Tratamiento quirúrgico de pie diabético basado en clasificación Wagner / Surgical treatment of diabetic foot based on Wagner classification

Se realizó un estudio que caracterizó a los pacientes que reciben tratamiento quirúrgico en el Hospital Roosevelt por pie diabético según la Clasificación Wagner. El objetivo era determinar el tratamiento quirúrgico brindado al paciente con pie diabético, basado en la clasificación Wagner, en el Departamento de Cirugía del Hospital Roosevelt durante el período de enero a octubre 2015. Se realizó un estudio descriptivo estudiando a los pacientes con diagnóstico de pie diabético, con una muestra de 81 pacientes. Se encontró que 56% presentaron grado IV, edad de 56-65 años en 38%, de sexo masculino 65%. 134 procedimientos quirúrgicos realizados, más común lavado y desbridamiento en 38%. Principalmente diagnóstico de Diabetes mellitus tipo II, con tiempo diagnóstico mayor a 10 años en 51%. Uso de hipoglucemiantes orales 49%. De los estudiados, 41% no presentaba ninguna comorbilidad. Se concluyó que el tratamiento quirúrgico más frecuente para Pie diabético Wagner II y III fue el lavado y desbridamiento, grado IV amputación de dedos y grado V las amputaciones femorales supracondíleas. Caracterizados como pacientes en rango de edad entre los 56-65 años, de sexo masculino, que padece Diabetes mellitus tipo II, clasificado como pie diabético Wagner IV, ameritando tratamiento quirúrgico como amputación de dedos seguido de amputaciones radicales descritas como amputación supracondílea, con tiempo de diagnóstico mayor a 10 años, con tratamiento de hipoglucemiantes orales, y sin ninguna comorbilidad médica asociada. (AU)

A study was conducted that characterized patients receiving surgical treatment at Roosevelt Hospital for diabetic foot according to the Wagner Classification. The objective was to determine the surgical treatment provided to the patient with diabetic foot, based on the Wagner classification, in the Department of Surgery at Roosevelt Hospital during the period from January to October 2015. A descriptive study was carried out studying patients with a diagnosis of diabetic foot, with a sample of 81 patients. It was found that 56% had grade IV, age 56-65 years in 38%, male 65%. 134 surgical procedures performed, the most common was lavage and debridement in 38%. Mainly diagnosis of type II diabetes mellitus, with a diagnosis time greater than 10 years in 51%. Use of oral hypoglycemic agents 49%. Of those studied, 41% did not present any comorbidity. The conclusion was that the most frequent surgical treatment for Wagner II and III was lavage and debridement, grade IV finger amputation and grade V supracondylar femoral amputations. Characterized as patients in the age range between 56-65 years, male, suffering from type II diabetes mellitus, classified as Wagner IV diabetic foot, meriting surgical treatment such as amputation of fingers followed by radical amputations described as supracondylar amputation, with time of diagnosis greater than 10 years, with treatment of oral ypoglycemic agents, and without any associated medical comorbidity. (AU)

Úlceras del pie diabético: importancia del manejo multidisciplinario y salvataje microquirúrgico de la extremidad / Diabetic foot ulcers: importance of a multidisciplinary approach and microsurgical limb rescue

Las úlceras del pie diabético son el principal factor de riesgo para las amputaciones no traumáticas en personas con diabetes. El éxito de la intervención requiere un completo entendimiento de la patogénesis y una implementación oportuna y estandarizada de un tratamiento efectivo. Es necesario un enfoque multidisciplinario para inicialmente controlar y tratar múltiples factores causantes de la ulceración severa del pie diabético. El desbridamiento, control de la infección y revascularización son pasos clave para la estabilización de la herida y su preparación para una reconstrucción exitosa. La microcirugía y supermicrocirugía permite proporcionar un tejido bien vascularizado para controlar la infección, un contorno adecuado para el calzado, durabilidad y anclaje sólido para resistir las fuerzas de cizallamiento durante la marcha. De esta manera, se puede lograr el salvataje de la extremidad, mejorando la calidad de vida y aumentando la sobrevida.

