Clinical examination and risk classification of the diabetic foot

Lawrence A. Lavery, David G Armstrong

Research output: Chapter in Book/Report/Conference proceedingChapter

3 Citations (Scopus)

Abstract

Foot ulceration is one of the most common precursors to lower extremity amputations among persons with diabetes (Singh et al., JAMA. 2005; 293(2):217-28; Boulton and Vileikyte, Wounds. 2000; 12(Suppl B):12B-8; Reiber et al., Rehabil Res Dev. 2001; 38(3):309-17). Ulcerations are pivotal events in limb loss for two important reasons. They allow an avenue for infection (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167- 77), and they can cause progressive tissue necrosis and poor wound healing in the presence of critical ischemia. Infections involving the foot rarely develop in the absence of a wound in adults with diabetes, and ulcers are the most common type of wound in this population (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167-77). Foot ulcers, therefore, play a central role in the causal pathway to lower extremity amputation (Pecoraro et al., Diabetes Care. 1990; 13:513-21). The etiology of ulcerations in persons with diabetes is commonly associated with the presence of peripheral neuropathy and repetitive trauma due to normal walking activities to areas of the foot exposed to moderate or high pressure and shear forces (Armstrong et al., J Foot Ankle Surg. 1998; 37(4):303-7). Foot deformities, limited joint mobility, partial foot amputations, and other structural deformities often predispose diabetics with peripheral neuropathy to abnormal weight bearing, areas of concentrated pressure, and abnormal shear forces that significantly increase their risk of ulceration (Cavanagh et al., Diabet Med. 1996; 13 Suppl 1:S17-22; Lavery et al., Diabetes Care. 1996; 19(8):818-21; Diabetes Care. 1995; 18(11):1460-2). Brand (The diabetic foot. In: Diabetes mellitus, theory and practice. Medical Examination) theorized that when these types of forces were applied to a discrete area over an extended period they would cause a local inflammatory response, focal tissue ischemia, tissue destruction, and ulceration. Clearly, identification of persons at risk for ulceration is of central importance in any plan for amputation prevention and diabetes care.

Original languageEnglish (US)
Title of host publicationThe Diabetic Foot
Subtitle of host publicationMedical and Surgical Management: Third Edition
PublisherHumana Press Inc.
Pages59-74
Number of pages16
ISBN (Electronic)9781617797910
ISBN (Print)9781617797903
DOIs
StatePublished - Jan 1 2012

Fingerprint

Diabetic Foot
Foot
Amputation
Wounds and Injuries
Peripheral Nervous System Diseases
Lower Extremity
Ischemia
Foot Ulcer
Foot Deformities
Pressure
Weight-Bearing
Infection
Ankle
Wound Healing
Ulcer
Walking
Diabetes Mellitus
Necrosis
Extremities
Joints

Keywords

  • Assessing a diabetic foot wound
  • Diabetic foot risk
  • Diabetic foot ulcer classification
  • Foot pathology
  • Limited joint mobility
  • Modified neuropathy disability score
  • Semmes-Weinstein monofilament
  • Sensory neuropathy
  • Tuning fork
  • UT ulcer classification
  • Vibration perception threshold
  • Wagner ulcer classifications

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lavery, L. A., & Armstrong, D. G. (2012). Clinical examination and risk classification of the diabetic foot. In The Diabetic Foot: Medical and Surgical Management: Third Edition (pp. 59-74). Humana Press Inc.. https://doi.org/10.1007/978-1-61779-791-0_4

Clinical examination and risk classification of the diabetic foot. / Lavery, Lawrence A.; Armstrong, David G.

The Diabetic Foot: Medical and Surgical Management: Third Edition. Humana Press Inc., 2012. p. 59-74.

