Escolar Documentos
Profissional Documentos
Cultura Documentos
Presented to:
Dr. Nichapatr Putthicamin
Assoc. Prof. Dr. Darunee Jongudomkarn
Assoc. Prof. Dr. Kritaya Sawangchareon
Presented by:
Parliani 575060120-1
1. Seminar Leader:
Parliani 575060120-1
2. SeminarParticipants:
Asri 575060127-7
Ngatoiatu Rohmani 575060125-1
Romiko 575060118-8
Sukron 575060119-6
Suwarno 575060122-7
Tri Sumarsih 575060123-5
Yuyud Wahyudi 575060121-9
3. Advisor:
Dr. Nichapatr Putthicamin
4. Objectives:
After finishing the seminar, the participant will be:
a. Know about the evidence based of risk factors of Diabetic Foot Ulcer (DFU)
b. Know about the pathway of risk factors lead to DFU
c. Know about the categorize of risk factors od DFU which fit to theory in conceptual
framework
d. Know about the draft of risk factors and their tools instrument from the literatures
e. Know about the draft of the new tools assessment to predict DFU based on risk
factors in the evidence based
5. Process of the seminar
The process of seminar will be arranged in around 20 minutes, with some activities:
a. Introduction/Background time 3 minutes
b. Seminar on time 10 minutes
c. Summary time 2 minutes
d. Feedback and conclusion time 5 minutes
2 Al-Kafrawy, N.A.E., The research aim is to Population: The measurement of this The finding of study are:
Ehab, A.B.E.M., Alaa, study the risk factors 100 Patients with diabetic foot. study are:
E.A.E.D., Osama, M.E., & for diabetic foot ulcers The selected patients were a. Comparison between
Omnia, M.A.Z. (2014). (DFUs) in Menoufia subdivided into two groups a) Physical examination diabetic patient with and
Study of risk factors of University Hospital (group 1: 50 patients with DFU using anthropometric without DFU in terms of
diabetic foot ulcers. and group II:50 patients without for measure such as demographic data and
Menoufia Medical DFU) BMI laboratory tests
Journal, 27:28-34. b) Foot examination that 1) Significant data are:
Doi:10.4103/1110- Inclusion criteria: included neurological - Duration of diabetes
2098.132298 Patients with diabetes, type 1 or assessment for diabetic (P<0.001)
type 2 with and without diabetic retinopathy through - Serum cholesterol
foot touch sensation or (P=0.022)
sensory neuropathy that - Fasting blood glucose
Exclusion criteria: was assessed using a 10 (P<0.001)
Patients with peripheral vascular g Semmes-Weinstein - 2h postprandial blood
diseases because of non-diabetic monofilament that was glucose (P<0.001)
causes, patients with traumatic constructed to buckle - HbA1c (P<0.001)
foot ulcers, and patients with when a 10g force is - Smoker (P<0.001)
joint disease applied - Retinopathy
c) Vibration sense was (P<0.032)
Research Type: checked for neuropathies 2) Not significant data are:
Descriptive using a 128 Hz tuning - Age (P=0.381)
fork - BMI (P=0.092)
Statistical Methodology: d) Patellar and ankle deep - Serum creatinine
The data collected were tendon reflexes (P=0.761)
tabulated and analyzed using e) Vascular assessment - Serum albumin (0.091)
statistical package for social through palpation of - Serum triglycerides
science, version 17.0 on an IBM dorsalis pedis and (0.473)
compatible computer posterior tibial pulses - Sex (P=0.160)
f) Doppler examination of - Nephropathy
Types of statistic were dorsalis pedis and (P=0.223)
calculated: posterior tibial arteries
with calculation of the
a. Descriptive statistic ankle brachial index
b. Analytic statistic (ABI) b. Comparison between
Qualitative data were diabetic patients with and
analyzed by X2 and without foot ulcer in
whenever one cell of the terms of diabetic foot
expected was equal to or examination with
less than 5, Fisher’s exact significant is P value <
test was used. 0.05
Quantitative data were 1) Significant data are:
analyzed using the t-test - Previous foot ulcer is
(Student’s test) for high significant
comparison of quantitative (P<0.001)
variables among two - Previous amputation
independent groups and the is high significant
Mann-Whitney test (P<0.001)
(nonparametric test) for - Normal skin
comparison between two (P=0.009)
groups that were not - Foot deformities
normally distributed (P=0.009)
- Joint mobility
(P=0.002)
Factors measured: - Monofilaments
(P<0.001)
a. Demographic data and - Vibration sensation
laboratory tests (P<0.001)
- Age
- Pinprick sensation
- Duration of diabetes
(P<0.001)
- BMI 2) Not significance data are:
- Serum creatinine - Ankle reflexes
- Serum albumin (P=1.00)
- Serum cholesterol
- Serum triglycerides c. Comparison between both
- Fasting blood glucose
groups in terms of
- 2h postprandial blood vascular assessment with
glucose significant data are
- HbA1c - ABI (P<0.001)
- Sex - Doppler (P<0.001)
- Smoker
- Nephropathy (micro-
albuminuria)
- Retinopathy
c. Vascular assessment
- ABI
- Doppler
3 Pham, H., David, G.A., A multicenter Population: a. Neuropathy symptom a. Comparison between
Carolyn, H., Lawrence, prospective follow-up A total of 248 patients with score (NSS) non-ulcerated and
B.H., John, M.G., and study was conducted diabetes The neuropathic ulcerated patients with
Aristidis,V. (2000). to determine which symptoms were assessed significance levels of
Screening techniques to risk factors in foot Research type: by using a modified P=0.05
identify people at high screening have a high Prospective longitudinal mode neuropathy symptom 1) Significance Data
risk for diabetic foot association with the score (NSS) that was - Sex (P=0.000)
ulceration. Diabetes development of foot Statistical analysis: simplified from a version - Diabetes duration
Care, 23:606-611 ulceration The Minitab statistical package developed by Boulton. (P=0.019)
Version 12.0 (Minitab, State - Non-palpable pedal
Furthermore, this College, PA) for personal b. Neuropathy disability pulses (P=0.000)
study aimed to identify computers was used for score (NDS) - Maximal plantar
as many risk factors statistical analysis. The NDS was used to pressure (P=0.000)
as possible and to Comparison between patients quantify the severity of - STJ mobility (P=0.026)
develop a screening who developed and did not diabetic neuropathy - First MTPJ mobility
strategy that by develop foot ulceration were obtained from physical (P=0.000)
combining the made by using X2 tests for examination and was - NDS (P=0.000)
detection of 2 or more categorical variables. based on the - VPT (P=0.000)
risk factors, would For individual continuous examination of tendon - SWF (P=0.000)
provide the best tool variables, comparison were reflexes and sensory - Feet with high foot
for identifying the at- made by using 2-tailed Student’s modalities as previously pressure (P=0.000)
risk patient t test if assumptions of described - Feet with high NDS
normality were achieved or with Sensory tests included a (P=0.000)
Wilcoxon’s rank-sum test if pinprick with a pointed - Feet with high VPT
nonparametric hypothesis testing metal or wooden pin, (P=0.000)
was required light touch with a strip of - Feet with high SWF
cotton ball, vibration (P=0.000)
Factors measured: with a tuning fork, and 2) Not significant data:
temperature perception - Age
a. Age with a test tube filled - BMI
b. Sex with cold water - History of foot ulceration
c. BMI (P=0.062)
d. Diabetes duration c. Vibration Perception - Type of diabetes(P=0.36)
e. History of foot Threshold (VPT) - NSS
ulceration The study used a
f. Type of diabetes biothesiometer
g. Non-palpable pedal (Biomedical, Newbury,
pulses OH) to test the VPT.