Diabetic foot ulcers are the main risk factor for non-traumatic amputations in people with diabetes. A succesful intervention requires a thorough understanding of the pathogenesis and a timely and standardized implementation of an effective treatment. A multidisciplinary approach is needed to initially control and treat multiple factors that cause severe diabetic foot ulceration. Debridement, infection control, and revascularization are key steps in wound stabilization and preparation for successful reconstruction. Microsurgery and supermicrosurgery provide a well-vascularized tissue to control infection, an adequate shoe contour, durability and solid anchorage to resist shearing forces during gait. In this way, the salvage of the limb can be achieved, improving the quality of life and increasing the survival rate.

Degree of risk for foot ulcer due to diabetes: nursing assessment / Grado de riesgo para las úlceras en los pies por diabetes: evaluación de enfermería / Grau de risco para úlceras nos pés por diabetes: avaliação de enfermagem

ABSTRACT Objective: To classify the level of risk for foot ulcers in people with diabetes mellitus and identify their main predictive risk factors. Method: Exploratory, descriptive study, in which patients were assessed in a municipal ambulatory of São Paulo through nursing consultation, following the guidelines of the International Consensus on the Diabetic Foot. Data were descriptively analyzed. Results: The analyzed population was composed of 50 longevous and retired people, with household income of up to two minimum wages, with dermato-neurofunctional risk factors and unfavorable clinical indicators, and 66% had Risk 1; 16% Risk 2; 6% Risk 3 and 12% Risk 4. Of this analyzed total, 96% never had their feet examined with the Semmes-Weinstein monofilament. Conclusion: The data found indicate the importance of careful feet examination in people with diabetes by the nursing staff to identify future risks of ulcers and, thus, prevent them.

RESUMEN Objetivo: Clasificar el grado de riesgo para las ulceraciones en los pies de las personas con diabetes mellitus e identificar sus principales factores de riesgo predictivos. Método: Estudio exploratorio, descriptivo, en el cual los pacientes fueron evaluados en un ambulatorio municipal de São Paulo por medio de la consulta de enfermería, según las directrices del International Consensus on the Diabetic Foot. Los datos fueron analizados descriptivamente. Resultados: La población analizada fue de 50 personas, longevos jóvenes, jubilados, con ingresos familiares de hasta dos salarios mínimos, con factores de riesgo dermato-neurofuncionales e indicadores clínicos desfavorables, siendo que el 66% presentó riesgo 1; el 16% de riesgo 2; el 6% riesgo 3; y el 12% de riesgo 4. De ese total analizado, el 96% nunca tuvo los pies examinados con el monofilamento de Semmes-Weinstein. Conclusión: Los datos encontrados apuntan la importancia de la evaluación cuidadosa de los pies de las personas con diabetes por la enfermería para identificar los riesgos futuros de ulceraciones y, de esta forma, prevenirlos.

RESUMO Objetivo: Classificar o grau de risco para ulcerações nos pés de pessoas com diabetes mellitus e identificar seus principais fatores de risco preditivos. Método: Estudo exploratório, descritivo, onde os pacientes foram avaliados em um ambulatório municipal de São Paulo por meio da consulta de enfermagem, segundo diretrizes do International Consensus on the Diabetic Foot. Os dados foram analisados descritivamente. Resultados: a população analisada foi de 50 pessoas, longevos jovens, aposentados, renda familiar de até dois salários mínimos, com fatores de risco dermato-neuro-funcionais e indicadores clínicos desfavoráveis, sendo que 66% apresentaram risco 1; 16% risco 2; 6% risco 3 e 12% risco 4. Dentre estes, 96% nunca tiveram seus pés examinados com o monofilamento de Semmes Weinstein. Conclusão: Os dados encontrados apontam a importância da avaliação criteriosa dos pés das pessoas com diabetes pela enfermagem para identificar os riscos futuros de ulcerações, e desta forma trabalhar a prevenção dos mesmos.

