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Review: The clinical evaluation of lower limb perfusion in diabetic foot disease

Patricia Price

Keith G Harding

Wound Healing Research Unit, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK, hardingkg{at}whru.co.uk

Athorough clinical assessment and evaluation of foot perfusion is essential in managing diabetic foot disease. The treatment of macrovascular disease is key to reducing the high amputation rates seen in diabetic patients, particularly as small vessel dysfunction may make diabetic individuals more vulnerable to the effects of macrovascular, atherosclerotic disease. The clinical assessment remains paramount in the management of diabetic foot disease. The confounding effects of peripheral neuropathy on the symptoms and signs of lower limb arterial insufficiency can make assessment difficult. This article provides a resume of the clinical manifestation of lower limb ischaemia and neuropathy and the importance of accurate evaluation of the diabetic foot.

Key Words: diabetic foot • neuropathy • peripheral vascular disease.

References

• Van Houtum WH, Lavery LA, Harkless LB The impact of diabetes-related lower-extremity amputations in The Netherlands. J Diabetes Complications 1996;10:325-30.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Boulton AJM. The diabetic foot: a major problem for the new millennium. Int Diab Monitor 2001;13:1-7.
• Edmunds ME Progress in care of the diabetic foot. Lancet 1999;354: 270-2.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• McNeely MJ, Boyko EJ, Ahroni JH et al. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. How great are the risks? Diabetes Care 1995;18:216-19.[Abstract]
• Alder AL, Boyko EJ, Ahroni JH, Smith DG Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy and foot ulcers. Diabetes Care 1999;22:1029-35.[Abstract/Free Full Text]
• Boyko EJ, Ahroni JH, Davignon D., Stensel V., Prigeon RL, Smith DG Diagnostic utility of the history and physical examination for peripheral vascular disease among patients with diabetes mellitus. J Clin Epidemiology 1997;50:659-68.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Rosenblum BI, Pomposelli FB Jr, Giurini JM et al. Maximising foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes. A 5-year experience. Diabetes Care 1994;17:983-7.[Abstract]
• Tan JS, Friedman NM, Hazelton-Miller C., Flanagan JP, File TM Jr. Can aggressive treatment of diabetic foot infections reduce the need for above-knee amputation? Clin Infect Dis 1996;23:286-91.[Web of Science][Medline] [Order article via Infotrieve]
• McGee SR, Boyko EJ Physical examination and chronic lower-extremity ischemia: a critical review. Arch Intern Med 1998;158:1357-64.[Abstract/Free Full Text]
• Menzoian JO, LaMorte WW, Paniszyn CC et al. Symptomatology and anatomic patterns of peripheral vascular disease: differing impact of smoking and diabetes. Ann Vasc Surg 1989;3:224-8.[Medline] [Order article via Infotrieve]
• Marinelli MR, Beach KW, Glass MJ, Primozich JF, Strandness DE Jr. Noninvasive testing vs clinical evaluation of arterial disease. A prospective study. JAMA 1979;241:2031-4.
• Rutherford RB Initial Patient evaluation: The vascular consultation. In Rutherford RB, ed. Vascular surgery. 5th edition. Philadelphia: WB Saunders, 2000:1-19.
• Goebel FD, Fuessl HS Monckeberg's sclerosis after sympathetic denervation in diabetic and non-diabetic subjects. Diabetologia 1983;24:347-50.[Web of Science][Medline] [Order article via Infotrieve]
• Faglia E., Favales F., Quarantiello A. et al. Angiographic evaluation of peripheral arterial occlusive disease and its role as a prognostic determinant for major amputation in diabetic subjects with foot ulcers. Diabetes Care 1998;21:625-30.[Abstract]
• Williams DT, Price P., Harding KG An evaluation of screening methods for the arterial component of diabetic foot disease in the community (O43). Proceedings of the 4th International Symposium on The Diabetic Foot. 2003;64.
• European Working Group on critical leg ischaemia. Second European consensus document on chronic critical leg ischaemia. Eur J Vasc Surg 1992;6(suppl A):1-32.[Medline] [Order article via Infotrieve]
• Williams PL, Warwick R, ed. Gray's Anatomy 36th edition. Edinburgh: Churchill Livingstone, 1980:731-6.
• Boyko EJ, Ahroni JH, Stensel VL Skin temperature in the neuropathic diabetic foot. J Diabetes Complications 2001;15:260-4.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Purewal TS, Goss DE, Watkins PJ, Edmonds ME Lower limb venous pressure in diabetic neuropathy. Diabetes Care 1995;18:377-81.[Abstract]
• Apelqvist J., Bakker K., van Houtum WH, Nabuurs-Franssen MH, Schaper NC International consensus and practical guidelines on the management and the prevention of the diabetic foot. International working group on the diabetic foot. Diabetes Metab Res Rev 2000;16(suppl 1):S84-S92.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Tesfaye S. Diabetic neuropathy: achieving best practice. Br J Diabetes Vasc Dis 2003;3:112-17.[Abstract/Free Full Text]
• The International Working Group on the Diabetic Foot. International Consensus on the Diabetic Foot. 2003.
• Brooks B., Dean R., Patel S., Wu B., Molyneaux L., Yue DK TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Diabet Med 2001;18:528-32.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Uccioli L., Monticone G., Durola L. et al. Autonomic neuropathy influences great toe blood pressure. Diabetes Care 1994;17:284-7.[Abstract]
• Aly S., Sommerville K., Adiseshiah M., Raphael M., Coleridge Smith PD, Bishop CC Comparison of duplex imaging and arteriography in the evaluation of lower limb arteries. Br J Surg 1998;85:1099-102.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Bagi P., Sillesen H., Bitsch K., Hansen HJ Doppler waveform analysis in evaluation of occlusive arterial disease in the lower limb: comparison with distal blood pressure measurement and arteriography. Eur J Vasc Surg 1990;4:305-11.[CrossRef][Medline] [Order article via Infotrieve]
• Kalani M., Brismar K., Fagrell B., Ostergren J., Jorneskog G. Transcutaneous oxygen tension and toe blood pressure as predictors for outcome of diabetic foot ulcers. Diabetes Care 1999;22:147-51.[Abstract/Free Full Text]
• de Graaff JC, Ubbink DT, Legemate DA, de Haan RJ, Jacobs MJ The usefulness of a laser Doppler in the measurement of toe blood pressures. J Vasc Surg 2000;3:1172-9.
• Jorneskog G., Brismar K., Fagrell B. Skin capillary circulation is more impaired in the toes of diabetic than non-diabetic patients with peripheral vascular disease. Diabet Med 1995;12:36-41.[Web of Science][Medline] [Order article via Infotrieve]

The British Journal of Diabetes & Vascular Disease, Vol. 3, No. 6, 394-398 (2003)
DOI: 10.1177/14746514030030060201


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Williams, D. T Articles by Harding, K. G Search for Related Content Social Bookmarking                         What's this?