Diabetic foot ulcer Foot problems are an important cause of morbidity in diabetes mellitus. vascular and neurologic disease contribute to this problem.

15% of patients with type 1 and type 2 diabetes will develop one or more foot ulcerations in their lifetime

Assessment of risk factors

Diabetic peripheral neuropathyPeripheral vascular diseaseSkin conditionFoot deformityFootware

Facts

Amputation rates are 15 – 40 times higher for diabetic than non-diabetic patients .

Assessment of Risk Factors

Diabetic peripheral neuropathyPeripheral vascular diseaseSkin conditionFoot deformityFootware

DETECTING FEET-AT-RISK

Prior LEAPrior foot ulcerKnown PAD or claudication < 1 blockMajor foot deformitiesPre-ulcer cutaneous pathologyInsensate to 5.07/10g monofilamentPAD

Screening

All patients with diabetes should be screened

at regular intervals to identify those at risk

for foot ulceration

Foot ULCER RISKS

Decrease adherence to self-foot care

Emotional maladaptive responsesDepression, anxietyCognitive dysfunctionDecrease self-foot care

– Can’t see feet (retinopathy)Not access to foot care centers

Visual Inspection

Colour of SkinTrauma/UlcerationCallusSwellingNail deformitiesSigns of pressureGeneral hygiene/self care

FOOT DEFORMITIES

Hammer toesClaw toesProminent metatarsal headsHallux valgusCollapsed plantar arch

Neuropathy

Neuropathy promotes ulcer formation by decreasing pain sensation and perception of pressure, by causing muscle imbalance that can lead to anatomic deformities and by impairing the microcirculation and the integrity of the skin.

Symptom of Neuropathy

What is the sensation felt ? burning, numbness, or tingling (2 points); fatigue, cramping, or

aching (1 point). Maximum is 2 points

What is the location of symptoms ? feet (2 points); calves (1 point); elsewhere (no points). Maximum is 2

points.

Have the symptoms ever awaken you at night ? yes (1 point).

Symptom of Neuropathy

What is the timing of symptoms ? worse at night (2 points); present day

and night (1 points); present only during the day (no points). Maximum is 2 points.

How are symptoms relieved ? walking around (2 points); standing (1

point); sitting or lying or no relief (no points). Maximum is 2 points.

Diabetic symptoms score

0 to 2 — normal

3 to 4 — mild

5 to 6 — moderate

7 to 9 — severe

Neuropathy Sign

What is the Achilles tendon reflex ? absent (2 points for each foot); present with reinforcement (1

point for each foot).

What is the vibration sense ? absent or reduced (1 point for each foot).

What is the pinprick sensation ? absent or reduced (1 point for each foot).

What is the temperature sensation ?

reduced (1 point for each foot).

Neuropathy Sign

0 to 2 — normal

3 to 5 — mild

6 to 8 — moderate

9 to 10 — sever

Neuropathy

Peripheral neuropathy is considered to be present if there are moderate or severe signs (6 or more) even in the absence of symptoms.

Mild signs (3 to 5) in the presence of moderate symptoms.

A neurologic signs score of 8 or more is indicative of a high-risk foot.