Ofmentioning

confidence: 99%

Effectiveness of the Diabetic Foot Risk Classification System of the International Working Group on the Diabetic Foot

Peters

Lavery²

2001

Diabetes Care

254

203

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“…Autonomic dysfunction, as is often seen in patients with long-standing diabetes mellitus, can eliminate plantar sweating and result in desiccation of the protective, keratinized outer layer. Fissuring of the skin and associated breakdown of epidermal integrity can lead to localized infection in these patients whose peripheral circulation is already compromised by their autonomic insufficiency (53,56).…”

Section: For Sensate Individualsmentioning

confidence: 99%

Complexities of Foot Architecture as a Base of Support

Saltzman¹,

Nawoczenski²

1995

J Orthop Sports Phys Ther

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The human foot is a unique structure in the animal kingdom, as it is capable of supporting sustained bipedal gait. The foot facilitates upright walking in several ways: 1) load bearing, 2) leverage, 31 shock absorption, 4) balance, and 5) protection. In this article, we discuss the specialized architecture that enables the foot to accomplish these functions. The human foot has five main functions. First, it is a load-bearing structure that can endure substantial vertical and shear forces. Second, its arched structure confers a mechanical advantage to the calf musclespermitting the body to be lifted off the ground and propelled forward. Third, it absorbs and dissipates the shock waves propagated with each step. Fourth, it balances the body and withstands the body's constant tendency to fall. Finally, the foot serves a protective function as a barrier and source of sensory information regarding the external environment.Our understanding of the complexities of foot architecture as a basis of support is still evolving. In the past decade, there has been an e x p b sion of scientific interest regarding foot function. The purpose of this article is to present a current overview of how the human foot s u b serves its essential roles in load bearing, leverage, shock absorption, balance, and protection. LOAD BEARINGThe foot and ankle are exposed to considerable and varying loads. The vertical ground reaction forces during walking exceed body weight. Shear forces in fore-aft and mediallateral directions average 10% of body weight (40,41). Peak compressive forces across the ankle joint a p proximate three to five times body weight during normal stance, and the magnitude of the shear forces in the ankle range from 30 to 70% of body weight during stance (54). The magnitudes of all these forces vary with the speed of gait. In slow walking, these forces lessen, and in rapid walking, they increase (41). Ground reaction forces rise to approximately three times body weight with running (1 3) and up to 16 times body weight with jumping (23).The distribution of pressure un-'der the foot during gait is dependent on the phase of stance. At heel strike, virtually all of the pressure is carried by the medial aspect of the heel. By 15% of the gait cycle, the forefoot shares load bearing with the heel. By 30%, the load has shifted to the metatarsal heads and the toes have begun to participate in weight bearing. The forefoot load reaches a peak around 45% of the walking cycle. By 50%. the center of load begins to sweep medially toward the hallux and second toe, and by 55% of the gait cycle, the load is moving onto the hallux for toe-off (30,31,55).Cavanagh et al have analyzed the peak plantar pressure distributions during normal walking (14). The average peak pressure distributions were distributed 60% in the heel, 8% in the midfoot, 28% in the forefoot, and 4% in the toe region. The medial heel region experienced the largest peak pressure, approximating 2.6 times that of the forefoot. The highest pressure across the ball of the foot occu...

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“…The risk of diabetic foot was determined by a six-point scale: 0 -intact and preserved sensitivity, 1 -loss of plantar protective sensation, 2 -loss of plantar protective sensation and deformity / plantar pressure increase, 3 -loss of plantar protective sensation and previous ulcer history, 4 -loss of plantar protective sensation and previous ulcer history with deformity or increased plantar pressure and 5 -Presence of neuropathic fracture [28], from related to external factors on interview.…”

Section: Figure 1 Study Design Diagrammentioning

confidence: 99%