Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Which diabetic patients should receive podiatry care? An objective analysis
M. McGill, L. Molyneaux and D. K. Yue
Internal Medicine Journal Volume 35 Issue 8 Page 451 - August 2005
Quote:
Introduction: Diabetes is the leading cause of lower limb amputation in Australia. However, due to limited resources, it is not feasible for everyone with diabetes to access podiatry care, and some objective guidelines of who should receive podiatry is required.
Methods: A total of 250 patients with neuropathy (Biothesiometer; Biomedical Instruments, Newbury, Ohio, USA) (>30, age <65)) but no active foot lesion, and 222 without neuropathy matched for age, type of diabetes, gender and duration, was followed prospectively for 2 years. Sensation was also tested using a 10 g Semmes Weinstein monofilament (Royal Prince Alfred Hospital Diabetes Centre). After the baseline examination, patients were contacted at 6 months and thereafter yearly to determine ulcer status. Incidence of foot ulceration across different risk categories was calculated using Kaplan-Meier survival curve. Log-rank test and Cox's proportional model were used to compare groups. The Number Needed to Treat (NNT) to prevent one ulcer per year was calculated using the standard formulae.
Results: During the follow-up period, 34 new ulcers occurred in the neuropathy group and three ulcers in the control group (chi21df = 21.3; P < 0.0001), equating to an annual incidence of 6.3% and 0.5%, respectively. Fifty-four per cent of the ulcers were due to trauma from footwear. Further stratification of the neuropathy group showed annual incidence of ulceration to be 4% for those with abnormal biothesiometer reading, but who could still feel the monofilament, 10% for those who cannot feel the monofilament and 26% for those with previous ulceration or amputation. Predictors of ulceration were past history of ulceration/amputation (chi2 = 27.8; P < 0.0001) and the presence of neuropathy (chi2 = 4.7; P = 0.03). Assuming a 55% relative risk reduction in ulceration from podiatry care (mean of estimates from 10 reports), the NNT to prevent one foot ulcer per year was: no neuropathy (vibration perception threshold (VPT) <30)), NNT = 367; neuropathy (VPT >30) alone, NNT = 45; +cannot feel monofilament, NNT = 18; +previous ulcer/amputation, NNT = 7.
Conclusion: Provision of podiatry care to diabetic patients should not be only economically based, but should also be directed to those with reduced sensation, especially where there is a previous history of ulceration or amputation. (Intern Med J 2005; 35: 451-456 )
This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15–101) years and duration of diabetes was 8.8 (±1.5 SD) years. Patients were categorised into 'low' (64%), 'moderate' (23%) or 'high' (13%) risk of developing foot ulcers by trained staff using five clinical criteria during routine patient care. During follow-up (1.7 years), 166 (4.7%) patients developed an ulcer. Foot ulceration was 83 times more common in high risk and six times more in moderate risk, compared with low-risk patients. The negative predictive value of a 'low-risk score' was 99.6% (99.5–99.7%; 95% confidence interval). This clinical tool accurately predicted foot ulceration in routine practice and could be used direct scarce podiatry resources towards those at greatest need.
For easy clinical reference try the Tayside Foot Risk Assessment protocol (A.Morris et al)
which was published in the Scottish SIGN guidelines
and later in the English NICE guidelines
Actually,it is not a bad idea to see ALL diabetic patients!I work in a multidisciplinary office and the office manager sets me up with almost EVERY DIABETIC seen by the medical doctor/PCP in that office.And what have I seen?PVD,ingrown nails with abcesses,of course ulcerations/Charcot,neuropathy,even "routine" stuff like onychomycosis,T.Pedis(one patient the other day had a maceration between her toes and I pointed out that this small crack can lead to a nasty plantar infection if not treated properly.
Then I look at their blood work...I see a lot of glucose above 300 and Hb1ac at least 9 WITH SOME READINGS AS HIGH AS 14!!!!
As for followups,it depends.If they have no real pathology,once a year or so is fine.If I see something,it could be every 2-4 months or sooner.For example,diabetic neuropathy with corresponding numbness may require about 2 to 5 visits a year and active ulcerations may require a heck of a lot more than that.
Last edited by John Spina : 9th August 2006 at 12:52 PM.
Reason: wrong punctuation
Which diabetic patients should receive podiatry care?
Linear Mode