Pie de riesgo en personas con diabetes mellitus de tipo 2 en la Atención Primaria de Salud durante 2016 / Risky feet in patients with diabetes mellitus type 2 in the Primary Health Care during 2016

Se realizó un estudio observacional, descriptivo y transversal para determinar la estratificación del pie de riesgo y los factores concurrentes en 534 pacientes con diabetes mellitus de tipo 2, pertenecientes a las áreas de salud de los policlínicos docentes Dr Carlos J Finlay y Julián Grimau del municipio de Santiago de Cuba, durante el segundo trimestre de 2016 y dispensarizados en los consultorios médicos correspondientes. Entre los principales resultados sobresalió la frecuencia elevada en los grados 1, 2 y 3 de la estratificación del pie de riesgo y la baja en la categoría sin riesgo, mientras que entre los factores concurrentes predominaron la hiperqueratosis plantar, el hallux valgus, la edad mayor de 40 años, la neuropatía periférica, la enfermedad arterial periférica, el calzado inadecuado y la obesidad

An observational, descriptive and cross-sectional study to determine the stratification of the risky feet and the concurrent factors in 534 patients with diabetes mellitus type 2, belonging to the health areas of Dr Carlos J Finlay and Julián Grimau Teaching polyclinics in Santiago de Cuba municipality was carried out during the second trimester of 2016 and they were classified in their corresponding doctors´ offices. Among the main results there were the increased frequency in the 1, 2 and 3 degrees of the stratification of the risky foot and the low frequency in the category without risk, while among the concurrent factors the plantar hyperkeratosis, the hallux valgus, more than 40 years of age, peripheral neuropathy, the peripheral arterial disease, inadequate shoes and obesity prevailed

Classificação do risco para pé diabético em unidades de atenção primária de saúde em Divinópolis - MG: perfil de pacientes com diabetes mellitus tipo 2 / Risk rating for diabetic foot in primary health care units in Divinópolis - MG: profile of patients with type 2 diabetes mellitus

Objetivo: Classificar o risco para pé diabético em pessoas diagnosticadas com Diabetes Mellitus tipo 2 em um município do Centro-Oeste de Minas Gerais, Métodos: Estudo transversal descritivo, exploratório, realizado em pessoas diagnosticadas com Diabetes Mellitus tipo 2, vinculadas às Unidades de Atenção Primária de Saúde com maior número de diabéticos cadastrados no município, Resultados: Foram avaliados 150 participantes, A estratificação do risco demonstrou maior frequência no grau 1 (46%), caracterizada por ausência de sensibilidade, Observou-se prevalência de hipertensão, idade avançada, baixa escolaridade, uso de calçado inadequado, sinais e sintomas sensoriais e autonõrnicos. Conclusão: Constatou-se que a maioria dos fatores envolvidos no desenvolvimento do pé diabético podem ser prevenidos com a detecção precoce e o tratamento oportuno das manifestações clínicas, como também a educação em saúde dos pacientes e o cuidado adequado com os pés.

Objective: To classify the risk for diabetic foot in people diagnosed with Type 2 Diabetes Mellitus in a municipality the Midwest of Minas Gerais, Methods: A descriptive, exploratory cross-sectional study conducted in people diagnosed with type 2 diabetes, linked the Primary Health Care Units with the highest number of diabetics registered in the municipality, Results: A total of 150 participants, risk stratification showed a higher rate in grade 1 (46%), characterized by lack of sensitivity, It was observed prevalence of hypertension, advanced age, low education, inadequate footwear use, signs and sensory and autonomic syrnptorns. Conclusion: It was found that most of the factors involved in the development of diabetic foot can be prevented with early detection and timely treatment of the clinical manifestations, as well as health education of patients and proper foot care.

Objetivo: clasificar el riesgo de pie diabético en personas con diagnóstico de diabetes mellitus tipo 2 en un municipio dei Medio Oeste de Minas Gerais, Métodos: Estudio descriptivo transversal, exploratorio realizado en personas diagnosticadas con diabetes tipo 2, vinculadas las Unidades de Atención Primaria de la Salud con el mayor número de diabéticos registrados en el rnunicipio. Resultados: Un total de 150 participantes, la estratificación de riesgo mostraron una tasa más alta en el grado 1 (46%), que se caracteriza por la falta de sensibilidad. Se observó Ia prevalencia de Ia hipertensión, edad avanzada, bajo nivel educativo, el uso inadecuado de calzado, 105 signos y 105 síntomas sensoriales y autonórnicas. Conclusión: Se encontró que Ia mayoría de 105 factores que intervienen en el desarrollo dei pie diabético se pueden prevenir con Ia detección temprana y el tratamiento oportuno de Ias manifestaciones clínicas, así como educación para Ia salud de los pacientes y el cuidado adecuado de los pies.