h. Maximal plantar
pressure d. Semmes Weinstein
i. STJ mobility Monofilament (SWF)
j. First MTPJ mobility This study used a set of
k. NSS 8 SWFs that apply
l. NDS pressure from 1 to 100 g
m. VPT to evaluate the cutaneous
n. SWF perception threshold
o. Feet with high foot
pressure e. Maximal plantar foot
p. Feet with high NDS pressure
q. Feet with high VPT The F-Scan mat system
r. Feet with high SWF (Tekscan, Boston, MA)
was used to measure the
dynamic plantar foot
pressures
f. Joint mobility
The total range of
motion at the first
metatarsophalangeal
joint (MTPJ) and the
subtalar joint (STJ) was
measured by using a
goniometer
g. Peripheral Vascular
Disease (PVD)
The diagnosis of PVD
was based on the
absence of foot pulses
and/or symptoms of
claudication or history of
bypass operation
4 Madanchi, N., Ozra, T.M., The purpose of the Population: a. Renal co-morbidity as The findings of study are:
Mohammad, P., Ramin, study is to investigate 873 DFU patients admitted presence of micro-
H., Bagher, L., & the characteristics of between 2002 and 2008 in two albuminuria, macro- a. Basic demographic
Mohammaad-Reza, M.T. diabetic foot patients university hospitals albuminuria, or end- characteristics:
(2013). Who are diabetic and their foot ulcers stage renal disease - Gender with male
foot patients? A Research type: (58.1%) and female
descriptive study on 873 The descriptive with b. Cardiovascular co- (41.9%)
patients. Journal of retrospective study morbidity as presence of - Age is about 25-87
Diabetes & Metabolic hypertension or ischemic years old
Disorders, 12:36 Data Collection: heart disease - Duration of DM is
Medical archives of the patients around 0-600 months
were utilized and necessary data c. Ophthalmic co- - Positive family history
was collected using a predesign morbidity as presence of of DM (28.8%)
data collection sheet simple or proliferative
diabetic retinopathy or
Data analysis: cataract
b. Method of DM control
Data were analyzed using SPSS
- Under treatment with
software, version 15 d. Pin Prick test to
oral hypoglycemic
temperature or
(43.99%)
Factors measured: superficial pain
- Patients were receiving
sensation or two-point
a. Basic demographic insulin (45.47%)
discrimination
characteristics: - Patients were receiving
- Gender both oral hypoglycemic
- Age e. Monofilament (10-g) for agents and insulin
- Duration of DM seeing the decreasing of (2.29%)
- Positive family history sensation - Under no medication
of DM (8.25%)
f. Autonomic neuropathy
as presence of
unexplained orthostatic
b. Method of DM control hypotension, c. Mean hemoglobin A1C
- Under treatment with gastroparesis, dyspepsia, (HbA1c) level was 9.51%,
oral hypoglycemic diabetic diarrhea or and only 14.4% of the
- Patients were receiving constipation, neurogenic patients had HbA1c < 7%
insulin bladder, erectile
- Patients were receiving dysfunction, vaginal or d. Mean patients’ first fasting
both oral hypoglycemic skin dryness blood sugar during
agents and insulin admission was 198.7 mg/dl
- Under no medication
5 Clayton, W., and Tom, The purpose of this - a. ABI is obtained by a. Pathogenesis of Ulceration
A.E. (2009). A review of review is to describe measuring the systolic blood The major underlying causes
the pathophysiology, the causes of lower- pressure in the ankles are note to be peripheral
classification, and extremity ulceration in (dorsalis pedis and posterior neuropathy and ischemic from
treatment of foot ulcers in diabetic patients and to tibiall arteries) and arms peripheral vascular disease
diabetic patients. Clinical identify common (brachial artery) using a
Diabetes, Volume 27, no methods of handheld Doppler and then 1) Neuropathy
2 classification and calculating the ration, the More than 60% of diabetes
treatment to aid ratio below 0.91 are foot ulcers are the result of
primary care providers suggestive of obstruction underlying neuropathy
in determining - Motor
appropriate treatment b.Loss of pressure sensation Damage to the
approaches for their in the foot has been innervations of the
patients identified as a significant intrinsic foot muscles
predictive factor for foot leads to an imbalance
ulceration. A screening tool between flexion and
in the examination of the extension of the
diabetic foot is the 10-gauge affected foot. This
monofilament produces anatomic foot
deformities that create
c.Surgical bypass is a abnormal bony
common method of prominences and
treatment for ischemic pressure points, which
limbs, and favorable long- gradually cause skin
term results have been breakdown and
reported. ulceration
- Autonomic
Autonomic neuropathy
leads to a diminution in
sweat and oil gland
functionality. As a
result, the foot loses its
natural ability to
moisturize the
overlying skin and
becomes dry and
increasingly
susceptible to tears and
the subsequent
development of
infection
- Sensation
The loss of sensation as
a part of peripheral
neuropathy exacerbates
the development of
ulcerations. As trauma
occurs at the affected
site, patients are often
unable to detect the
insult to their lower
extremity
2) Peripheral Vascular
Disease (PVD)
PVD is a contributing factor
to development of foot
ulcers in up to 50% of
causes.
Endothelial cell dysfunction
and smooth cell
abnormalities develop in
peripheral arteries as a
consequence of the
persistent hyperglycemic
state. This is a resultant
decrease endothelium-
derived vasodilators leading
to constriction. Further, the
hyperglycemia in diabetes
is associated with an
increase in thromboxane
A2, a vasoconstrictor and
platelet aggregation agonist,
which leads to an increased
risk plasma
hypercoagulability.
