Influence of Neuropathy and Ischemia in the Development and Treatment of the Diabetic Foot / 대한정형외과학회잡지

ABSTRACT

PURPOSE: To investigate the influence of sensory impairment and vascular insufficiency on the development and treatment of diabetic foot lesions. MATERIALS AND METHODS: From July 1995 to June 1997, 25 subjects with diabetic foot lesions were treated with an average follow-up of 19.6 months (range, 12-35 months). Sensory evaluation was performed with the Semmes-Weinstein monofilaments and a 256 cycles-per-second tuning fork, Vascular testing was performed with IMEXLAB 9,000 workstation in 24 of 25 subjects. RESULTS: In 22 of 25 patients, they could not perceive 5.07 monofilament and also could not feel vibration. In 6 patients, the vascular flow was normal, and there were mild insufficiency in 10 patients and severe insufficiency in 8 patients. The degree of vascular insufficiency correlated with the severity of the lesion (Wagner classification) and also with the result of the treatment. Despite severe vascular insufficiencies, foot lesions could be treated by forefoot amputations in 7 of 8 patients. Overall there were 9 recurrences after initial healing. CONCLUSIONS: This study shows that it is essential to educate patients on taking care of their foot because most of them do not have protective sensation. Vascular insufficiency may be related to the severity of the lesions and the result of treatment. We have to pay continuous attention to these patients for early detection of recurrence after initial treatment of the foot lesions.