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Diagnostic Pathways

  • Dirk Hochlenert
  • Gerald Engels
  • Stephan Morbach
  • Stefanie Schliwa
  • Frances L. Game
Chapter

Abstract

This chapter describes the steps involved in recording the patient’s medical history and performing a physical examination. The order is based on possible procedures for an initial consultation. It focuses firstly on building trust as a necessary basis for good communication and secondly on systematically identifying the causes of DFS.

References

  1. 1.
    Brand P, Yancey P. The gift of pain. Michigan: Zondervan; 1994.Google Scholar
  2. 2.
    Ali Z, Carroll M, Robertson KP, Fowler CJ. The extent of small fibre sensory neuropathy in diabetics with plantar foot ulceration. J Neurol Neurosurg Psychiatry. 1989;52(1):94–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hoitsma E, Reulen JP, de Baets M, Drent M, Spaans F, Faber CG. Small fiber neuropathy: a common and important clinical disorder. J Neurol Sci. 2004;227(1):119–30.  https://doi.org/10.1016/j.jns.2004.08.012.CrossRefPubMedGoogle Scholar
  4. 4.
    Liniger C, Albeanu A, Bloise D, Assal JP. The tuning fork revisited. Diabet Med. 1990;7(10):859–64.CrossRefPubMedGoogle Scholar
  5. 5.
    Meijer JW, Smit AJ, Lefrandt JD, van der Hoeven JH, Hoogenberg K, Links TP. Back to basics in diagnosing diabetic polyneuropathy with the tuning fork! Diabetes Care. 2005;28(9):2201–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Thivolet C, el Farkh J, Petiot A, Simonet C, Tourniaire J. Measuring vibration sensations with graduated tuning fork. Simple and reliable means to detect diabetic patients at risk of neuropathic foot ulceration. Diabetes Care. 1990;13(10):1077–80.CrossRefPubMedGoogle Scholar
  7. 7.
    Mueller MJ. Identifying patients with diabetes mellitus who are at risk for lower-extremity complications: use of Semmes-Weinstein monofilaments. Phys Ther. 1996;76(1):68–71.CrossRefPubMedGoogle Scholar
  8. 8.
    Chantelau EA. Nociception at the diabetic foot, an uncharted territory. World J Diabetes. 2015;6(3):391–402.  https://doi.org/10.4239/wjd.v6.i3.391.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36(2):150–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Yang Z, Chen R, Zhang Y, Huang Y, Hong T, Sun F, Ji L, Zhan S. Scoring systems to screen for diabetic peripheral neuropathy. Cochrane Database Syst Rev. 2014. Reviews (3).  https://doi.org/10.1002/14651858.cd010974.
  11. 11.
    Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285–93.  https://doi.org/10.2337/dc10-1303.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Schriger DL, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med. 1988;17(9):932–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Hiller B. The hydrostatic measurement of systolic toe blood pressure: a preliminary validation of the method. Vasa. 1998;27(4):229–32.PubMedGoogle Scholar
  14. 14.
    Jachertz G, Stappler T, Do DD, Mahler F. The pole-pressure test: an easy alternative in patients with ischemic legs and incompressible arteries. Vasa. 2000;29(1):59–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Lawall H, Huppert P, Rümenapf G, Deutschen Gesellschaft fur Angiologie und Gefassmedizin. Leitlinie Periphere arterielle Verschlusskrankheit (PAVK), Diagnostik, Therapie und Nachsorge. 2015:S3.Google Scholar
  16. 16.
    Diehm C, Kareem S, Diehm N, Jansen T, Lawall H. Does calculation of ankle brachial pressure index need revision? Vasa. 2005;34(2):123–6; discussion 127.CrossRefPubMedGoogle Scholar
  17. 17.
    Schroder F, Diehm N, Kareem S, Ames M, Pira A, Zwettler U, Lawall H, Diehm C. A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. J Vasc Surg. 2006;44(3):531–6.  https://doi.org/10.1016/j.jvs.2006.05.016.CrossRefPubMedGoogle Scholar
  18. 18.
    Janssen A. Pulsatility index is better than ankle-brachial doppler index for non-invasive detection of critical limb ischaemia in diabetes. Vasa. 2005;34(4):235–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Hurley L, Kelly L, Garrow AP, Glynn LG, McIntosh C, Alvarez-Iglesias A, Avalos G, Dinneen SF. A prospective study of risk factors for foot ulceration: the West of Ireland Diabetes Foot Study. QJM. 2013;106(2):1103–10.  https://doi.org/10.1093/qjmed/hct182.CrossRefPubMedGoogle Scholar
  20. 20.
    Margolis DJ, Hofstad O, Feldman HI. Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes. Diabetes Care. 2008;31(7):1331–6.  https://doi.org/10.2337/dc07-2244.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ndip A, Lavery LA, Boulton AJ. Diabetic foot disease in people with advanced nephropathy and those on renal dialysis. Curr Diab Rep. 2010;10(4):283–90.  https://doi.org/10.1007/s11892-010-0128-0.CrossRefPubMedGoogle Scholar
  22. 22.
    Quattrone F, Dini V, Barbanera S, Zerbinati N, Romanelli M. Cutaneous ulcers associated with hydroxyurea therapy. J Tissue Viability. 2013;22(4):112–21.  https://doi.org/10.1016/j.jtv.2013.08.002.CrossRefPubMedGoogle Scholar
  23. 23.
    Jerosch J, Heisel J. Operative Therapie von Fuß und Sprunggelenk: Fußchirurgie in Klinik und Praxis 1. Aufl. Köln: Deutscher Ärzte-Verlag; 2008.Google Scholar
  24. 24.
    Coleman SS, Chesnut WJ. A simple test for hindfoot flexibility in the cavovarus foot. Clin Orthop Relat Res. 1977;123:60–2.Google Scholar
  25. 25.
    Stinus H. Neue Ansätze in der konservativen Versorgung des Hohlfußes. Paper presented at the Gesellschaft für Fusschirurgie - Association for Foot Surgery; 2013.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dirk Hochlenert
    • 1
  • Gerald Engels
    • 2
  • Stephan Morbach
    • 3
  • Stefanie Schliwa
    • 4
  • Frances L. Game
    • 5
  1. 1.Amb. Zentrum für DiabetologieEndoskopie & Wundheilung GemeinschaftspraxisKölnGermany
  2. 2.Department of Wound SurgerySt. Vinzenz Hospital and MVZ St. MarienKölnGermany
  3. 3.Department of Diabetes and AngiologyMarienkrankenhaus GmbHSoestGermany
  4. 4.Institute of Anatomy, Anatomy and Cell BiologyUniversity of BonnBonnGermany
  5. 5.Department of Diabetes and EndocrinologyDerby Hospitals NHS Foundation TrustDerbyUK

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