Smoking, hypertension and
hyperlipidemia are other
factors that are common in
diabetic patients and
contribute to the
development of PAD
b.Assessment of Diabetic
Foot Ulcers
The literature review
showed that a complete
history will aid in assessing
the risk for foot ulceration,
such as
- History of ulceration
or amputation
- Symptoms of
neuropathy
- Symptoms of PVD
- Smoking
- Inappropriate
footwear
- Presence of ulceration
or signs of infection
- The presence of callus
or nail abnormalities
- A temperature
different between feet
- Deformities
- Charcot arthropathy
- The dorsalis pedis
and posterior tibial
pulses should be
palpated and
characterized as
present or absent
- Claudication, loss of
hair, the presence of
pale, thin, shiny, or
col skin are physical
findings suggestive of
potential ischemia
- ABI
6 Iversen, M.M., Grethe, The study aim is to Population: a. The Hospital Anxiety a. Baseline characteristic of
S.T., Birgitte, S., Kristian, prospectively examine Participants without diabetes, and Depression Scale the analysis sample
M., Marit, G., Berit, R., whether depressive participant with diabetes not (HADS-D subscale) 1) Demographic
Line, I.B., and Truls, O. symptom increase the reporting a foot ulcer, and assessed depressive characteristic
(2015). Is depression a risk of diabetes and participants with diabetes symptom - Age with mean is
risk factor for diabetic diabetic foot ulcer reporting a foot ulcer around 47 years
foot ulcers? 11-years b. Height and weight were - Male gender (44.8%)
follow-up of the Nord- Statistical analyses: measured and body mass 2) Clinical factors
Trondelag Health Study Descriptive statistic with mean index (BMI) was - BMI with mean is
(HUNT). Journal of and standard deviation, t-test calculated as around 26.1 kg/m2
Diabetes and Its and X2 tests were used to weight/height2 (kg/m2) - Serum glucose with
Complications, 29; 20-25 compare baseline characteristic mean 5.3 mmol/L
between subgroup. (blood sample were
Logistic regression analyses c. Serum glucose was non-fasting
were performed to estimate the measured using an - Stroke (0.7%)
effect of depressive symptoms. autoanalyzer (Hitachi - Myocardial infarction
Analyses were also performed Biocore Systems, (1.4%)
using HADS-D as a continuous Thornhill, ON, Canada) - Angina pectoris (2.3%)
variable. Statistical significance - Any cardiovascular
was set as P<0.05, and analyses disease (3.6%)
were conducted using SPSS 3) Assessment of depression
version 20.0 - HADS-D with mean is
3.3
Factors measured: - HADS-D (≥8) (9.2%)
- HADS-D (8-10) (6.8%)
a. Characteristics of sample - HADS-D (≥11) (2.4%)
1) Demographic characteristic - Using anti-depressant
- Age agents (2.7%)
- Male gender - Combination of HADS
2) Clinical factors ≥ 8 and/or use of anti-
- BMI depressant agents
- Serum glucose (11.0)
- Stroke
- Myocardial infarction
- Angina pectoris
- Any cardiovascular b. Depressive symptoms as a
disease risk factor for diabetes
3) Assessment depression Odds for reporting diabetes
- HADS-D at follow up were
- HADS-D (≥8) significantly higher among
- HADS-D (8-10) individuals with a HADS-D
- HADS-D (≥11) score ≥ 8 compared to
- Using anti-depressant HADS-D < 8 at baseline
agents (OR 1.30 95%, CI: 1.07-
- Combination of HADS 1.57)
≥ 8 and/or use of anti-
depressant agents c. Depressive symptoms as a
risk factor for DFU
b. Depressive symptoms as a
risk factor for diabetes
c. Depressive symptoms as
risk factor for DFU
7 Molvear, A.K., Marit, G., The study is to Population: c. Self-reported eye a. Factors associated with
Birgitte, E., Truls, O., determine the Diabetes patients with foot ulcer problems diagnosed by a history of foot ulcer (Socio-
Kristian, M., and proportion of people and without foot ulcer doctor as due to diabetes demographic)
Marjolein, M.I. (2014). with diabetes reporting d. Macro-vascular 1) Significance data:
Journal of Diabetes and a history of foot ulcer Research type: complications (history - Sex male (p=0.003)
Its Complications, and investigate Cross sectional study stroke, myocardial - Marital status
28:156-161 associated factors infarction, angina (p=0.007)
healing time in the Statistical analyses: pectoris and/or - Height (p=0.02)
Nord-Trondelag peripheral surgery), 2) Not significance data:
Health Survey - T-test for continuous history of amputation by - Age
(HUNT3), Norway variables. questionnaires
- Chi-square tests for e. Height, weight, and
nominal variables waist circumference
- Fisher’s exact test instead were measured by b. Factors associated with
of chi-square when the clinical examination history of foot ulcer (Life
assumption of expected f. BMI was calculated as style characteristic)
counts was not met (for kilogram per meter 1) Significance data:
variables peripheral squared - BMI
surgery and any g. Smoking was based on - Waist
amputation) the question “do you - Physical inactivity
- Logistic regression to smoke?” 2) Not significance data:
generate odds ratio and h. The study defined micro- - Smoke
95% CI to determine which albuminuria as an
independent variables were albumin-creatinine ratio
associated with a history of > 3 mg/mmol in at least c. Factors associated with
foot ulcer two of three urine history of foot ulcer
- Using SPSS version 19 (P samples. (Clinical characteristic)
1) Significance data:
value= 0.05) - Insulin
- Duration of diabetes
2) Not significance data:
Factors measured: - HbA1c
- Ever used
a. Factors associated with
antihypertensive
history of foot ulcer
medication
1) Socio demographic
- Age
d. Factors associated with
- Sex male
history of foot ulcer (Micro-
- Marital status vascular complication)
- Height 1) Significance data:
2) Lifestyle characteristic
- Eye problems due to
- BMI
diabetes
- Waist - Any micro-vascular
- Physical inactivity complication
- Current smokers 2) Not significance data:
3) Clinical characteristic - Micro-albuminuria
- HbA1c
- Insulin
- Duration of diabetes
- Ever used e. Factors associated with
antihypertensive history of foot ulcer
medication (Macro-vascular
4) Micro-vascular complication)
complication 1) Significance data
- Micro-albuminuria - Self-reported stroke
- Eye problems due to - Self-reported
diabetes myocardial infarction
- Any micro-vascular - Self-reported angina
complication pectoris
5) Macro-vascular - Any macro-vascular
complication complication
- Self-reported stroke 2) Not significance data
- Self-reported - Peripheral vascular
myocardial infarction surgery
- Self-reported angina
pectoris
- Peripheral vascular
surgery f. Any lower-limb amputation
- Any macro-vascular (p=0.03)
complication
6) Any lower-limb
Bivariate and multivariate in
amputation
characteristic
a. Significance data:
b. Bivariate and multivariate 1) Demographic
in characteristic - Age ≥ 75 years
1) Demographic (OR=2.1)
