Exploring Diabetic Foot Exam Performance in a Specialty Clinic

2016 ◽  
Vol 26 (1) ◽  
pp. 82-92 ◽  
Author(s):  
Jesse Pocuis ◽  
Sam Man-Hoi Li ◽  
Mary M. Janci ◽  
Hilaire J. Thompson
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Exam Performance ◽  
Specialty Clinic ◽  
Foot Complications ◽  
Improve Compliance ◽  
And Performance ◽  
Self Examination ◽  
Record Review

Detection of diabetic foot complications is key to amputation prevention. This study used survey and retrospective record review to examine the relationship between frequency and performance of clinician’s diabetic foot examinations on performance of patient home self-foot examinations. An additional aim was to assess clinician performance of annual foot examination per American Diabetes Association (ADA) guidelines in a specialty clinic. The relationships between demographic characteristics, diabetic foot ulcer beliefs, health literacy, HbA1c level, and foot self-exam performance was also examined. No relationship was found between the performance frequency of foot examinations by providers and patient self-examination ( N = 88). The presence of specific barriers to self-management was significantly higher in those patients who did not complete daily home self-foot examinations. Only 16% of patients’ charts reviewed met the ADA criteria for a complete annual foot exam. Motivational interviewing during patient visits could be a strategy to break down barriers to self-foot exam performance. Furthermore, the development of an Electronic Medical Record (EMR)–based diabetic foot exam template to improve provider documentation may improve compliance with ADA recommendations.

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

scholarly journals Prevention and treatment of diabetic foot ulcers

2017 ◽  
Vol 110 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Jonathan Zhang Ming Lim ◽  
Natasha Su Lynn Ng ◽  
Cecil Thomas
Keyword(s):  
Diabetic Foot ◽  
Healthcare Access ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Care ◽  
Healthcare Provision ◽  
Foot Complications

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

Management of Diabetic Foot Ulcer by Nishadi Yoga Avachoornana - A Case Study

2017 ◽  
Vol 2 (06) ◽  
Author(s):  
Chiranth Kumar R. ◽  
Syeda Ather Fathima
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Life Style ◽  
Genetic Factor ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Complications ◽  
Scientific Approach

Diabetes is considered as ‘ice burg’ of diseases as only 1/3rd of its manifestations can be made out clinically, though the exact cause is not known following are the theories put forth to explain diabetes mellitus - Genetic factor, Life style disorder, Autoimmune cause. Slight injury to glucose laden tissue will cause infection which is precipitated by an ulcer and it tends to a state of non - healing. Main stay of treatment includes antibiotics, debridement, local wound care. Inspite of these treatments there is less reduction in the statistics of diabetic foot complications and amputations. In Sushrutha Samhitha we get the most scientific approach for the management of Vrana, where Sushrutha has mentioned 60 Upakrama’s (modalities of treatment) of which Avachoornana (dusting) is one modality, seen to be effective in the management of diabetic non healing ulcers (Madhu Mehaja Dusta Vrana).

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

scholarly journals Diabetic Foot Infection Impostors

2016 ◽  
Vol 3 (2) ◽  
pp. 88-91
Author(s):  
Radhika Jindal ◽  
Subhash K Wangnoo ◽  
Mohammad A Siddiqui
Keyword(s):  
Diabetic Foot ◽  
Erythema Nodosum ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Venous Ulcer ◽  
Asia Pacific ◽  
Thromboangiitis Obliterans ◽  
Therapeutic Approaches ◽  
Diabetic Foot Infection ◽  
Foot Complications

ABSTRACT Diabetic foot complications continue to be the main reason for diabetes-related hospitalization and lower extremity amputations. Most can be cured if managed properly. But improper diagnostic and therapeutic approaches result in many patients needlessly undergoing amputations. There are many other conditions “imposing” as a diabetic foot, which may mislead the diagnosis and management. One should be aware of these conditions and keep a watchful eye for them as well in a diabetic patient. Every ulcer in a diabetic need not be a diabetic foot ulcer. Some of these diabetic foot infection imposters are discussed herewith and these include pyoderma gangrenosum, squamous cell carcinoma in a chronic ulcer, venous ulcer, bullosis diabeticorum, necrobiosis lipoidica diabeticorum, malignant melanoma, thromboangiitis obliterans (TAO), superficial thrombophlebitis, erythema nodosum, and granuloma annulare. How to cite this article Wangnoo SK, Jindal R, Siddiqui MA. Diabetic Foot Infection Impostors. J Foot Ankle Surg (Asia- Pacific) 2016;3(2):88-91.

