Preventing Foot Ulcers In Patients With Diabetes

Among persons diagnosed as having diabetes, the lifetime prevalence of foot ulcers can be as high as 25%. These ulcers frequently become infected, cause great morbidity, engender considerable financial costs, and are the usual first step to lower extremity amputation.

To systematically review the evidence on the efficacy of methods advocated for preventing diabetic foot ulcers in the primary care setting. the National Guideline Clearinghouse databases were searched for articles published between January 1980 and April 2004.

Prevention of diabetic foot ulcers begins with screening for loss of protective sensation, which is best accomplished in the primary care setting with a brief history and the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy with biothesiometry, measure plantar foot pressure, and assess lower extremity vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, enable clinicians to stratify patients based on risk and to determine the type of intervention.

Educating patients about proper foot care and periodic foot examinations are effective interventions to prevent ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of calluses, and certain types of prophylactic foot surgery. The value of various types of prescription footwear for ulcer prevention is not clear.

Conclusions reached from the data supports screening all patients with diabetes to identify those at risk for foot ulceration. These patients might benefit from certain prophylactic interventions, including patient education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions.

JAMA. 2005 Jan 12;293(2):217-28.

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FACT:
Patients who are older or have a long history of diabetes may have noncompressible brachial arteries, producing pseudohypertension. Hypertension. 2005;45:2-21