Research output: Chapter in Book/Report/Conference proceedingChapter

Lavery, LA & Armstrong, DG 2012, Clinical examination and risk classification of the diabetic foot. in The Diabetic Foot: Medical and Surgical Management: Third Edition. Humana Press Inc., pp. 59-74. https://doi.org/10.1007/978-1-61779-791-0_4
Lavery LA, Armstrong DG. Clinical examination and risk classification of the diabetic foot. In The Diabetic Foot: Medical and Surgical Management: Third Edition. Humana Press Inc. 2012. p. 59-74 https://doi.org/10.1007/978-1-61779-791-0_4
Lavery, Lawrence A. ; Armstrong, David G. / Clinical examination and risk classification of the diabetic foot. The Diabetic Foot: Medical and Surgical Management: Third Edition. Humana Press Inc., 2012. pp. 59-74
@inbook{abbb0e62adfe46bc8bc5025c3b153866,
title = "Clinical examination and risk classification of the diabetic foot",
abstract = "Foot ulceration is one of the most common precursors to lower extremity amputations among persons with diabetes (Singh et al., JAMA. 2005; 293(2):217-28; Boulton and Vileikyte, Wounds. 2000; 12(Suppl B):12B-8; Reiber et al., Rehabil Res Dev. 2001; 38(3):309-17). Ulcerations are pivotal events in limb loss for two important reasons. They allow an avenue for infection (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167- 77), and they can cause progressive tissue necrosis and poor wound healing in the presence of critical ischemia. Infections involving the foot rarely develop in the absence of a wound in adults with diabetes, and ulcers are the most common type of wound in this population (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167-77). Foot ulcers, therefore, play a central role in the causal pathway to lower extremity amputation (Pecoraro et al., Diabetes Care. 1990; 13:513-21). The etiology of ulcerations in persons with diabetes is commonly associated with the presence of peripheral neuropathy and repetitive trauma due to normal walking activities to areas of the foot exposed to moderate or high pressure and shear forces (Armstrong et al., J Foot Ankle Surg. 1998; 37(4):303-7). Foot deformities, limited joint mobility, partial foot amputations, and other structural deformities often predispose diabetics with peripheral neuropathy to abnormal weight bearing, areas of concentrated pressure, and abnormal shear forces that significantly increase their risk of ulceration (Cavanagh et al., Diabet Med. 1996; 13 Suppl 1:S17-22; Lavery et al., Diabetes Care. 1996; 19(8):818-21; Diabetes Care. 1995; 18(11):1460-2). Brand (The diabetic foot. In: Diabetes mellitus, theory and practice. Medical Examination) theorized that when these types of forces were applied to a discrete area over an extended period they would cause a local inflammatory response, focal tissue ischemia, tissue destruction, and ulceration. Clearly, identification of persons at risk for ulceration is of central importance in any plan for amputation prevention and diabetes care.",
keywords = "Assessing a diabetic foot wound, Diabetic foot risk, Diabetic foot ulcer classification, Foot pathology, Limited joint mobility, Modified neuropathy disability score, Semmes-Weinstein monofilament, Sensory neuropathy, Tuning fork, UT ulcer classification, Vibration perception threshold, Wagner ulcer classifications",
author = "Lavery, {Lawrence A.} and Armstrong, {David G}",
year = "2012",
month = "1",
day = "1",
doi = "10.1007/978-1-61779-791-0_4",
language = "English (US)",
isbn = "9781617797903",
pages = "59--74",
booktitle = "The Diabetic Foot",
publisher = "Humana Press Inc.",

}

TY - CHAP

T1 - Clinical examination and risk classification of the diabetic foot

AU - Lavery, Lawrence A.

