Document Detail

Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings.
MedLine Citation:
PMID:  10333919     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the frequency and constellations of anatomic, pathophysiologic, and environmental factors involved in the development of incident diabetic foot ulcers in patients with diabetes and no history of foot ulcers from Manchester, U.K., and Seattle, Washington, research settings. RESEARCH DESIGN AND METHODS: The Rothman model of causation was applied to the diabetic foot ulcer condition. The presence of structural deformities, peripheral neuropathy, ischemia, infection, edema, and callus formation was determined for diabetic individuals with incident foot ulcers in Manchester and Seattle. Demographic, health, diabetes, and ulcer data were ascertained for each patient. A multidisciplinary group of foot specialists blinded to patient identity independently reviewed detailed abstracts to determine component and sufficient causes present and contributing to the development of each patient's foot ulcer. A modified Delphi process assisted the group in reaching consensus on component causes for each patient. Estimates of the proportion of ulcers that could be ascribed to each component cause were computed. RESULTS: From among 92 study patients from Manchester and 56 from Seattle, 32 unique causal pathways were identified. A critical triad (neuropathy, minor foot trauma, foot deformity) was present in > 63% of patient's causal pathways to foot ulcers. The components edema and ischemia contributed to the development of 37 and 35% of foot ulcers, respectively. Callus formation was associated with ulcer development in 30% of the pathways. Two unitary causes of ulcer were identified, with trauma and edema accounting for 6 and < 1% of ulcers, respectively. The majority of the lesions were on the plantar toes, forefoot, and midfoot. CONCLUSIONS: The most frequent component causes for lower-extremity ulcers were trauma, neuropathy, and deformity, which were present in a majority of patients. Clinicians are encouraged to use proven strategies to prevent and decrease the impact of modifiable conditions leading to foot ulcers in patients with diabetes.
G E Reiber; L Vileikyte; E J Boyko; M del Aguila; D G Smith; L A Lavery; A J Boulton
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Diabetes care     Volume:  22     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-07-13     Completed Date:  1999-07-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  157-62     Citation Subset:  IM    
Department of Health Services, University of Washington, Seattle, USA.
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MeSH Terms
Aged, 80 and over
Diabetes Mellitus / physiopathology*
Diabetic Angiopathies / physiopathology
Diabetic Neuropathies / physiopathology
England / epidemiology
Foot Ulcer / epidemiology*,  etiology*,  physiopathology
Ischemia / physiopathology
Middle Aged
Washington / epidemiology
Wounds and Injuries

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