- Age - Male sex (OR=1.8)
- Gender - Height
- Height ≥176cm/≥162cm
2) Lifestyle (OR= 1.2)
- Current smoker 2) Lifestyle
- Waist - Current smoker
3) Clinical (OR=1.1)
- Duration of DM - Waist ≥ 102cm/ ≥
- Insulin 88cm (OR=1.6)
4) Vascular complication 3) Clinical
- Micro-vascular - Duration of diabetes ≥
complication 10years (OR=1.4)
- Macro-vascular - Insulin (OR=2.0)
complication 4) Vascular complication
- Micro-vascular
complications
(OR=1.3)
- Macro-vascular
complications
(OR=2.1)
8 Dubsky, M., Alexandra, The aim of this study Population a. End-stage renal disease Potential risk factors for ulcer
J., Robert, B., Vladimira, was to assess the 1200 patients with anew DFU (defined as needing recurrence:
F., Jelena, S., Nicolaas, frequency of ulcer for 12 months dialysis)
C.S., and Benjamin, A.L. recurrence in patients b. Overweight or obesity a. Significance data
(2012). Risk factors for with a healed DFU Research type: defined as a body mass - Osteomyelitis
recurrence of diabetic foot followed up in our Prospective follow-up analysis index > 27 kg/m2 (p=0.0124)
ulcers: prospective follow- centre for the 3 years during 3 year c. Chronic alcohol usage - Elevated CRP (> 5
up analysis in the after completing the defined as drinking more mg/l) (P=0.0454)
Eurodiale subgroup. Eurodiale study, and to Statistical analysis: than 1 IU/day - Plantar location of
International Wound identify risk factors for d. PAD defined as an DFU
Journal, 1742-4801. recurrence - X2 test ankle-brachial index (0.0001)
Doi:10.1111/j.1742- - Logistic regression (ABI) < 0.9 or the
481X.2012.01022.x absence of both foot b. Not significance data
pulses on the study foot - Age
Factor measured: e. Osteomyelitis diagnosed - Sex
a. Potential risk factors for by clinical features and - Poor glycemic control
ulcer recurrence plain X-ray finding (HbA1c >7.5%)
- Age f. Charcot foot diagnosed - Distance from hospital
by a presence of > 2C > 15 km
- Sex
difference in skin foot - Diabetes duration > 10
- Distance from hospital >
temperature between the years
15 km
two feet and plain X-ray - Diabetes treatment with
- Diabetes duration > 10
and/or radionuclide bone insulin
years
scan compatible with - Overweight (BMI > 27
- Diabetes treatment with
Charcot foot kg/m3)
insulin
g. DFU infections as - Smoking active
- Poor glycemic control
defined by the - Chronic alcohol usage
(HbA1c >7.5%)
International Working - End-stage renal disease
- Overweight (BMI > 27
Group on the Diabetic - Peripheral arterial
kg/m3)
foot disease
- Smoking active
h. Elevated C-reactive - Charcot foot
- Chronic alcohol usage
protein (CRP) level - Clinical signs of DFU
- End-stage renal disease
defined as > 5 mg/l infection
- Peripheral arterial
disease - Ulcer size > 5 cm2
- Osteomyelitis - Deep ulcer depth
- Charcot foot (subcutaneous)
- Clinical signs of DFU - Ulcer duration > 3
infection months
- Elevated CRP (> 5 - Foot deformity
mg/l) - Previous ipsilateral
- Plantar location of DFU amputation
- Ulcer size > 5 cm2 - Previous contralateral
- Deep ulcer depth amputation
(subcutaneous) - Multiresistant
- Ulcer duration > 3 microorganisms
months - Days to complete
- Foot deformity healing
- Previous ipsilateral
amputation Multivariate stepwise logistic
- Previous contralateral regression- independent risk
amputation factors statistically
- Multiresistant significantly associated with
microorganisms ulcer recurrence (Significant
- Days to complete with OR>1)
healing
- Plantar location of the
ulcer (OR=2.15)
- Osteomyelitis
b. Multivariate stepwise (OR=1.64)
logistic regression- - HbA1c > 7.5%
independent risk factors (OR=1.4)
statistically significantly - CRP > 5 mg/l
associated with ulcer (OR=1.45)
recurrence
- Plantar location of the
ulcer
- Osteomyelitis
- HbA1c > 7.5%
- CRP > 5 mg/l
9 Consultant. (2013). Risk The study believe that Methodology : - a. Direct and indirect causes
factors for Diabetic Foot a high percentages of Articles review of risk factors of DFU
Ulcers (DFU): the first DFU are preventable 1) Indirect factors that leads to
step in prevention,53(11) by recognizing the DFU through secondary
: 800-803 major factors that lead mechanism
to DFU and - Neuropathy
implementing 4 - Deformity
essential measures to - Peripheral artery
prevent these wounds disease
from occurring. - Venous stasis disease
- Glycosylation of
tissues
- Collagen vascular
disease
- Angiitis
2) Direct factors that leads to
DFU through an immediate
effect of the cause
- Deformity
- Trauma
- Charcot
neuroarthropathy
- Malunited fractures
- Osteoporosis
congenital anomalies
b. Recurrent condition in
risk factors for DFU
- Deformity
- Peripheral artery
disease
- History of previous
wound
- Previous amputation
- Neuropathy
10 Edo, A.E., Gloria, O.E., The aim of study is to Population: a. Ulcer grade at a. Frequency of risk factors
and Ignatius, U.E. (2013). determine the risk Diabetes patients with DFU presentation using and co-morbidities of
Risk factors, ulcer grade factors, ulcer grade, Wagner’s grading DFU
and management outcome and management Research type: b. Peripheral neuropathy - Hypertension (50.8%)
of diabetic foot ulcers in a outcome of patients Prospective observational study was defined as - Peripheral Vascular
Tropical Tertiary Care with diabetic foot ulcer diminished or lack of Disease (PVD) (44.3%)
Hospital. Nigerian (DFU) managed in a Statistical analysis: perception of - Peripheral Neuropathy
Medical Journal, tropical tertiary touch/pain stimuli (42.6%)
54(1):59-63. Doi: hospital - The study was using c. Loss of joint assessed - Visual impairment
10.4103/0300- SPSS version 16 and using a 128 mHz (21.3%)
1652.108900 Stata/IC 11. tuning fork - Erectile dysfunction
- Comparison of means d. Peripheral vascular (14.75%)
was done using t-test for disease was defined as - Diabetic Ketoacidosis
continuous data and a defined as the presence (DKA)/ Hyperglycemic
chi-square test for of diminished or absent hyperosmolar state
categorical data lower limb arterial (NHS) (8.2%)
- Logistic regression pulsation on palpation - HIV (3.28%)
analysis was performed e. Visual impairment was - Nephropathy (1.64%)
to examine the defined as diminished - Previous DKA (3.28
association of some risk vision resulting from %)
factors for Lower refractive errors,
Extremity Amputation cataracts
(LEA) f. Diabetic foot ulcer was
defined as any full b. Frequency preceding
thickness ulcer below events of DFU
Factors measured: the ankle in any person - Spontaneous (52.46%
with diabetes mellitus - Puncture injury
a. Risk factors and co- (16.39%)
morbidities of DFU - Trauma (12.5%)
- Hypertension - Tight foot wears
- Peripheral Vascular (8.20%)
Disease (PVD) - Thermal injury (6.56%)
- Peripheral Neuropathy - Pedicure injury
- Visual impairment (3.28%)
