• 1

    Palumbo PJ, Melton L: “Peripheral Vascular Disease and Diabetes,” in Diabetes in America, p 401, US Government Printing Office, Washington, DC. ,1985. .

  • 2

    Leibson CL, Ransom JE, Olson W, et al: Peripheral arterial disease, diabetes, and mortality. .Diabetes Care 27::2843. ,2004. .

  • 3

    Hooi JD, Kester AD, Stoffers HE, et al: Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study. .Am J Epidemiol 153::666. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Palumbo PJ, O’Fallon M, Osmundson PJ, et al: Progression of peripheral occlusive arterial disease in diabetes mellitus. .Arch Intern Med 151::717. ,1991. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Rendell M, Bamisedun O: Diabetic cutaneous microangiopathy. .Am J Med 93::611. ,1992. .

  • 6

    Ngo BT, Hayes KD, DiMiao DJ, et al: Manifestations of cutaneous diabetic microangiopathy. .Am J Clin Dermatol 6::225. ,2005. .

  • 7

    Kasalova Z, Prazny M, Skrha J: Relationship between peripheral diabetic neuropathy and microvascular reactivity in patients with type 1 and type 2 diabetes mellitus: neuropathy and microcirculation in diabetes. .Exp Clin Endocrinol Diabetes 114::52. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Lahoz C, Mostaza JM: Atherosclerosis as a systemic disease. .Rev Esp Cardiol 60::184. ,2007. .

  • 9

    Belcaro G, Nicolaides AN, Volteas N, et al: Skin flow the venoarteriolar response and capillary filtration in diabetics: a 3-year follow-up. .Angiology 43::490. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Rayman G, Hassan A, Tooke JE: Blood flow in the skin of the foot related to posture in diabetes mellitus. .Br Med J (Clin Res Ed) 292::87. ,1986. .

    • Search Google Scholar
    • Export Citation
  • 11

    Delbridge L, Appleberg M, Reeve TS: Factors associated with development of foot lesions in the diabetic. .Surgery 93::78. ,1983. .

  • 12

    Melton LJ 3rd, Dyck PJ, Karnes JL, et al: Non-response bias in studies of diabetic complications: the Rochester Diabetic Neuropathy Study. .J Clin Epidemiol 46::341. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Dyck PJ, Melton LJ 3rd, O’Brien PC, et al: Approaches to improve epidemiological studies of diabetic neuropathy: insights from the Rochester Diabetic Neuropathy Study. .Diabetes 46: (suppl 2):S5. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Maggiore P, Echols RM: “Infections in the Diabetic Foot,” Disorders of the Foot & Ankle: Medical & Surgical Management, 2nd Ed, p 1937, WB Saunders, Philadelphia. ,1991. .

  • 15

    Foss NT, Polon DP, Takada MH, et al: Skin lesions in diabetic patients [in Portuguese]. .Rev Saude Publica 39::677. ,2005. .

  • 16

    Gupta AK, Konnikov N, MacDonald P, et al: Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: a multicentre survey. .Br J Dermatol 139::665. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Sinnreich M, Taylor BV, Dyck PJ: Diabetic neuropathies: classification, clinical features, and pathophysiological basis. .Neurologist 11::63. ,2005. .

  • 18

    Horowitz HS: Diabetic neuropathy. .Clin Orthop 296::78. ,1993. .

  • 19

    Low PA, Lagerlund TD, McManis PG: Nerve blood flow and oxygen delivery in normal, diabetic, and ischemic neuropathy. .Int Rev Neurobiol 31::355. ,1989. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Guyton GP, Saltzman CL: The diabetic foot: basic mechanisms of disease. .Instr Course Lect 51::169. ,2002. .

  • 21

    Said G: Diabetic neuropathy: a review. .Nat Clin Pract Neurol 3::331. ,2007. .

  • 22

    Nube VL, Molyneaux L, Yue DK: Biomechanical risk factors associated with neuropathic ulceration of the hallux in people with diabetes mellitus. .JAPMA 96::189. ,2006. .

