Measurements in the Diabetic Foot

Alberto Piaggesi, MD; Francesca Palumbo, MD; Anna Tedeschi, MD; Laura Ambrosini, DPM; Silvia Macchiarini, DPM; Alessia Scatena, MD; Chiara Goretti, MD; Fabrizio Campi, MD; Loredana Rizzo, MD

Disclosures

Wounds. 2005;17(9):247-254. 

In This Article

Abstract and Introduction

Abstract

Diabetic foot syndrome is complex, affects up to 20% of patients with diabetes at least once in their lifetime, and is responsible for the vast majority of amputations in the United States and in Europe. Since its clinical history evolves from an initial nonulcerative phase, to an acute ulcerative phase, an eventual recurrence, and a chronic post-ulcerative phase, measurements related to such a complex condition should explore and exhaustively describe all aspects of the pathology. In the pre-ulcerative phase, evaluation and quantification of risk factors for the development of ulceration are the most important aspects. In this phase, neuropathy and peripheral vascular disease are addressed. In the ulcerative phase, measurements related to the ulcer, including size, location, involvement of deep structures, presence of ischemia, and infection, are all relevant to establish a therapeutic program and a prognosis of the pathologic condition. In the post-ulcerative phase, emphasis should be placed on determining the risk of recurrences and evaluating postural loads and gait imbalances secondary to the outcomes of the acute phase. Such evaluation is important in the prescription of orthesis and shoes that have a protective role with the at-risk foot and thus reduce the risk of recurrences. Measurements in the diabetic foot are of paramount importance to create a quantitative paradigm and reduce empiricism in clinical practice in the management of such a complex pathology.

Introduction

Diabetic foot syndrome (DFS) is a complex and heterogeneous disorder that affects 1 out of 5 patients with diabetes at least once in his or her lifetime with relevant consequences both on lower limb survival and general morbidity.[1] Diabetes is the most frequent determinant of lower limb amputations in developed countries, and foot ulcers are the principal cause of amputations in patients with diabetes.[2] Lower limb complications are major contributors to hospitalization of patients with diabetes, and they account for the vast majority of in-hospital stay and resource consumption in this patient population.[3] According to the international consensus guidelines' protocols,[4] such a complex pathology necessitates the participation of a multidisciplinary team, including the diabetologist, the podologist, the vascular surgeon, the radiologist, and the infectious disease specialist, to manage and address all the various aspects and presentations of the pathology. The measurements in DFS are of paramount importance to guide clinical judgement and provide quantitative information not only on the nature of the present disease but also on its clinical course and the efficacy of therapeutic interventions. Due to variety in the presentations of the disease and its clinical course, the different techniques of measurements, with their indications and clinical significance, can be better understood if they are preceded by a physiopathologic evaluation and a brief description of the principal clinical presentations with the relative measurements.

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