Diabetic foot: Difference between revisions
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{{Diabetes mellitus }} | {{Diabetes mellitus }} | ||
{{CMG}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}} | {{CMG}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}} | ||
==Diabetic Foot Physical Examination== | ==Diabetic Foot Physical Examination== | ||
Revision as of 17:35, 25 February 2013
For patient information, click here
| Diabetic foot | |
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| Diabetic Foot Infection: Cellulitis and gangrene. (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA) |
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Diabetic foot Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Diabetic foot On the Web |
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American Roentgen Ray Society Images of Diabetic foot |
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Diabetes mellitus Main page |
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Patient Information |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Afsaneh Morteza, MD-MPH [2] Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [3]; Cafer Zorkun, M.D., Ph.D. [4]
Diabetic Foot Physical Examination
Inspection
- Dilated veins
- Scar, Sinuses
- Shiny skin
- Hair distribution
- Areas of Pigmentation
- Areas of discolouration
- Varicose vein
- Ulcers
- Brittle or broken nail
- Fungal infection
Palpation
- Temperature (increase temperature- deep vein thrombosis, decrease temperature-ischemia)
- Tenderness (squeeze calf muscle and achilles tendon for tenderness)
- Pulsation- Dorsalis pedis
- Capillary filling time
- Ulcers in pressure areas like ball of great toe, base of fifth metatarsal, posterior aspect of heel
Motor Examination
- Nutrition/Bulk
- Tone
- Power
- Reflexes
Sensory
- Vibration
- Joint position sense
Video: Physical Examination Diabetes
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Video: Diabetic Foot Care
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Image: Diabetic Foot Ulcer
Treatment
Foot ulcers in diabetes require multidisciplinary assessment, usually by diabetes specialists and surgeons. Treatment consists of appropriate bandages, antibiotics (against staphylococcus, streptococcus and anaerobe strains), debridement and arterial revascularisation. It is often 500 mg to 1000 mg of flucloxacillin, 1 g of amoxicillin and also metronidazole to tackle the putrid smelling bacteria. Specialists are investigating the role of nitric oxide in diabetic wound healing. Nitric oxide is a powerful vasodilator, which helps to bring nutrients to the oxygen deficient wound beds. Specialists are using forms of light therapy such as LLLT to treat diabetic ulcers.
Prevention
Foot ulcers can be prevented by is by frequent physical examinations, good foot hygiene, diabetic socks and shoes, and by avoiding injury.
- Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions [1].
- Footwear; all major reviews recommend special footwear for patients with a prior ulcer or with foot deformities. One review added neuropathy as an indication for special footwear. The comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear.
Clinical Trials
Clinical Evidence reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customized shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option" [2].
National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided [3]
A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes" [4]. However, the meta-analysis was published before the major trial that is in the table below.
The major randomized controlled trial of specialized footwear show no benefit in patients with a prior foot ulceration (see table below).[5] A prior, smaller, non-randomized trial that showed benefit of custom foot wear in patients with a prior foot ulceration.[6]. In this trial, the number needed to treat was 4 patients.
| Trial | Patients | Intervention | Comparison | Outcome | Results | Comment | |
|---|---|---|---|---|---|---|---|
| Intervention | Control | ||||||
| Litzelman[1] 1993 |
395 patients • general medicine practice |
Patient and provider education | Usual care | • Any foot lesion • Serious foot lesions at one year |
Not reported | • 11% • 2.9% |
• Insignificant • Significant reduction |
| Lincoln[8] 2008 |
172 patients • Prior ulceration • specialist clinic |
Targeted, one-to-one education | Usual care | Re-ulceration at • 1 year 2 years |
• 30% • 41% |
• 20% • 41% |
• Insignificant • Insignificant |
| McCabe[7] 1998 |
2002 patients • high-risk • general diabetic clinic |
Screening and referral to foot-care clinic if they had prior ulcer, had low ankle–brachial index (<0.75), or had foot deformities | Usual care | • Ulceration within 2 years • Amputation rates |
• 2% • 0.1% |
4% 1.2% |
• Insignificant • Significant |
| Reiber[5] 2002 |
400 patients • Prior ulceration • Excluded severe deformity |
Therapeutic shoes | Usual footwear | Re-ulceration | 15% | 17% | Insignificant difference |
External Links
- Diabetic Foot Research Page at the Center for Lower Extremity Ambulatory Research; for Professionals and Patients
- Imaging of the Diabetic Foot and Its Complications
- Assessing The Potential of Nitric Oxide in the Diabetic Foot
- Maggot Therapy Project
References
- ↑ 1.0 1.1 1.2 Litzelman D, Slemenda C, Langefeld C, Hays L, Welch M, Bild D, Ford E, Vinicor F (1993). "Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial". Ann Intern Med. 119 (1): 36–41. PMID 8498761.
- ↑ Hunt D. "Foot ulcers and amputations in diabetes". Clin Evid: 455–62. PMID 16620415. Text " based on September 2005 search" ignored (help)
- ↑ "Scope: Management of type 2 diabetes: prevention and management of foot problems (update)" (PDF). Clinical Guidelines and Evidence Review for Type 2 Diabetes: Prevention and Management of Foot Problems. National Institute for Health and Clinical Excellence. 20 February 2003. Retrieved 2007-12-04.
- ↑ Spencer S. "Pressure relieving interventions for preventing and treating diabetic foot ulcers". Cochrane Database Syst Rev: CD002302. doi:10.1002/14651858.CD002302. PMID 10908550.
- ↑ 5.0 5.1 5.2 Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C; et al. (2002). "Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial". JAMA. 287 (19): 2552–8. PMID 12020336.
- ↑ Uccioli L, Faglia E, Monticone G, Favales F, Durola L, Aldeghi A, Quarantiello A, Calia P, Menzinger G (1995). "Manufactured shoes in the prevention of diabetic foot ulcers". Diabetes Care. 18 (10): 1376–8. PMID 8721941.
- ↑ 7.0 7.1 McCabe CJ, Stevenson RC, Dolan AM (1998). "Evaluation of a diabetic foot screening and protection programme". Diabet Med. 15 (1): 80–4. doi:10.1002/(SICI)1096-9136(199801)15:1<80::AID-DIA517>3.0.CO;2-K. PMID 9472868.
- ↑ 8.0 8.1 Lincoln NB, Radford KA, Game FL, Jeffcoate WJ (2008). "Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial". Diabetologia. 51 (11): 1954–61. doi:10.1007/s00125-008-1110-0. PMID 18758747.
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