Pie diabético / Diabetic foot

The prevalence of diabetes has increased considerably, constituting a global epidemic today. Many of these patients will develop chronic complications of diabetes, including diabetic foot, which aggravates the patient’s clinical condition, decreases the quality of life and has a great socioeconomic impact. The most important action to reduce the morbidity and mortality associated with this pathology is the prevention of this complication, performing a propermetabolic management and serial control of the patient, educating about self-care of the feet. Once diabetic foot ulcer is present, the cornerstones of treatment are debridement of the wound, management of any infection, revascularization procedures when indicated, and discharge of the ulcer, all of the above in order to avoid amputation. This article intends tomake a review about the epidemiology, pathophysiology, classification, diagnosis, prevention and management of diabetic foot oriented to the primary care doctor.

Pé diabético, uma avaliação sistematizada / Diabetic foot – a systematic examination

O objetivo deste trabalho é descrever o processo de avaliação dos pés de portadores de diabetes mellitus, classificando-os quanto ao grau de risco para o desenvolvimento de úlceras. O estudo foi realizado em um Ambulatório de Hospital Universitário e em duas Unidades Básicas de Saúde de pequenos municípios situados na região norte do estado do Paraná. Trata-se de um estudo descritivo exploratório cuja amostra se constituiu de 228 indivíduos. Os dados foram coletados por meio de um instrumento que registrou a identificação dos participantes, informações sobre a doença e suas complicações e os resultados do exame dos pés, destacando aspectos ortopédicos, dermatológicos e neurovasculares. Dentre a população estudada, 79,5% dos indivíduos apresentaram grau de risco 0, 12% grau de risco 1 e 8,5% grau de risco 2 para o desenvolvimento de úlceras nos pés, segundo classificação do Ministério da Saúde, 2001.

The objective of this study is to describe the process of evaluating the foot of diabetic patients, classifying them according to the degree of risk for the development of ulcers. The study was conducted in a university hospital and two Basic Health Units of small municipalities in northern Paraná State. This is a descriptive study in which the sample consisted of 228 individuals. Data were collected using an instrument that included the identity of the participants, information about the disease and its complications and results of examination of the feet, emphasizing orthopedic, dermatologic and neuro-vascular factors. Results showed that 79.5% of patients had 0, 12% risk level 1 and 8.5% had risk level 2 for developing foot ulcers, according to the classification of the Ministry of Health, 2001.

Diabetic septic foot in Omdurman Teaching Hospital

To audit the management of diabetic septic foot [DSF] lesions in Omdurman Teaching Hospital, using Wagner classification. This is a retrospective study on 208 patients with DSF admitted to Omdurman Teaching Hospital, Sudan between June 2006 and May 2007. Data were analyzed manually. The male to female ratio was 2:1. The mean age +/- SD was 56 +/- 12.35 year. 16.8% patients were grade 1. 33 [15.9%] patients were grade 2. grades 3, 4, 5 patients were 66 [37%], 38 [18.3%] and 36 [17.3%] respectively. Major lower limb amputation and mortality were 19.2%, and 6.7% respectively. Preventive measures for patients at risk are highly needed, and early presentation is encouraged when ulcer develops in diabetic foot to avoid subsequent complications

Foot abnormalities in diabetics: prevalence and predictors in Basrah

Diabetic foot abnormalities are clearly one of the most important complications of diabetes mellitus [DM] and the leading cause of hospitalization with substantial morbidity, impairment of quality of life, and engender high treatment costs. The aim of this study was to estimate the prevalence of diabetic foot abnormalities among patients with type 2 DM and the predictors of these abnormalities in Basrah. This was a cross sectional study of patients attending the out patient clinic of two hospitals in Basrah [the General and the Teaching] for the period from January to the end of December 2005. All patients had type 2 DM. The total number of patients was 182 [80 males and 102 females]. Diabetic foot abnormalities were reported in 46.7% of patients. Most patients had more than one abnormality. Structural foot abnormalities reported in diabetic patients were prominent metatarsal heads in 36.2%, wasting in 11.5% hammer toes in 10.9%, pes cavus in 5.4%, claw toes in 3.8%, and amputees in 2.1%. While skin changes included dryness of the skin in 17%, fissures in the skin in 14.7%, callosities in 14.2%, Tinea pedis in 13.7%, foot ulcer in 13.7% and nail changes in 7.1%. Peripheral neuropathy and dermopathy were seen in 21.9% and 6% respectively. Variables predicting foot abnormalities were higher age, male sex, less school achievement, longer duration of DM, higher BMI, smoking history, low social class, insulin use, hypertension, heart failure and proteinuria

