TAILIEUCHUNG - PATHWAY 2_PAD

Neurologic Evaluation Peripheral sensory neuropathy is the major risk factor for diabetic foot ulceration (24, 26, 27, 46, 50). The patient history and physical examination utilizing the SemmesWeinstein monofilament (10-g) wire are sufficient to identify individuals at risk for ulceration (26, 232-235). Vibration perception threshold assessment with the biothesiometer is also useful in identifying patients at high risk for ulceration (44, 57, 236). More sophisticated studies such as nerve conduction studies are rarely necessary to diagnose peripheral sensory neuropathy. Patients with neuropathic ulcerations usually have such profound sensory neuropathy that these studies add little to their clinical management. | PATHWAY 2 DIABETIC FOOT DISORDERS VOLUME 45 NUMBER 5 SEPTEMBER OCTOBER 2006 S-15 Neurologic Evaluation Peripheral sensory neuropathy is the major risk factor for diabetic foot ulceration 24 26 27 46 50 . The patient history and physical examination utilizing the Semmes-Weinstein monofilament 10-g wire are sufficient to identify individuals at risk for ulceration 26 232-235 . Vibration perception threshold assessment with the bioth-esiometer is also useful in identifying patients at high risk for ulceration 44 57 236 . More sophisticated studies such as nerve conduction studies are rarely necessary to diagnose peripheral sensory neuropathy. Patients with neuropathic ulcerations usually have such profound sensory neuropathy that these studies add little to their clinical management 49 . Plantar Foot Pressure Assessment High plantar foot pressure is a significant risk factor for ulceration 26 45 59 70 76 80 237 . Measurement of high plantar foot pressure is possible utilizing a variety of modalities. Several computerized systems can provide quantitative measurement of plantar foot pressure 76 81 238-241 . While these measurements may be important in identifying areas of the foot at risk for ulceration and possibly in evaluating orthotic adjustments 57 59 they are primarily used in diabetic foot research. The Harris mat while not as sophisticated can provide a qualitative measurement of plantar foot pressures and can identify potentially vulnerable areas for ulceration. 242 . A newer noncomputerized device PressureStat FootLogic New York City NY which is similar to the Harris mat and uses pressure-sensitive contact sheets that provide a semi-quantitative estimation of pressure distribution under the foot has been suggested as an inexpensive screening tool for identifying areas at high risk for ulceration 76 243 . Risk Stratification Following a thorough diabetic foot examination the patient may be classified according to a cumulative risk cat egory. This enables .

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