Diabetes, first described in ancient Egypt, remains at the forefront of health care in modern times. Roughly 537 million adults aged 20 to 79 years are living with diabetes worldwide, a number expected to rise over the next decades … Diabetic complications are vast. Diabetic foot infection (DFI) is a chronic, more severe complication that affects roughly 15% of people with diabetes. DFIs have been associated with decreased quality of life, frequent and prolonged hospitalizations and greater risk for lower extremity amputation … read more
Tag: peripheral neuropathy
Physical Training and Activity in People With Diabetic Peripheral Neuropathy
Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (ie, walking and stair climbing). Although many beneficial effects of exercise for people with diabetes have been well established, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered to be a contraindication for walking or any weight-bearing exercise because of concerns about injuring a person’s insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people who have DPN but do not have severe foot deformity. Emerging research has revealed positive adaptations in response to overload stress in these people, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This perspective article reviews the evidence for peripheral neuroplasticity in animal models and early clinical trials, as well as adaptations of the integumentary system and the musculoskeletal system in response to overload stress. These positive adaptations are proposed to promote improved function in people with DPN and to foster the paradigm shift to including weight-bearing exercise for people with DPN. This perspective article also provides specific assessment and treatment recommendations for this important, high-risk group … read more
Foot Sensation Testing in the Patient With Diabetes
Abstract: Introduction. Sensory testing of patients with diabetes is an integral part of preventing new and recurrent wounds. The Semmes-Weinstein monofilament (SWM) test is considered the gold standard to screen for loss of protective sensation; however, the authors’ experience has shown that it is not only time consuming, but is of negligible value for a patient with a diabetic foot ulcer (DFU).
Methods. This article discusses the shortfalls with regard to the SWM test and reviews other techniques for sensory evaluation. In addition, the Quick & Easy system is introduced, which combines sensory assessment with guidance for anesthesia requirements during wound debridements or other surgical interventions. Results. A scale ranging from grade 2 (normal sensation) to grade 0 (absent sensation) reflects the patient’s responses to wound manipulation, palpation of an underlying deformity, and/or evaluation of the difference between light touch sensation with the patient’s hands compared to the feet. For patients with total loss of sensation (grade 0), no anesthesia is needed for surgical procedures. If there is diminished sensation (grade 1), surgical intervention can be performed following administration of either topical or local anesthesia. For patients with normal sensation (grade 2), complete anesthesia of the surgical site will be required. A preliminary observation was conducted on 50 patients with DFUs using the Quick & Easy system. Anesthetic requirements were accurately predicted in all cases without the need to modify the type of anesthesia during the procedure. Conclusion. The Quick & Easy system serves as a simple sensory evaluation for a patient with a DFU and provides valuable anesthesia guidance for wound care procedures … read more
Spend a Minute, Save a Life
Inlow’s 60-Second Diabetic Foot Screen
Boulton states that “throughout our medical training, we are taught how to manage patients who present with symptoms, which usually leads to a clinical examination, a diagnosis, and a treatment and management plan. However, virtually no time is spent on teaching how to manage patients who have no symptoms because they have lost the ability to feel pain; that is, they have peripheral neuropathy.”1 Clinical experience and the literature1 have shown us that the lack of symptoms Boulton referred to in those with or at risk for diabetic foot complications can have devastating effects on the person, their family and health systems. As clinicians, we have the opportunity, and the obligation, to step in and fill the gap left when peripheral neuropathy is present, or potentially present, in any of our patients. The key is a simple, quick procedure: foot screening … read more