    • Search Google Scholar
    • Export Citation
  • 23

    Praet SF, Louwerens JW: The influence of shoe design on plantar pressures in neuropathic feet. .Diabetes Care 26::441. ,2003. .

  • 24

    Uccioli L, Caselli A, Giacomozzi C, et al: Pattern of abnormal tangential forces in the diabetic neuropathic foot. .Clin Biomech 16::446. ,2001. .

    • Search Google Scholar
    • Export Citation
  • 25

    Wong MC, Chung JW, Wong TK: Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. .BMJ 14::335. ,2007. .

    • Search Google Scholar
    • Export Citation
  • 26

    Wagner FM: “Surgery of the Diabetic Foot,” in Surgery of the Musculoskeletal System, ed by MC Evarts, p 189, WB Saunders Co, Philadelphia. ,1990. .

  • 27

    Dyck PJ, Kratz KM, Karnes JL, et al: The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. .Neurology 43::817. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Bailey CC, Root HF: Neuropathic lesions in diabetes mellitus. .N Engl J Med 236::397. ,1947. .

  • 29

    Giurato L, Uccioli L: The diabetic foot: Charcot joint and osteomyelitis. .Nucl Med Commun 27::745. ,2006. .

  • 30

    Sanders LJ: The Charcot foot: historical perspective 1827–2003. .Diabetes Metab Res Rev 20::S4. ,2004. .

  • 31

    Armstrong DG, Todd WF, Lavery LA, et al: The natural history of acute Charcot’s arthropathy in a diabetic foot speciality clinic. .Diabet Med 14::357. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Jeffcoate WJ: Abnormalities of vasomotor regulation in the pathogenesis of the acute Charcot foot of diabetes mellitus. .Int J Low Extrem Wounds 4::133. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Harrelson JM: Management of the diabetic foot. .Orthop Clin North Am 20::605. ,1989. .

  • 34

    Pirart J: Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. .Diabetes Care 1::168. ,1978. .

    • Search Google Scholar
    • Export Citation
  • 35

    Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. .N Engl J Med 329::977. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Martin CL, Albers J, Herman WH, et al: DCCT/EDIC Research Group: Neuropathy among the Diabetes Control and Complications Trial cohort 8 years after trial completion. .Diabetes Care 29::340. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Said G, Bigo A, Ameri A, et al: Uncommon early onset neuropathy in diabetic patients. .J Neurol 245::61. ,1998. .

  • 38

    Said G: Diabetic neuropathy. .Nat Clin Pract Neurol 3::331. ,2007. .

  • 39

    International Working Group on the Diabetic Foot: International Consensus on the Diabetic Foot, International Working Group on the Diabetic Foot, Maastricht, the Netherlands. ,1999. .

Preclinical Symptoms of the Diabetic Foot

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  • 1 Orthopaedics and Traumatology, Yeditepe University, Istanbul, Turkey.
  • | 2 Anadolu Universitesi Hastanesi, Yunusemre Kampusu, Eskisehir, Turkey.
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Background: The diabetic foot is one of the main complications of diabetes mellitus, with a high risk of minor or major amputation. The preclinical foot lesions of patients without foot complaints were compared with healthy controls and analyzed.

Methods: This study was conducted with 89 diabetic patients from an endocrinology clinic and 35 nondiabetic control patients. The patients were asked about the presence, types, and durations of pedal complaints; acquired and congenital foot deformities; and atrophy. Patient gaits were inspected for any swelling; skin and nail changes were also recorded. Ranges of articular motion, deformities, crepitations, and any painful perceptions were noted.

Results: The differences between groups were significant for sensorial defects, joint changes of the foot, nail abnormalities, and neuropathic changes.

Conclusions: Every patient with an established diagnosis of diabetes can be considered a potential sufferer of diabetic foot for whom medical therapy and foot protection programs are indicated. (J Am Podiatr Med Assoc 99(2): 114–120, 2009)

Corresponding author: Halil I. Bekler, MD, Orthopaedics and Traumatology, Yeditepe University, Devlet Yolu Ankara cad, no 102-104, Istanbul, 34752, Turkey. (E-mail: hbekler@yahoo.com)