- Erectile dysfunction - Tinea pedis (1.64%)
- Diabetic Ketoacidosis - Rat bite (1.64%)
(DKA)/ Hyperglycemic
hyperosmolar state
(NHS)
- HIV
- Nephropathy
- Previous DKA
(Not significance)
- Gender (male)
(P=0.715)
- History of smoking
(P=0.220)
- Callus (P=0.377)
- Hallux valgus
(P=0.379)
- Hammer toe (P=0.113)
- Flat foot (P=0.231)
13 Zaine, N.H., Joshua, B., The primary aim of Population: a. Diabetes Mellitus was a. Demographic
Mauro, V., John, P.F., this study was to Type 1 and type 2 diabetes defined according to the - Age with median of
Lindy, B., and Kerry, H. evaluate the patients with foot ulcers criteria set by WHO that male is 65 years and
(2014). Characteristics of characteristics of are a fasting plasma women is 69.5 years
diabetic foot ulcers in diabetic foot ulcers in Research type: glucose ≥ 7.0 mmol/L - Gender male (66.2%)
Western Sydney, patients presenting to a Descriptive study (126 mg/dl) or 2-hour - Height with median 1.7
Australia. Journal of tertiary referral plasma glucose ≥ 11.1 meters
Foot and Ankle outpatient hospital Statistical analysis: mmol/l (200 mg/dl) - Weight with 84.5 kg of
Research, 7:39 setting in Western median score
Sydney, Australia - SPSS 21.0 (IBM SPSS b. A foot ulcer was defined - BMI (77.7% is more
Statistic for Windows, as a full-thickness than overweight)
The secondary Armonk, NY, USA) wound located distal to - Socioeconomic median
Aim was to evaluate - Continuous data were ankle (level of malleoli) is 996
the use of vascular compared using the Mann - Nationality of
investigation and off- Whitney U test and c. Peripheral neuropathy Australian born
loading modalities in proportions using the Chi was diagnosed by a (50.8%) and born
this high risk group Square (X2) test. With P< Podiatrist using a overseas is 49.2%
patients 0.05 neurothesiometer, - Marital status with
128Hz tuning fork or 10 married (58.5%)
g monofilament - Duration of DM is with
Factors measured: median 17 years
d. PAD was assessed and
a. Demographic diagnosed by measuring
- Age toe pressures using a
- Gender photoplethysmography b. Medical history and
- Height (Hadeco Smartdop 30 lifestyle risk factors of
- Weight EX vascular Ultrasound Patients
- BMI Dopppler). A toe 1) More than 50%
- Socioeconomic pressure of < 55 mmHg - Neuropathy (75.4%)
- Nationality indicates PAD in a foot - Hypertension (67.2%)
- Marital status - Hyperlipidemia
- Duration of DM e. The socioeconomic (54.9%)
status was based on the 2) Less than 50%
b. Medical history and Australian Bureau of - History of ulcer
lifestyle risk factors of Statistic (ABS) (41.5%)
Patients residential postcode - Retinopathy (39.5%)
- Neuropathy method for general - History of amputation
- Hypertension Australian population (32.8%)
- Hyperlipidemia (mean index=1000) - Angina/Infarct (24.1%)
- History of ulcer - Nephropathy (22.1%)
- Retinopathy - Renal failure (13.3%)
- History of amputation - Claudication (11.3%)
- Angina/Infarct - Cerebrovascular
- Nephropathy Accident (10.8%)
- Renal failure - Transient ischemic
- Claudication attack (7.7%)
- Cerebrovascular - Charcot arthropathy
Accident (5.6%)
- Transient ischemic - Smoking that smoker
attack (14.5%) and ex-smoker
- Charcot arthropathy (42.6%)
- Smoking
14 Ahmad, W., Ishtiaq, A.K., The objective of this Population: a. X-ray foot was advised Findings:
Salma, G., Farhan, K.A., study was to identify Diabetes patients and diabetes to assess condition of
and Ihsanullah Khan. risk factors and their patients with foot ulcers underlying bones - Age is around 58.09
(2013). Risk factors for frequency in patients years old (mean)
diabetic foot ulcer. J presenting at Ayub Exclude population: - Gender male is 80.1%
Ayub Med Coll Teaching Hospital, Patients with medical co- - Duration of DM is 52%
Abbottabad; 25 (1-2): Abbottabad morbidity especially chronic more than 10 years old
16-8 heart failure and chronic renal - Glucose control (43.4%
failure were excluded from the had poorly controlled
study sugar)
- Distal pulse (62.8%
Research Type: patients both distal
Descriptive study pulse absent
- Sensory loss (40.8%)
Statistical analysis: - Osteomyelitis (42.9%)
SPSS-10 - Infection (85.7%)
Factors measured:
- Age
- Gender
- Duration of DM
- Glucose control
- Distal pulse
- Sensory loss
- Osteomyelitis
- infection
15 Deribe, B., Kifle, W., and The main objective of Population: a.Diabetes was diagnosed if a. Demographic variables
Gugsa, N. (2014). this study is to assess Diabetes patients the patients with fasting among diabetic patients
Prevalence and factors prevalence and factors plasma glucose level ≥ 126 with and without foot ulcer
influencing diabetic foot influencing diabetic Exclusion criteria: mg/dl or a 2-h post glucose 1) Significance
ulcer among diabetic foot ulcer among Diabetes patients who have level after a 75-g oral - Residence (P=0.001)
patients attending diabetic patients traumatic ulcer other than glucose tolerance test ≥ 200 - Age interval
Arbaminch Hospital, attending Arbaminch perceived risk factors such as mg/dl plus suggestive (P=0.038)
South Ethiopia. Journal hospital car accident were excluded from clinical manifestations - Occupation (p=0.002)
Diabetes Metabolic, the study - Type of co-morbidity
2:322. Doi: 10.4171/2155- b.Diabetes self-care attitude (P=0.003)
6156.1000322 Research type: measured using statement - Attitude (P=0.02)
A cross sectional study related to diabetic self-care. - Body Mass Index
Likert scale of attitude (BMI) (P=0.003)
Statistical analysis: measurement will be used to - Systolic blood
classify patients to sat have pressure (P=0.01)
- SPSS version 16.0 favorable attitude or - Diastolic BP
- Chi-square and student unfavorable attitude towards (P=0.024)
t-test diabetes self-care - Duration of DM
(P=0.001)
c.Diabetic foot self-care is - Skin texture
Factors measured: defined as ability of patient (P=0.005)
a. Demographic variables to perform self-care - Sensory loss to
among diabetic patients activities that help the feet vibration (P=0.001)
with and without foot ulcer to be healthy - Use of ill-fitting shoes
- Sex (P=0.015)
- Residence d.Neuropathy is assessed - Callus of the feet
- Educational status and determined from (P=0.004)
- Marital status patient’s medical history 2) Not significance
- Age interval meaning the patient’s - Sex (P=0.443)
- Occupation medical card was reviewed - Educational status
- Type of co-morbidity for the presence of (P=0.121)
- DM knowledge neuropathy - Marital status
- Attitude (P=0.097)
- DM self-care practice e.Knowledge of patients’ - DM knowledge
- Body Mass Index (BMI) relating to diabetes and self- (P=0.81)
- Systolic blood pressure care practice will be - DM self-care practice
- Diastolic BP assessed by using ‘yes/no’ (P=0.54)
- Duration of DM questions
- Skin texture
