Reducing Foot Complications for People with Diabetes - Registered ...

Reducing Foot Complications for People with Diabetes
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There are other factors that are linked with the risk of foot ulcers such as smoking habits, an
exercise injury of the insensate foot, visual difficulties and socioeconomic factors, etc. –
these, however, are not consistently supported by research.
History and presence of foot ulcers
Significant evidence supports a causal link between the presence of peripheral neuropathy,
foot deformity, minor trauma and a previous history of foot ulceration and the development
of future foot ulcers (Boyko et al., 1997; Reiber et al., 1999; Mayfield et al., 1998). Recurrence rates for
foot ulcers may be as high as 50-70% over 3-5 years (ADA, 1999; Apelqvist, Larsson & Agardh, 1993;
Bloomgarden, 2001). Foot ulceration is associated with a 2 to 10.5 fold increased risk of lower
extremity amputation (Mayfield et al., 1998) and a foot ulceration history is described as
preceding approximately 85% of lower extremity amputations (Pecoraro, Reiber & Burgess, 1990).
Nurses are frequently in contact with people with diabetes and have a prime opportunity to
conduct a risk assessment for the development of foot ulcers and amputation, as well as to
plan and direct interventions aimed at minimizing identified risk factors. In the presence of
a positive history for foot ulcers, it is the consensus recommendation of this panel that the
individual be assigned a “higher risk” status for foot ulceration and referral made to a
diabetes foot specialist.
Sensation
There is strong evidence to support assessing foot sensation using a 10-gram, 5.07
Semmes-Weinstein monofilament. The point at which a 10-gram filament buckles when
pressure is applied is highly correlated to the loss of protective sensation in the presence of
diabetes (ADA, 2001; Campbell et al., 2000; Frykberg et al., 2000; Hunt, 2001; Hutchinson et al., 2000; ICSI,
2000; Lavery & Gazewood, 2000; McCabe, Stevenson & Dolan, 1998; NZGG, 2000; Smieja et al., 1999;
Zangaro & Hull, 1999).
There are discrepant recommendations regarding the number of sites on the foot to test with
the Semmes-Weinstein monofilament. One technical review (Mayfield & Sugarman, 2000) and one
multi-center cross-sectorial study (Smieja et al., 1999) recommend testing more than one site
on the foot to assess sensation. Some suggest that testing less sensitive areas such as the heel
and the dorsum provide little additional information (Mayfield & Sugarman, 2000). Smieja et al.
(1999) conducted a clinical trial comparing eight-site versus four-site evaluation. They found
that testing four rather than eight sites identified 90% of insensate feet. Based on these