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Abstract
Diabetic foot ulcers are one of the main complications of diabetes and frequently lead to amputation of the lower extremities. All patients with diabetes should be screened annually to establish their risk of foot ulceration. While foot ulcers affect almost 5% of the patients with diabetes, the cumulative lifetime incidence may be as high as 15%. The development of a foot ulcer usually result from a combination of neuropathy and tissue ischemia caused by peripheral artery disease. Other factors have been identified such as repetitive pressure loading on insensitive feet, previous foot ulcer or amputation of the other leg and poor glycemic control. An understanding of the risk factors for diabetic foot ulcer permits identification of individuals at high risk and prompt management is essential to prevent the development of a foot ulcer. Further studies are needed to establish the independent risk factors associated with diabetic foot ulceration.
REFERENCES
1. Adler A. Risk factors for diabetic neuropathy and foot ulceration. Curr Diab Rep. 2001; 1:202–7.
2. Boulton AJ. The diabetic foot: from art to science. The 18th Camillo Golgi lecture. Diabetologia. 2004; 47:1343–53.
3. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293:217–28.
4. Macgilchrist C, Paul L, Ellis BM, Howe TE, Kennon B, Godwin J. Lower-limb risk factors for falls in people with diabetes mellitus. Diabet Med. 2010; 27:162–8.
5. Abrao L, Chagas JK, Schmid H. Periodontal disease and risk for neuropathic foot ulceration in type 2 diabetes. Diabetes Res Clin Pract. 2010; 90:34–9.
6. Wu SC, Driver VR, Wrobel JS, Armstrong DG. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007; 3:65–76.
7. Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes Care. 1999; 22:1036–42.
8. Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy. Results of the Seattle Prospective Diabetic Foot Study. Diabetes Care. 1997; 20:1162–7.
9. McNeely MJ, Boyko EJ, Ahroni JH, Stensel VL, Reiber GE, Smith DG, Pecoraro RF. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. How great are the risks? Diabetes Care. 1995; 18:216–9.
10. Crawford F, McCowan C, Dimitrov BD, Woodburn J, Wylie GH, Booth E, Leese GP, Bekker HL, Kleijnen J, Fahey T. The risk of foot ulceration in people with diabetes screened in community settings: findings from a cohort study. QJM. 2011; 104:403–10.
11. Vamos EP, Bottle A, Majeed A, Millett C. Trends in lower extremity amputations in people with and without diabetes in England, 1996-2005. Diabetes Res Clin Pract. 2010; 87:275–82.
12. Jeffcoate WJ. Stratification of foot risk predicts the incidence of new foot disease, but do we yet know that the adoption of routine screening reduces it? Diabetologia. 2011; 54:991–3.
13. Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, Hann AW, Hussein A, Jackson N, Johnson KE, Ryder CH, Torkington R, Van Ross ER, Whalley AM, Widdows P, Williamson S, Boulton AJ. North-West Diabetes Foot Care Study. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002; 19:377–84.
14. Altenburg N, Joraschky P, Barthel A, Bittner A, Pöhlmann K, Rietzsch H, Fischer S, Mennicken G, Koehler C, Bornstein SR. Alcohol consumption and other psycho-social conditions as important factors in the development of diabetic foot ulcers. Diabet Med. 2011; 28:168–74.
Table 1.
Factors increasing risk of diabetic foot ulceration
Table 2.
3-year risk of foot ulcer and amputation
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