AU - Armstrong, David G

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Foot ulceration is one of the most common precursors to lower extremity amputations among persons with diabetes (Singh et al., JAMA. 2005; 293(2):217-28; Boulton and Vileikyte, Wounds. 2000; 12(Suppl B):12B-8; Reiber et al., Rehabil Res Dev. 2001; 38(3):309-17). Ulcerations are pivotal events in limb loss for two important reasons. They allow an avenue for infection (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167- 77), and they can cause progressive tissue necrosis and poor wound healing in the presence of critical ischemia. Infections involving the foot rarely develop in the absence of a wound in adults with diabetes, and ulcers are the most common type of wound in this population (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167-77). Foot ulcers, therefore, play a central role in the causal pathway to lower extremity amputation (Pecoraro et al., Diabetes Care. 1990; 13:513-21). The etiology of ulcerations in persons with diabetes is commonly associated with the presence of peripheral neuropathy and repetitive trauma due to normal walking activities to areas of the foot exposed to moderate or high pressure and shear forces (Armstrong et al., J Foot Ankle Surg. 1998; 37(4):303-7). Foot deformities, limited joint mobility, partial foot amputations, and other structural deformities often predispose diabetics with peripheral neuropathy to abnormal weight bearing, areas of concentrated pressure, and abnormal shear forces that significantly increase their risk of ulceration (Cavanagh et al., Diabet Med. 1996; 13 Suppl 1:S17-22; Lavery et al., Diabetes Care. 1996; 19(8):818-21; Diabetes Care. 1995; 18(11):1460-2). Brand (The diabetic foot. In: Diabetes mellitus, theory and practice. Medical Examination) theorized that when these types of forces were applied to a discrete area over an extended period they would cause a local inflammatory response, focal tissue ischemia, tissue destruction, and ulceration. Clearly, identification of persons at risk for ulceration is of central importance in any plan for amputation prevention and diabetes care.

AB - Foot ulceration is one of the most common precursors to lower extremity amputations among persons with diabetes (Singh et al., JAMA. 2005; 293(2):217-28; Boulton and Vileikyte, Wounds. 2000; 12(Suppl B):12B-8; Reiber et al., Rehabil Res Dev. 2001; 38(3):309-17). Ulcerations are pivotal events in limb loss for two important reasons. They allow an avenue for infection (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167- 77), and they can cause progressive tissue necrosis and poor wound healing in the presence of critical ischemia. Infections involving the foot rarely develop in the absence of a wound in adults with diabetes, and ulcers are the most common type of wound in this population (Armstrong and Lipsky, Diabetes Technol Ther. 2004; 6:167-77). Foot ulcers, therefore, play a central role in the causal pathway to lower extremity amputation (Pecoraro et al., Diabetes Care. 1990; 13:513-21). The etiology of ulcerations in persons with diabetes is commonly associated with the presence of peripheral neuropathy and repetitive trauma due to normal walking activities to areas of the foot exposed to moderate or high pressure and shear forces (Armstrong et al., J Foot Ankle Surg. 1998; 37(4):303-7). Foot deformities, limited joint mobility, partial foot amputations, and other structural deformities often predispose diabetics with peripheral neuropathy to abnormal weight bearing, areas of concentrated pressure, and abnormal shear forces that significantly increase their risk of ulceration (Cavanagh et al., Diabet Med. 1996; 13 Suppl 1:S17-22; Lavery et al., Diabetes Care. 1996; 19(8):818-21; Diabetes Care. 1995; 18(11):1460-2). Brand (The diabetic foot. In: Diabetes mellitus, theory and practice. Medical Examination) theorized that when these types of forces were applied to a discrete area over an extended period they would cause a local inflammatory response, focal tissue ischemia, tissue destruction, and ulceration. Clearly, identification of persons at risk for ulceration is of central importance in any plan for amputation prevention and diabetes care.

KW - Assessing a diabetic foot wound

KW - Diabetic foot risk

KW - Diabetic foot ulcer classification

KW - Foot pathology

KW - Limited joint mobility

KW - Modified neuropathy disability score

KW - Semmes-Weinstein monofilament

KW - Sensory neuropathy

KW - Tuning fork

KW - UT ulcer classification

KW - Vibration perception threshold

KW - Wagner ulcer classifications

UR - http://www.scopus.com/inward/record.url?scp=84893549799&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893549799&partnerID=8YFLogxK

U2 - 10.1007/978-1-61779-791-0_4

DO - 10.1007/978-1-61779-791-0_4

M3 - Chapter

AN - SCOPUS:84893549799

SN - 9781617797903

SP - 59

EP - 74

BT - The Diabetic Foot

PB - Humana Press Inc.

ER -