- Sensory loss to vibration f.Diabetic foot ulcer is non-
- Use of ill-fitting shoes traumatic lesions of the skin
- Callus of the feet (partial or full thic kness) on
the foot of a person who has
diabetes mellitus
16 Nehring, P., Beata, M.R., The purpose of this Populations: a. Diabetic foot was Factors measured:
Monika, K., Agnieszka, study is to compare diagnosed according to a.Diabetic foot risk factors in
S.K., Rafal, P., Grazyna, diabetic foot risk - Diabetes type 2 without Global consensus guidelines type 2 diabetes patients
B., & Waldemar, K. factors in diabetic type diabetic foot on the management and 1) Significance
(2014). Diabetic foot risk 2 and risk factors for - Diabetic foot prevention of the diabetic - Gender male (OR=2.83)
factors in type 2 diabetes diabetic in healthy - Healthy subjects foot criteria, as an a wound, - Diabetes duration
patient: a cross-sectional infection and/or deep foot (OR=1.04)
case control study. tissues destruction localized - Weight (OR=1.04)
Journal of Diabetes & Exclusion criteria: in lower limb below the - Height (OR=1.08)
Individuals with dominating ankle in patients with
Metabolic Disorder, - Waist circumference
13:79 angiopathic of diabetic foot were diabetes complicated with
(OR=1.028)
disqualified from the study neuropathy and/or PAD
2) Not significance
Research type: - Age (OR=0.94)
Case control study b. The diabetic foot type
was defined with b.Risk factors for type
Statistical analysis: detailed physical diabetes in general
examination of population
- Logistic regression superficial sensation
- U Mann-Whitney (Significance)
impairment - Weight (OR=1.035)
- T- student tests with
STATISTICA 9PL - Waist circumference
(StatSoft,Inc) (OR=1.075)
c. Neuropathy was - Hip circumference (OR=1.03)
evaluated using - BMI (OR=2.49)
Factors measured: Thermo-tip - Hyperlipidemia (OR=0.54)
a.Diabetic foot risk factors in (temperature),
type 2 diabetes patients monofilament (touch),
- Gender Neuro-tip (pain), and
- Age Semmens-Weinstein
- Diabetes duration pitchfork (vibration)
- Weight
- Height d. The presence of pulse
- Waist circumference was assessed on dorsal
pedis and tibial posterior
b.Risk factors for type arteries
diabetes in general population
- Weight e. The criteria of
- Waist circumference hyperlipidemia were
- Hip circumference hipercholesterolaemia,
- BMI hipertrigliceridaemiaor
- Hyperlipidemia lipid-lowering
medications intake
17 Merza, Z & S. Tesfaye. The study or literature Review literatures Review literatures Risk factors of DFU in DM
(2003). The risk factors review will go through
for diabetic foot the various risk factors a. Diabetic neuropathy
ulceration. The Foot, 13; for diabetic foot - Chronic sensorimotor
125-129 ulceration - Autonomic neuropathy
b. Peripheral vascular disease
(PVD)
c. Biomechanical factors
d. Previous foot ulceration
e. Poor glycemic control
f. Long duration of DM
g. Race
h. Smoking
i. Retinopathy
j. Nephropathy
k. Insulin use and history of
poor vision
l. Age and male sex
m. Other factors
- Weight
- Height
18 Hokkam, E.N. (2009). The aims of the study Population: a. The socioeconomic a. Significance data of main
Assessment of ristk is to identify risk 300 diabetic patients where 180 status was classifies risk factors for DFU
factors in diabetic foot factors for diabetic diabetes patients with DFU and into low and accepted 1. Gender (male)
ulceration and their impact foot ulcer and their 120 diabetes patients without according to the (P=0.009)
on the outcome of the impact on the outcome DFU monthly income of 2. Type 2 diabetes
disease. Primary Care of the disease each person (low ≤150 (P=0.02)
Diabetes, 3: 219-224. Research Method: L.E and accepted > 150 3. Previous ulcer
Doi: Prospective study L.E) mention in Egypt (P=0.003)
10.1016/j.pcd.2009.08.009 human development 4. Chronic medical illness
Factors measured: report prepared by (P=0.005)
United Nations 5. Foot examination
a. Age Development (P=0.002)
b. Duration of diabetes Programme 6. Low socioeconomic
c. Gender (male) b. A standard general state (P=0.01)
d. Type 2 diabetes health examination was 7. Ischemia (P=0.004)
e. Insulin use performed to all 8. Neuropathy (P=0.006)
f. Previous ulcer patients focusing on 9. Anemia (P=0.003)
g. Chronic medical illness measurement of height 10. Duration of diabetes
h. Foot examination and weight (without (P=0.004)
i. Smoking shoes) for calculation 11. Poor of glycemic
j. Low economic state of body mass index control (P= 0.006)
k. Ischemia (BMI) 12. Presence of infection
l. Neuropathy c. Sensory neuropathy (P<0.001)
m. Renal insufficiency was considered positive b. Not significance data of
n. Retinopathy if three or more sensory main risk factors for DFU
o. Anemia modalities were absent 1. Age
p. Glycemic control d. The patient was 2. Insulin use
q. Infection considered to have 3. Smoking
peripheral vascular 4. Renal insufficiency
disease that may affect 5. Retinopathy
the development of
ulcer if there was
absent pulsation of
either the dorsalis pedis
or posterior tibial
artery, or ankle-
brachial systolic blood
pressure index <0.80
e. Chronic renal
insufficiency was
stratified as creatinine
> 4.0 mg/dl, current
dialysis or a history of
renal transplantation
f. Retinopathy was
assessed by one
independent
opthalmologist
19 Crawford, F, et al,. (2013). The study undertook a Search strategy: - The most significance results
Protocol for a systematic systematic review to Electronic search strategies were are Peripheral neuropathy and
review and individual determine the used to identify studies which excessive plantar pressure
patient data meta-analysis predictive values of assessed the predictive value of
of prognostic factors of such features in diagnostic tests, signs and
foot ulceration in people estimating the risk of symptoms using MEDLINE
with diabetes: the diabetic foot ulceration (1966-February 2005),
international research EMBASE (1980-March 2005),
collaboration for the CINAHL (1982-February 2005).
prediction of diabetic foot The electronic search strategy
ulcerations (PODUS). was developed from clinical
BMC Medical Research MeSH headings and test words.
Methodology, 13:22
Inclusion criteria:
Statistical analyses:
The study present estimates of
effectiveness where there were
two or more reports for
individual predictive factors.
As the review focused on a
single outcome (diabetic foot
ulceration) groups of patients
were categorized into those who
ulcerated and those who did not.
Continuous outcomes, expressed
as means and SDs were pooled
as weighted mean differences
(WMD). Peak plantar pressure
was measured using different
dynamic platform-based
equipment system, and
consequently a standardized
mean difference (SMD) was
used to pool data. Tests for
heterogeneity was evident, a
random effects model was used.