Evaluation and management of diabetic foot according to Wagner's classification. A study of 100 cases

Wagner's classification is the most widely utilized grading system for lesions of the diabetic foot. The aim of the study was to evaluate and manage the different lesions of diabetic foot according to Wagner classification. This will help to describe the lesions we treat study and compare outcomes and also identify measures to decrease morbidity and mortality due to diabetic foot disease. The study was conducted in surgical 'c' unit of Khyber teaching hospital, Peshawar from July 2002 to June 2003. 100 patients with diabetic foot disease were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner classification and appropriate medical and surgical treatment carried out. Diabetic foot disease formed 1.04% of total admissions and 0.23% of OPD patients. 62 [62%] were males and 38 were females. Common age group was 40 ' 60 years, 6 patients had grade 0, 14 grade 1, 25 with grade 2, 30 with grade 4 and 4 with grade 5 lesions. 17 patients were managed conservatively with antibiotics alone, 33 had incision drainage and debridement while 48 needed amputation of different types. Staphylococcus aureus was the commonest organism isolated. Majority of the diabetic foot lesions were in grade 2 to 5. Lesser grade lesions responded well to conservative treatment with antibiotics and surgical debridement while those with higher grades needed amputations. Effective glycemic control, timely hospital admissions, approximate surgical / medical treatment along with patient education in foot care can decrease morbidity and mortality due to diabetic foot disease

Comparación de los niveles séricos de óxidos nítrico y malondialdehído en pacientes con pie diabético con o sin infección / Comparison of serum nitric oxide and malondialdehyde levels in patients with infected and non infected diabetic foot

La patogenia de la infecciones del pie diabético involucra la polineuropatía, la enfermedad macro y microvascular y el déficit funcional de los neutrófilos. La vasodilatación dependiente del endotelio, relacionada con el Oxido Nítrico (NO), está comprometida en diabéticos predispuestos a ulceración del pie. El NO, es producido también por neutrófilos y macrófagos estimulados por citoquinas o lipopolisacáridos bacterianos mediante la sintetasa de NO inducible (iNOS), ejerciendo actividad microbicida. La peroxidación lipídica reflejada por la producción de malondialdehido (MDA), está implicada en el desarrollo de microangiopatía diabética. Para comparar los niveles séricos de NO y MDA en pacientes con pie diabético con o sin infección, se estudiaron 27 individuos diabéticos tipo 2 con edades entre 38 y 65 años divididos en 3 grupos: 8 controles sin afección de los pies (A), 10 con pie diabético sin infección (B) y 9 con pie diabético infectado (C). El NO fué determinado mediante ensayo de diazotización y el MDA mediante la relación de Acido Thiobarbitúrico. B y C mostraron niveles de NO menores (p= 7.636 x 10-5 y p= 0,006) que A. El NO fue mayor en el grupo infectado que en el grupo sin infección (p=0,05), sin embargo los valores obtenidos no coinciden con lo esperado teniendo en cuenta las grandes cantidades de NO producido mediante iNOS, sugiriendo un defecto más del leucocito del diabético. No hubo diferencia significativa en el MDA entre los grupos, indicando ausencia de stress oxidativo relevante

