Advertisement

Current Diabetes Reports

, Volume 2, Issue 6, pp 477–481 | Cite as

The epidemiology of neuropathic foot ulcers in individuals with diabetes

  • Jay Sosenko
Article

Abstract

There is now substantial evidence that diabetic neuropathy is a major etiologic factor for diabetic foot ulcers. Epidemiologic data show a very strong association between foot ulcers and indicators of sensorimotor neuropathy. Additionally, a causal pathway (sensorimotor neuropathy, which leads to increased pressures at foot surfaces, which then leads to foot ulcers) has been postulated. Evidence suggests that other factors also contribute to foot ulcer risk through an interaction with neuropathy such as foot deformity, footwear, and body weight. There has been an effort to optimize modalities for screening diabetic patients for hypoesthesia in order to prevent foot ulcers; however, there have not been definitive prospective studies that have compared the effectiveness of available tests.

Keywords

Neuropathy Peripheral Vascular Disease Diabetic Neuropathy Diabetic Peripheral Neuropathy Plantar Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Ramsey SD, Newton K, Blough D, et al.: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 1999, 22:382–387. Provides substantial information on the morbidity resulting from foot ulceration.PubMedCrossRefGoogle Scholar
  2. 2.
    Most RS, Sinnock P: The epidemiology of lower extremity amputations in diabetic individuals. Diabetes Care 1983, 6:87–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Nelson RG, Gohdes DM, Everhart JE, et al.: Lower-extremity amputations in NIDDM: 12-yr follow-up study in Pima Indians. Diabetes Care 1988, 11:8–16.PubMedCrossRefGoogle Scholar
  4. 4.
    Adler AI, Boyko EJ, Ahroni JH, Smith DG: Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care 1999, 22:1029–1035. Gives useful epidemiologic data on risk factors for lower-extremity amputation in diabetic patients.PubMedCrossRefGoogle Scholar
  5. 5.
    Boulton AJ, Hardisty CA, Betts RP, et al.: Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care 1983, 6:26–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Boulton AJ, Kubrusly DB, Bowker JH, et al.: Impaired vibratory perception and diabetic foot ulceration. Diabet Med 1986, 3:335–337.PubMedCrossRefGoogle Scholar
  7. 7.
    Sosenko JM, Kato M, Soto R, Bild DE: Comparison of quantitative sensory-threshold measures for their association with foot ulceration in diabetic patients. Diabetes Care 1990, 13:1057–1061.PubMedCrossRefGoogle Scholar
  8. 8.
    Boyko EJ, Ahroni JH, Stensel V, et al.: A prospective study of risk factors for diabetic foot ulcer. the Seattle diabetic foot study. Diabetes Care 1999, 22:1036–1042. Comprehensively examines risk factors for foot ulceration.PubMedCrossRefGoogle Scholar
  9. 9.
    Pham H, Armstrong DG, Harvey C, et al.: Screening techniques to identify people at high risk for diabetic foot ulceration. Diabetes Care 2000, 23:606–611. A prospective study of foot ulceration that uses several different assessments of sensory neuropathy.PubMedCrossRefGoogle Scholar
  10. 10.
    Kastenbauer T, Sauseng S, Sokol G, et al.: A prospective study of predictors for foot ulceration in type 2 diabetes. J Am Podiatr Med Assoc 2001, 91:343–350.PubMedGoogle Scholar
  11. 11.
    Abbott CA, Carrington AL, Ashe H, et al.: The northwest diabetes foot care study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med 2002, 19:377–384. extensive prospective epidemiologic study of risk factors for foot ulceration.PubMedCrossRefGoogle Scholar
  12. 12.
    Veves A, Murray HJ, Young MJ, Boulton AJ: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia 1992, 35:660–663.PubMedCrossRefGoogle Scholar
  13. 13.
    Frykberg RG, Lavery LA, Pham H, et al.: Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care 1997, 21:855–858.Google Scholar
  14. 14.
    Lavery LA, Armstrong DG, Vela SA, et al.: Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med 1998, 158:157–162.PubMedCrossRefGoogle Scholar
  15. 15.
    Ahroni JH, Boyko EJ, Forsberg RC: Clinical correlates of plantar pressure among diabetic veterans. Diabetes Care 1999, 22:965–972. One of the few studies that specifically examines risk factors for increased foot pressures.PubMedCrossRefGoogle Scholar
  16. 16.
    Caselli A, Pham H, Giurini JM, et al.: The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes Care 2002, 25:1066–1071. Examines a possible mechanism for the causation of foot ulcers.PubMedCrossRefGoogle Scholar
  17. 17.
    Mueller MJ, Minor SD, Diamond JE, Blair VPIII: Relationship of foot deformity to ulcer location in patients with diabetes mellitus. Phys Ther 1990, 70:356–362.PubMedGoogle Scholar
  18. 18.
    Ashry HR, Lavery LA, Murdoch DP, et al.: Effectiveness of diabetic insoles to reduce foot pressures. J Foot Ankle Surg 1997, 36:26s8–271.Google Scholar
  19. 19.
    Lavery LA, Vela SA, Fleischli JG, et al.: Reducing plantar pressure in the neuropathic foot. A comparison of footwear. Diabetes Care 1997, 20:1706–1710.PubMedCrossRefGoogle Scholar
  20. 20.
    Reiber GE, Smith DG, Wallace C, et al.: Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA 2002, 287:2552–2558.PubMedCrossRefGoogle Scholar
  21. 21.
    Vela SA, Lavery LA, Armstrong DG, Anaim AA: The effect of increased weight on peak pressures: implications for obesity and diabetic foot pathology. J Foot Ankle Surg 1998, 37:416–420.PubMedCrossRefGoogle Scholar
  22. 22.
    Cavanagh PR, Sims DSJr, Sanders LJ: Body mass is a poor predictor of peak plantar pressure in diabetic men. Diabetes Care 1991, 14:750–755.PubMedCrossRefGoogle Scholar
  23. 23.
    Reiber GE, Vileikyte L, Boyko EJ, et al.: Causal pathways for incidental lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999, 22:157–162.PubMedCrossRefGoogle Scholar
  24. 24.
    Holewski JJ, Stess RM, Graf PM, Grunfeld C: Aesthesiometry: quantification of cutaneous pressure sensation in diabetic peripheral neuropathy. J Rehabil Res Dev 1988, 25:1–10.PubMedGoogle Scholar
  25. 25.
    Kumar S, Fernando DJS, Veves A, et al.: Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk for foot ulceration. Diabetes Res Clin Pract 1991, 13:63–67.PubMedCrossRefGoogle Scholar
  26. 26.
    Rith-Najarian SJ, Stolusky T, Gohdes DM: Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. Diabetes Care 1992, 15:1386–1389.PubMedCrossRefGoogle Scholar
  27. 27.
    Birke JA, Sims DS: Plantar sensory threshold in the ulcerative foot. Lepr Rev 1986, 57:261–267.PubMedGoogle Scholar
  28. 28.
    Sosenko JM, Gadia MT, Norihiko N, et al.: Neurofunctional testing for the detection of diabetic peripheral neuropathy. Arch Intern Med 1987, 147:1741–1744.PubMedCrossRefGoogle Scholar
  29. 29.
    American Diabetes Association: Preventive foot care in people with diabetes (position statement). Diabetes Care 2002, 25(suppl 1):S69-S70.Google Scholar

Copyright information

© Current Science Inc. 2002

Authors and Affiliations

  • Jay Sosenko
    • 1
  1. 1.University of MiamiSchool of MedicineMiamiUSA

Personalised recommendations