20 Boulton et al. (2008). This article reviews - - Risk factors of DFU in this
Comprehensive foot aims is to review the study are:
examination and risk prevention of DFU in
assessment. Diabetes diabetes patients a. Previous amputation
Care,31 (8) And identify the risk b. Past foot ulcer history
c. Peripheral neuropathy
factors of DFU, d. Foot deformity
screening test in e. Peripheral vascular
predict in DFU disease
f. Visual impairment
g. Diabetic nephropathy
(especially patients on
dialysis)
h. Poor glycemic control
i. Cigarette smoking
j. Past history
1) Ulceration
2) Amputation
3) Charcot joint
4) Vascular surgery
5) Angioplasty
6) Cigarette smoking
k. Neuropathic symptoms
l. Vascular symptoms
1) Claudication
2) Rest pain
3) Non-healing ulcer
m. Other diabetes
complications:
1) Renal (dialysis,
transplant)
2) Retinal (visual
impairment)
21 Rebolledo, F.A., Teran, S, The objective of this - - The risk factors for
& Jorge, E.P. (2011). The study is to make development of DFU in
pathogenesis of the pathogenesis of DFU diabetes patients are:
diabetic foot ulcer:
prevention and a. Physiopathology
Management. 1) hyperglycemia
Doi:10.5772/30325 b. Anatomical and structural
alterations
1) Peripheral sensory
neuropathy
2) Peripheral motor
neuropathy
3) Autonomic
neuropathy
c. Environmental influences
1) Limited joint mobility
2) The gait
22 Lavery, L.A., David, The objective of this Population: Diabetes mellitus was Risk factors of DFU:
G.A., Steven, A.V., Terri, study is to evaluate The study used 76 case patients stratified into type 1 or 2 Univariate
L, Q., & John, G.F. risk factors for foot and 149 control subjects based on the criteria
(1998). Practical criteria ulcerations among described by the National Significances:
for screening patients at persons with diabetes Inclusion criteria: Institutes of Health’s
high risk for diabetic foot mellitus National Diabetes Data a. Historical data
ulceration. Arch Intern a. The presence of diabetes Group 1) Sex (male) (P<0.001)
Med, 158; 157-162 mellitus based on World 2) Diabetes duration > 10
Health Organization criteria Renal function was stratified years (P<0.001)
b. Evaluation by medicine and using the following criteria: 3) Previous amputation
ophthalmology services (P<0.001)
within the past 3 months at - No albuminuria (<20 4) ≥1 subjective
the time of enrollment μg/min) vs micro- symptoms of
c. Glycosylated hemoglobin, albuminuria (20-200 neuropathy (P<0.001)
urinalysis, creatinine, and μg/min) 5) Lower extremity
blood urea nitrogen - Macro-albuminuria bypass (P<0.04)
laboratory studies performed (>200 μg/min) b. Diabetes comorbidities
in the past 3 months, and - Chronic renal 1) Nephropathy
d. Age 18-80 years old insufficiency (P<0.001)
(creatinine level > 350 2) Macro-albuminuria
μmol/L [>4.0 mg/dL] (P<0.001)
Exclusion criteria: - Current dialysis 3) End-stage renal disease
- History of renal (P<0.003)
a. Patients with ulcers on the transplantation 4) Retinopathy (P<0.001)
ankle or leg 5) History of retinopathy
(P<0.009)
The presence and severity of 6) Proliferative
Research design: diabetic retinopathy was retinopathy (P<0.005)
Case control assessed from centrally 7) Glycosylated
graded retinal photographs hemoglobin (P<0.001)
Statistical analyzes: taken with a wideangle c. Physical examination
Logistic regression camera 1) Loss of protective
sensation (P<0.001)
Factors measured: Retinopathy was classified 2) Plantar pressure
Univariate as none vs background or (P<0.001)
proliferative 3) Hallux rigidus, hallux
a. Historical data vagus or rigid toe
1) Sex Proliferative retinopathy deformity (P<0.001)
2) Diabetes duration > 10 was differentiated from 4) Ankle equinus
years background retinopathy by (P<0.005)
3) Previous amputation the presence of any 5) Limited subtalar joint
4) ≥1 subjective symptoms neovascularization, fibrous range of motion
of neuropathy proliferations, preretinal (P<0.009)
5) Lower extremity bypass hemorrhage, vitareous
6) Current or past tobacco hemorrhage, or
use photocoagulation scars Not significance
7) Alcohol abuse
8) Intermittent claudication Visual acuity was evaluated a. Historical data
b. Diabetes comorbidities using a Rosenbaum eye 1) Current or past tobacco
1) Nephropathy chart at the standard use (P=0.74)
2) Micro-albuminuria distance of 36 cm 2) Alcohol abuse (P=0.19)
3) Macro-albuminuria 3) Intermittent
4) End-stage renal disease Corrected vision was scored claudication (P=0.08)
5) Retinopathy as normal(<20/20), impaired b. Diabetes comorbidities
6) History of retinopathy (20/25 to 20/200), or legally 1) Micro-albuminuria
7) Proliferative retinopathy blind (>20/200) (P=0.90)
8) Glycosylated 2) Impaired vision
hemoglobin Peripheral neuropathy was (P=0.97)
9) Impaired vision assessed using vibration 3) Legally blind (P=0.09)
10) Legally blind perception threshold testing c. Physical examination
c. Physical examination at the distal great toe with 1) Unable to see bottom of
1) Loss of protective Biothesiometer (Biomedical foot ≥ 1 palpable foot
sensation Instrument Co, Newbury, pulse (P=0.49)
2) Plantar pressure Ohio) 2) Ankle-brachial index
3) Hallux rigidus, hallux >0.80 (P=0.1)
vagus or rigid toe 3) Transcutaneous oxygen
deformity Peripheral vascular disease pressure < 30 mmHg
4) Ankle equinus was assessed by several (P=0.85)
5) Limited subtalar joint dichotomous variables
range of motion included the Rose
6) Unable to see bottom of intermittent claudication Multivariate
foot ≥ 1 palpable foot scale (history of claudication Significance
pulse =score >10 points), absence
7) Ankle-brachial index of palpable dorsalis pedis 1) Loss of protective
>0.80 and posterior tibial pulses in sensation (P<0.001)
8) Transcutaneous oxygen the foot, transcutaneous 2) History of amputation
pressure < 30 mmHg oxygen tension on the dorsal (P<0.02)
aspect of the first 3) Elevated plantar
intermetatarsal space (<30 lpressure (P<0.001)
Multivariate mmHg), and ankle-brachial 4) ≥1 subjective
systolic blood pressure (< symptoms of
a. Loss of protective sensation 0.08) neuropathy (P<0.02)
b. History of amputation 5) Hallux rigidus, hallux
c. Elevated plantar pressure To categorize forefoot vagus, toe deformity