New scoring system for diabetic foot ulcers

To review the management and outcome of diabetic foot ulcers based on a novel scoring system for ulcers depending on the Phase of the ulcer [P], Extent of the ulcer [E], Degree of infection [D], Associated problems [A]. This scoring system is called PEDA score. Design: A prospective study. Setting: Jordan University Hospital The database of 80 diabetic patients seen at Jordan University Hospital with foot lesions between September 97 to April 2000 were studied prospectively. Data for gender, age, nature of foot lesions, presence of peripheral vascular disease, peripheral neuropathy, associated bone deformity, types of surgical procedure, morbidity and mortality were reviewed. Eighty patients with foot infections were seen at the hospital during the period from Sept 97 to April 2000. Patients were followed up from 1 month to 30 months. Mean age of the patients was 55 years ranging between 17-90 years. They were 50 males [62.5%] and 30 females [37.5%] Peripheral neuropathy was documented in 52 patients [65%]. Distal pulses were not present in 18 patients [22.5%]. Twenty four patients with superficial cellulitis without ulcers were excluded from the study. Twenty two patients [39%] had Low grade ulcers [PEDA score <6] all had complete healing of their original ulcers in 4-6 weeks, twenty patients [36%] had moderate grade ulcers [PEDA score7-9], sixteen patients from this group had complete healing in 6-12 weeks. Fourteen patient [25%] had high-grade ulcers [PEDA score 10-12], two patients had ulcers in association with Charcot joints, and another two with hallux valgus deformity. Local bone excision was performed on these patients and all had good results. Ten patients had significant peripheral vascular disease, one patient had a successful reconstruction, and the remainder required amputation at different levels. Patients with high-grade ulcers required in hospital management in excess of 12 weeks. Diabetic foot ulcers inflect a huge cost to society and disrupt the quality of life. We have developed a new scoring system [FED A] that allows categorization of diabetic foot ulcers into three groups depending on severity; low, moderate and high grade ulcers. The goal of this system is to optimize local ulcer care, provide an idea about the place, duration and the outcome of management. According to this score 75% of diabetic foot ulcers will fit the low and moderate grade ulcers with 90% success rate of ulcer healing in 2-3 months

Pie diabético / Diabetic foot

Diabetes mellitus es común en nuestro medio; cerca de 15 por ciento de la población puede estar afectada. El paciente diabético mal o deficientemente tratado desarrolla complicaciones crónicas, la mayoría de las cuales comprometen el sistema arterial (desde arterias grandes y medianas a pequeñas y capilares). Se incluyen como pie diabético al pie isquémico debido a oclusión vascular y de pronóstico reservado, la oclusión parcial arterial con infecciones secundarias conocidas como gangrenas, la que a veces puede ir acompañada de neuropatía periférica, y al pie mixto (neuropatía más isquemia). El pie diabético usual incluye a una mezcla de isquemia moderada con infección. Se revisan tratamientos médicos y quirúrgicos e indicaciones de intervención vascular. No se recomienda el efectuar tratamientos caseros, ambulatorios, ni en el consultorio, porque la pérdida de tiempo en muchas ocasiones puede signifcar la pérdida del miembro. Se recomienda un período de tratamiento médico conservador antes de decidir una amputación, siempre y cuando no haya compromiso de la vida del paciente

Manejo y evolución intrahospitalaria del pie diabético complicado / Management and intrahospital evolution of the complicated diabetic foot

El pie diabético es una patología de gran prevalencia en la actualidad. Una de las complicaciones más temidas por estos pacientes es sufrir la amputación de una extremidad o parte de ella. Se realizó un estudio descriptivo retrospectivo con 68 pacientes ingresados al servicio de cirugía del hospital Gustavo Fricke, con diagnóstico de pie diabético, entre 1998 y 1999. La edad promedio fue de 67 años, y la relación hombre:mujer de 3:1. El antecedente más importante fue el de úlcera o amputación previa. La lesión se ubicó en un ortejo en 56 por ciento de los casos. Según el tipo de lesión, el Wagner III se presentó en un 48.5 por ciento, seguido de el wabner IV en un 33.8 por ciento. A mayor gravedad de la lesión, mayor es la proporción de amputación. En cuanto a los métodos de estudio, hubo poca utilización de la radiografía de pie y del estudio vascular. Se realizó cultivo al ingreso en un 35 por ciento, encontrándose gérmenes de la comunidad, la antibióticoterapia cubrió dichos microorganismos. Un segundo cultivo reveló alta frecuencia de infección intrahospitalaria; ello se asoció a reoperación en la totalidad de esos pacientes. Resultados: 52 pacientes amputados, de los cuales 6 se reamputan y 1 fallece. En conclusión, el estudio diagnóstico y tratamiento preciso y oportuno del pie diabético, influye significativamente en su evolución y resultado final

Foot screening technique in a diabetic population

Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population