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

Reducing Foot Complications for People with Diabetes
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arteries, calcification of vessels, and altered sensation may influence assessment findings. It
has, however, been shown that absence of both pedal pulses (dorsalis pedis and posterior
tibialis) may be associated with the presence of PVD. A positive history of lower limb
intermittent claudication combined with non-palpable pedal pulses bilaterally increases the
likelihood of identifying PVD in diabetes (Boyko et al., 1997).
The ankle-brachial index (ABI), or ratio of blood pressure in the lower extremity to blood
pressure in the arm, may be the best clinical measure of reduced circulation and is strongly
associated with impaired lower extremity wound healing and amputation. An ABI of < 0.8 has
been reported to be up to 95% sensitive and 100% specific in detecting PVD (Boyko et al., 1999).
Findings can be confounded by the presence of arterial calcification.
Since measurement of ABI is not a part of usual clinical practice for most nurses, and the outcome
of this assessment by individuals with varying experience will differ significantly, it has not been
included as a routine assessment technique in this guideline. Appropriately trained and
experienced nurses may, however, wish to include it as part of their assessment of foot ulcer risk.
Self-care behaviour and knowledge
There is evidence to support the value of assessing the self-care behaviour and knowledge of
people with diabetes. Evidence points to greater problems, such as “3.2 increased risk of
amputation” (Mason et al.,1999b, p. 802) where there is lack of foot care and foot care knowledge.
On the other hand, foot care education is linked with increased foot care knowledge, foot care
behaviours (CDA, 1998; Hutchinson et al., 2000; NZGG, 2000; Valk et al., 2002) and reduced amputation
risk (Reiber, Pecoraro & Koepsell, 1992).
Refer to Appendix C for an example of a Risk Assessment Algorithm.