d. ≥1 subjective symptoms of deformities in addition to (P<0.03)
neuropathy hallux rigidus evaluated the 6) Poor diabetes control
e. Hallux rigidus, hallux vagus, foot for the presence of (P<0.03)
toe deformity hallux valgus, 7) Duration of diabetes >
f. Poor diabetes control toecontractures (hammer- 10 years (P<0.04)
g. Duration of diabetes > 10 toe, claw toe or mallet toe 8) Sex (Male) (P<0.05)
years deformities), subluxation or
h. Sex dislocation of the
metatarsophalangeal joints
and prominent metatarsal
heads on the sole of the foot
FACTORS ASSOCIATED WITH DFU BASED ON LITERATURE REVIEW
No Factors References
1 Age Ref. 1.4.7.11.13.14.15.17.22
2 Duration of DM Ref. 1.2.3.4.7.10.11.12.13.14.15.16.17.22
3 Neuropathy Ref. 1.2.3.4.5.9.10.11.12.13.14.15.17.18.19.20.21.22
4 Gender (male) Ref. 1.3.4.7.11.13.15.16.17.18
5 Occupation Ref. 1.14
6 History of claudication Ref. 1
7 Fasting blood glucose Ref. 1.2
8 HbA1c Ref. 1.2.8
9 Waist circumference Ref. 1.7.16
10 Hypertension Ref. 1.13
11 Peripheral Vascular Disease Ref. 1.2.3.5.9.10.11.12.15.17.19.20
12 Irregular exercise Ref. 1
13 Footwear inappropriate Ref. 1.5.14.17
14 Poor of knowledge & practice Ref. 1.14.18
foot care
15 Serum cholesterol Ref. 2
16 2h postpradial blood glucose Ref. 2
17 Smoking Ref. 2.5.7.9.17.20
18 Retinopathy Ref. 2.4.10.17.20
17 Previous foot ulcer Ref. 2.4.5.9.17.18.19.20
20 Previous foot amputation Ref. 2.5.9.19.20.22
21 Deformity Ref. 2.5.9.20.22
22 Poor joint mobility Ref. 2.3.12.19.21
23 Plantar pressure Ref. 3.8.19.22
24 Family history Ref. 4
25 Un-control blood glucose Ref. 4.15.17.20.22
26 Cardiovascular Ref. 4
27 Renal disease/ Nephropathy Ref. 4.12.17.20
28 Cerebrovascular accident Ref. 4.12
29 Opthalmic Ref. 4
30 Symptom of neuropathy Ref. 5.22
31 Symptom of PVD Ref. 5
32 Infection Ref. 5.15
33 Callus Ref. 5.14
34 Charcot arthropathy Ref. 5.9.12
35 Trauma (finger) Ref. 1.9
36 Spontaneous blister Ref. 1.10
37 Burn Ref. 1
38 Depression Ref. 6
39 Height Ref. 7.13.16.17
40 Insulin Ref. 7.17
41 Micro-vascular Ref. 7
No Factors References
42 Macro-vascular Ref. 7
43 Osteomyelitis Ref. 8.15
44 CRP Ref. 8
45 Osteoporosis Ref. 9
46 Mal-united fracture Ref. 9
47 Congenital abnormalities Ref. 9
48 Venous statis disease Ref. 9
49 Glycosylation of tissue Ref. 9
50 Collagen vascular disease Ref. 9
51 Angitis Ref. 9
52 Obesity Ref. 9
53 Malnutrition Ref. 9
54 Immobility Ref. 9.17
55 Miscalleneous Ref. 9
56 Dry, Cracked of foot skin Ref. 14
57 Residence : rural Ref. 14
58 Kidney disease Ref. 14
59 Fissure Ref. 12
60 Laser coagulation Ref. 12
61 Revascularization Ref. 12
62 Claudication Ref. 5.12
63 Coronary artery disease Ref. 12
64 Weight Ref. 13.16.17
65 Body Mass Index Ref. 13
66 Socio-economic Ref. 13.17.18
67 Marital status Ref. 13
68 Race Ref. 17
69 Biomechanical fracture Ref. 17
70 Type 2 DM Ref. 18
71 Chronic medical illness Ref. 18
72 Ischemic Ref. 18
73 Lower limb bypass procedure Ref. 19
74 Bio-molecular level/ Ref. 21
hyperglycemia
75 The Gait Ref. 21
Depression Age Duration of DM Co-morbidities disease
(22) (1.3.8.11.15.17.19. 21.22) (1.2.3.8.11.13.14.15. (3.5.7.10.11.12.13.14.15.
Pathway of DFU 16.17.18.19.20.21) 16.18.21)
Diabetes Patients
Micro and Macro
vascular
Physical Un-controlled (19)
Inactivity blood sugar Neuropathy
(3.12.14) (1.3.5.11.15) (1.2.3.4.5.7.8.9.11.12.13.14.
Hyperglycemia 15.16.17.18.21)
(9) History of claudication
↓ Knowledge ↓ Foot practice (14)
(7.14.17) (7.14.17) ↑HbA1c
Smoking (10.14.16) Sensory Motoric Autonomy
(3.5.6.12.16.19
PVD (6) (6) (6)
(2.3.4.5.6.
Skin itching Scratching Non-traumatic 8.11.12.13
↓ Foot care the skin
(14) Injury .14.16.18) Loss of Foot muscle Diminution in
(14) (14) (14) sensation damaging sweat and oil
(6) (6) gland function
Thrombosis, (6)
Malnutrition Hypoproteinemia Edema vasoconstriction,
Dry skin (12) (12) (12) platelet
(3.17) Not aware Imbalance Loss of
aggregation of trauma between flexion moisturize skin
(6) (6) and extension of (6)
BMI
(21) the affected foot
(6)
Plasma Exacerbation Dry skin
Sex (male) Obesity coagulation injury (3.17)
(12) (6) (9) Deformities
(1.2.3.7.8.11.14.15.19.20.21)
Marital status (1.5.6.12.16)
(21) Impairment
Occupation (farmer) of tissue Fissures Callus
(14.17) perfusion Excessive (18) (6.17)
(3) Charcot foot
Socio-economic plantar pressure (6.12.18)
(3.7.21) (1.2.4.10)
Infection
Spontaneous Ischemic (6.11)
Blister (7)
(13.14) History of ulceration
Unclear (3.4.5.6.7.12.15.16)
Sources:
process History of amputation
(1.4.5.6.12.16)
1) Lavery et al., 199
Diabetes Mellitus
(DM) Diabetic Foot Ulcer
(Focal stimuli) (DFU)
- Impact of
Role quality of life
function - Negative role
Sex (male) in social
Residual Idiophatic Marital status
stimuli factors Occupation
Socio-economic - Increase cost
- Burden families’
Interdependence economic
- Government burden
- Long hospitalization
RISK FACTORS AND THEIR TOOLS TO MEASURE THEM
9 Callus
(ref.12.15)
10 Fissures
(ref.12)
17 Marital status
(ref.6.13)
18 Occupation
(ref.15)
20 Body Mass Index (BMI) Height Antropometric (ref.2.16) The height related to increasing of
(ref. 6.13.15) (ref. 6. 16) demyelination comparing in
Weight individuals who have shorter lower
(ref. 13.16) limbs never fibers (ref.16)
Waist Circumference
(ref. 6.16)
21 Duration of diabetes
(ref. 2.6.12.16)
21 HbA1c Fasting blood glucose Laboratory test
(ref. 2.7) 2h-postpardial blood
glucose
23 History of ulceration
(ref.2.5.9)
24 History of amputation
(ref. 2.9)
25 Co-morbidities diseases
(ref.2.4.6.8.9.10.12.13)
ASSESSMENT TOOL TO ASSESS RISK OF DIABETIC FOOT ULCER (DFU)
A. General Information
Name
Age
Gender
Marital status
Occupation
Socio-economic
Duration of DM
History of ulceration
History of amputation
B. Specific Assessment
1. Neuropathy
a. Sensory
b. Motoric
c. Autonomy
4. Spontaneous blister
Left
Right
Total
5. Depression
Level
C. Behavior Assessment
1. Physical inactivity
2. Smoking
3. Malnutrition
D. Laboratory Test
E. Co-Morbidities Disease
1. Retinopathy
2. Renal disease
3. Cardiovascular
4. Stroke
5. Osteomyelitis
6. Osteoporosis
7. Mal-united fracture
8. Hypertension
10. Cerebrovascular
11. Others…..
References:
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