Diabetic Foot, Causes, Risk Factors, and Clinical Evaluation. Including Pathophysiology(Neuropathy and Peripheral Artery Disease), Clinical Evaluation(general assessment, foot exam, artery and sensation check up)

1. Diabetic Foot
Causes, Risk Factors and
Clinical Evaluation
Reference:
Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359
David G. Armstrong et al. Diabetic Foot Ulcers and Their Recurrence. N Engl J
Med 2017; 376:2367-2375
Summarized By Yung-Tsai Chu

2. Pathway of Diabetic Foot Ulcer
Poor
Glycemic
Control
Neuropathy
Peripheral Artery Disease
Sensory
Motor
Autonomic
Loss of Protective Sensation
Less Sweating→ Dry Skin
Foot Deformity
Reference: David G. Armstrong et al. Diabetic Foot Ulcers and Their Recurrence.N Engl J Med 2017; 376:2367-2375

3. Risk Factors of Recurrence
High Vibration Threshold
Presence of Preulcerative Lesion
Presence of Peripheral Artery Disease
Presence of Osteomyelitis
Geriatric Depression Scale >= 10
CRP > 1.5mg/dL
HbA1c >7.5%
Reference: David G. Armstrong et al. Diabetic Foot Ulcers and Their Recurrence.N Engl J Med 2017; 376:2367-2375

4. Clinical Evaluation
Foot Examination
Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359
General Assessment Signs of Sepsis Visibly Unwell, Drowsy, Fever etc.
Active Disease Ulcer, Rest Pain, Gangrene, Cellulitis
Temp and Color
Ischemia: Cold, Pale/Dusky
Acute Charcot Foot: Warm, Red or
Swollen
Nails, Callus, Maceration, Pes Cavus,
Skin Fissures, Claw/Hammer Toes,
Rocker Bottom Foot, Fungal Infection
Lesions or
Deformities
(DEF)

5. Clinical Evaluation
Foot Examination
Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359
General Assessment Signs of Sepsis Visibly Unwell, Drowsy, Fever etc.
Active Disease Ulcer, Rest Pain, Gangrene, Cellulitis
Temp and Color
Ischemia: Cold, Pale/Dusky
Acute Charcot Foot: Warm, Red or
Swollen
Lesions or
Deformities
(DEF)
Nails, Callus, Maceration, Pes Cavus,
Skin Fissures, Claw/Hammer Toes,
Rocker Bottom Foot, Fungal Infection
Urgent Referral

6. Clinical Evaluation
Foot Examination
Loss of Protective Sensation
(LOPS)
Peripheral Artery Disease
(PAD)
Pinprick Monofilament
Vibration Tuning Fork
Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359
General Assessment
History of Intermittent Claudication
Posterior Tibial Artery
Dorsalis Pedis Artery
Foot Pulses
Ankle-Brachial Index < 0.9

7. Risk Assessment and Referrals
Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359
Presentation Management Follow-up
Low Risk Callus Alone
Patient Education
Glycemic Control, Foot care
Every Year
Medium Risk 1 of Followings:
Deformity, LOPS or PAD
Patient Education
Manage PAD
● Statin + Antiplatelet
● Exercise
● Vascular Intervention
Every
3-6 Months
High Risk
● Previous Amputation or
Ulceration
● 2 of Followings:
Deformity, LOPS or PAD
Diabetic Foot Center
Foot Protection Services
Surgical Management
Every
1-2 months