Choosing a Practical Screening Instrument to Identify Patients at Risk for Diabetic Foot Ulceration

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Abstract
THE MORBIDITY, direct cost, and mortality associated with lower extremity complications among patients with diabetes mellitus have been well described in the medical literature.1-6 Peripheral sensory neuropathy is one of the strongest risk factors for both foot ulceration and amputation in this population.7,8 In the absence of neuropathy, people rarely develop foot ulcers. Because of the lack of painful feedback, peripheral neuropathy provides a permissive environment that allows repetitive tissue injury to occur such that a person may wear a hole in the bottom of his or her foot much in the way that he or she may wear a hole in a stocking. Certainly, the early detection of a level of peripheral neuropathy sufficient to contribute to the development of foot wounds or "loss of protective sensation"9 is one of the most important criteria to identify high-risk patients for foot complications and is paramount when instituting a structured treatment plan to prevent lower extremity complications.10-12