Clinical methods for assessing the diabetes foot at risk of ulceration: overview

Abstract

Background : The diabetic foot at risk of ulceration is the diabetic foot with risk factors for foot ulceration but without actual ulcers–graded 0 by the Wagener algorithm for the diabetic foot. Peripheral Neuropathy (PN) and peripheral vascular disease (PVD) are the major risk factor predisposing individuals with diabetes mellitus (DM) to foot ulceration. Methods : This article reviews these clinical methods of diagnosis of the diabetic foot at risk of ulceration. Result and discussion : Diagnosis of these risk factors depends on the presence of typical symptoms and signs but these may be subjective and mislead at times, as significant sounding symptoms may not indicated presence of genuine PN or PVD, while many asymptomatic patients may possess genuine PN or PVD. Objective methods of diagnosis of these risk factors are currently available. Bio Thesiometry and aesthesiometry screen for presence of PN and are rapid, reliable and reproducible methods of objectively diagnosing PN. The hand–held Doppler ultrasound device is currently the gold standard for non-invasive and rapid assessment of the adequacy of peripheral circulation through the determination of the Ankle Brachial index (ABI) and the Quality of Doppler Signal. Conclusion : The highly subjective nature of the symptoms and signs of the factors for foot ulceration in DM patient merits augmentation of diagnosis with these objective and more reliable methods of diagnosis to facilitate early intervention in those with these risk factors. This article reviews these clinical methods of diagnosis of the diabetic foot at risk of ulceration Keywords : diabetes mellitus, peripheral neuropathy, peripheral vascular disease, bio- thesimetry, aesthesiometry, doppler ultrasound Tropical Journal of Medical Research Vol. 9(1) 2005: 21-27