Quality of Life with Diabetes-associated Foot Complications: Comparison Between Lower-limb Amputation and Chronic Foot Ulceration

2008 ◽  
Vol 29 (11) ◽  
pp. 1074-1078 ◽  
Author(s):  
David Boutoille ◽  
Alexis Féraille ◽  
Dominique Maulaz ◽  
Michel Krempf
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Foot Complications ◽  
Sf 36 ◽  
Physical Limitations

Background: Diabetic foot complications result in huge costs for both society and individual patients. Because our team performs numerous amputations each year for complicated diabetic foot ulcers, we conducted a study comparing the quality of life of diabetic amputees with a non-amputee group experiencing a diabetic foot ulcer. The aim of this study was to get better comprehension of the influence of amputation on physical and social aspects of our patients' quality of life. Materials and Methods: This study evaluated the influence of amputation for a diabetic foot ulcer on quality of life. We compared patients having experienced an amputation for a diabetic foot ulcer at least 1 year before the study, and outpatients experiencing regular visits for a current foot ulcer with no previous history of amputation. Quality of life was reported using the Medical Outcome Study Short Form 36 item health survey (MOS SF-36). Results: Most of the chronic ulcers were neuroischemic (8/9). Except for the bodily pain, which was significantly higher in the ulcer group, no difference was found between the amputee and the ulceration-group, when considering the different items of the MOS-SF 36 scales. The ulceration-group had significantly more physical limitations and pain than the toe-or-transmetatarsal-amputation-group, whereas physical limitations were identical between the transtibial-amputation-group and the ulceration-group. Median scores were quite low in both groups, reflecting strong social and psychological consequences of diabetic foot ulcers. Global prognosis was bad with 56% of the amputees having experienced another major cardiovascular event within 20 months after amputation. Conclusion: Better understanding of the consequences of diabetic foot complications is important for the general population and especially general practitioners. Psychological evaluation and support is important before and after amputation since it is a traumatic step for patients. Level of Evidence: III, Retrospective Case Control Study

Diabetic Foot Complications Despite Successful Pancreas Transplantation

2017 ◽  
Vol 38 (6) ◽  
pp. 656-661 ◽  
Author(s):  
Dong-Kyo Seo ◽  
Ho Seong Lee ◽  
Jungu Park ◽  
Chang Hyun Ryu ◽  
Duck Jong Han ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Pancreas Transplantation ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot And Ankle ◽  
Charcot Arthropathy ◽  
Level Of Evidence ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Normal Glucose Level

Background: It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal glucose level without insulin and reduces diabetes-related complications. However, we have little information about the foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation. Methods: This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and duration of foot and ankle complications were assessed. Results: Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and 7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77) months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group ( P = .02). Conclusion: Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes. Level of Evidence: Level III, comparative study

STUDY OF SURGICAL MANAGEMENT AND COMPLICATIONS OF DIABETIC FOOT ULCER

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Dr. Devi Das Verma ◽  
Dr. Anil Kumar Saxena
Keyword(s):  
Health Problem ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
World Health ◽  
Foot Ulcers ◽  
Age Group ◽  
Major Health Problem ◽  
Split Skin Grafting ◽  
Foot Problems

Introduction:  Diabetes is one of the most prevalent metabolic chronic diseases due to the imbalance production of insulin. One of the studies reported that in 2010 worldwide 285 million adults had diabetes and this figure may be increase to 439 million by the year 2030. Globally Diabetic foot ulcers (DFUs) constitute major health problem in people that significantly contribute to morbidity and mortality in diabetes patients. Approximate 1.0% to 4.1% of the annual population-based incidences of a diabetic foot ulcer (DFU) were reported. Due to this the lifetime may be as high as 25%. In Asian countries diabetic foot ulcer are major problems which are different from European countries or developing countries.  From many studies reported diabetic foot problems in India are infectious and neuropathic in nature as compared to developed countries. According to World Health Organization (WHO) diabetic foot is defined as lower limb of a diabetic patient characterized by infection, potential risk of pathologic consequences ulceration or destruction of deep tissues associated with neurological abnormalities, various changes in peripheral neuropathy vasculopathy and superimposed infection that are mainly responsible foot ulceration. Ulcers are one kind of abscess which is difficult to treat because of poor wound healing that result from a combination of neuropathy, ischemia and hyperglycemia.  Aim: The main objective was to study the outcome of treatment modalities and it’s relating factors to complication in diabetic foot ulcer.  Material and method:  Total 60 diabetic foot ulcer patients with the age range from 20 to 70 years were included.  From all the patients’ detailed past and present history were recorded.  For all the patients, general, physical and local and systemic examinations were also done. Detail   laboratory examination like Fasting and Post Prandial Blood sugar levels, blood count, ECG, ESR, complete urine examination for the presence of ketone bodies and sugar, x-ray as well as culture and sensitivity of the discharge from ulcer were also done. Patients were treated with various treatment methods like conservative treatment, split skin grafting and amputation. Result: In this study male patients were more in proportion as compared to female. This study showed that maximum with the age group 14 -50 (43.3%) years old followed by 18.3% in 31-40 years old, 16.7% in 61-70 years old.  6.7% showed the least age group as 20 -30 years old.  Out of total 60 patients, 38.3% of the patients showed diabetic ulcer foot which was more whereas 15% showed diabetic gangrene foot which was least. 25% showed diabetic cellulites foot and 21.7% showed as diabetic abscess foot.  Conclusion: Globally as diabetes mellitus cases are increasing and it became rapidly the public health problem. This may be due to burden on economy, health system and on society to manage the diabetic foot problems. Diabetic foot management guidelines must be made into our practice protocols which may preventing limb loss, and decrease mortality and increase the quality of life of the patient. Hence for this it is only possible with the help of foot care education and health care workers.  Hence, foot infection is to put first and care for it like hands. Keywords: Diabetes, foot ulcers, infections, amputations.

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