Practical criteria for screening patients at high risk for diabetic foot ulceration

Lawrence A. Lavery, David G Armstrong, Steven A. Vela, Terri L. Quebedeaux, John G. Fleischli

Research output: Contribution to journalArticle

301 Citations (Scopus)

Abstract

Background: A comprehensive understanding of clinical risk factors for developing foot ulcerations would help clinicians to categorize patients by their risk status and schedule intervention resources accordingly to prevent amputation. Objective: To evaluate risk factors for foot ulcerations among persons with diabetes mellitus. Method: We enrolled 225 age-matched patients, 46.7% male, with a ratio of approximately 1:2 cases: controls (76 case- patients and 149 control subjects). Case-patients were defined as subjects who met the enrollment criteria and who had an existing foot ulceration or a recent history of a foot ulceration. Control subjects were defined as subjects with no history of foot ulceration. A stepwise logistic regression model was used for analysis. Results: An elevated plantar pressure (>65 N/cm2), history of amputation, lengthy duration of diabetes (>10 years), foot deformities (hallux rigidus or hammer toes), male sex, poor diabetes control (glycosylated hemoglobin >9%), 1 or more subjective symptoms of neuropathy, and an elevated vibration perception threshold (>25 V) were significantly associated with foot ulceration. In addition, 59 patients (78%) with ulceration had a rigid deformity directly associated with the site of ulceration. No significant associations were noted between vascular disease, level of formal education, nephropathy, retinopathy, impaired vision, or obesity and foot ulceration on multivariate analysis. Conclusions: Neuropathy, foot deformity, high plantar pressures, and a history of amputation are significantly associated with the presence of foot ulceration. Although vascular and renal disease may result in delayed wound healing and subsequent amputation, they are not significant risk factors for the development of diabetic foot ulceration.

Original languageEnglish (US)
Pages (from-to)157-162
Number of pages6
JournalArchives of Internal Medicine
Volume158
Issue number2
DOIs
StatePublished - 1998
Externally publishedYes

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Diabetic Foot
Foot
Amputation
Foot Deformities
Vascular Diseases
Hammer Toe Syndrome
Hallux Rigidus
Logistic Models
Pressure
Glycosylated Hemoglobin A
Vibration
Wound Healing
Diabetes Mellitus
Appointments and Schedules
Multivariate Analysis
Obesity
Kidney
Education

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Practical criteria for screening patients at high risk for diabetic foot ulceration. / Lavery, Lawrence A.; Armstrong, David G; Vela, Steven A.; Quebedeaux, Terri L.; Fleischli, John G.

In: Archives of Internal Medicine, Vol. 158, No. 2, 1998, p. 157-162.

Research output: Contribution to journalArticle

Lavery, Lawrence A. ; Armstrong, David G ; Vela, Steven A. ; Quebedeaux, Terri L. ; Fleischli, John G. / Practical criteria for screening patients at high risk for diabetic foot ulceration. In: Archives of Internal Medicine. 1998 ; Vol. 158, No. 2. pp. 157-162.
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