Physiotherapeutic assessment of feet and risk degree of ulceration in physically active diabetic individuals
DOI:
https://doi.org/10.33233/fb.v20i6.3107Keywords:
diabetes, diabetic foot, risk factors, assessment, Physical therapyAbstract
Epidemiological evidence shows an increased number of diabetic individuals and type 2 diabetes mellitus (DM2) accounts for 90% of cases. Diabetic foot is among the most serious and costly complications which can be prevented by an assessment strategy and basic health care. Objective: To evaluate and detect morphofunctional changes, to classify the Risk Degree (RD) in developing foot ulcers of physically active diabetic individuals and to guide feet self-care. Methods: Twelve DM2 individuals were assessed based on observations regarding the type of shoes wearing, questions about the presence of ulcerations, pain, muscle weakness and other feet and lower limbs discomforts, plantar feet sensibility and, motor condition. Results: About the RD of ulceration and amputation, we verified that 8% of the individuals were included in the RD 0; 8% in the RD 1; 25% in the RD 2; 25% in the RD 3; and 34% already had ulceration. Conclusion: Despite regular physical activity, most individuals presented loss of protective plantar sensibility with four of them already showing foot ulceration. It is suggested that more strategies should be developed in the public health system for multidisciplinary and multiprofessional basic care for diabetics.
Epidemiological evidence shows an increased number of diabetic individuals and type 2 diabetes mellitus (DM2) accounts for 90% of cases. Diabetic foot is among the most serious and costly complications which can be prevented by an assessment strategy and basic health care. Objective: To evaluate and detect morphofunctional changes, to classify the Risk Degree (RD) in developing foot ulcers of physically active diabetic individuals and to guide feet self-care. Methods: Twelve DM2 individuals were assessed based on observations regarding the type of shoes wearing, questions about the presence of ulcerations, pain, muscle weakness and other feet and lower limbs discomforts, plantar feet sensibility and, motor condition. Results: About the RD of ulceration and amputation, we verified that 8% of the individuals were included in the RD 0; 8% in the RD 1; 25% in the RD 2; 25% in the RD 3; and 34% already had ulceration. Conclusion: Despite regular physical activity, most individuals presented loss of protective plantar sensibility with four of them already showing foot ulceration. It is suggested that more strategies should be developed in the public health system for multidisciplinary and multiprofessional basic care for diabetics.
References
Zimmet PZ, Magliano DJ, Herman WH, Sha JE. Diabetes: a 21st century challenge. Lancet Diabetes Endocrinol 2014;2:56-64. doi: 10.1016/S2213-8587(13)70112-8
Ziegler R, Neu A. Diabetes in Childhood and Adolescence. Dtsch Arztebl Int 2018;115(9):146-56. doi: 10.3238/arztebl.2018.0146
Diretrizes SBD 2015-2016. Diretrizes da Sociedade Brasileira de Diabetes. Parte 1 – Princípios Básicos, Avaliação e Diagnóstico do Diabetes Mellitus. Sociedade Brasileira de Diabetes 2016; 3-6.
Grupo de Trabalho Internacional sobre Pé Diabético. Consenso Internacional sobre o Pé Diabético. Secretaria de Estado de Saúde do Distrito Federal: 2001. [citado 2018 Oct 10]. Disponível em: http://189.28.128.100/dab/docs/publicacoes/geral/conce_inter_pediabetico.pdf.
Boffeli TJ, Goss MS. Distal Syme hallux amputation for tip of toe wounds and gangrene complicated by osteomyelitis of the distal phalanx: surgical technique and outcome in consecutive cases. J Foot Ankle Surg 2018;57(3):456-61. doi: 10.1053/j/jfas.2017.10.027
Barwick AL, van Netten JJ, Reed LF, Lazzarini PA. Independent factors associated with wearing different types of outdoor footwear in a representative inpatient population: a cross-sectional study. J Foot Alkle Res 2018;11:19. doi: 10.1186/s13047-018-0260-7
Lazzarini PA, O´Rourke SR, Russell AW, Derhy PH, Kamp MC. Reduced incidence of foot-related hospitalization and amputation amongst persons with diabetes in Queensland, Australia. PLoS One 2015;10(6):30130609. doi: 10.1371/journal.pone.0130609
Mavrogenis AF, Megaloikonomos PD, Antoniadou T, Igoumenou VG, Panagopoulos GN, Dimopoulos L et al. Current concepts for the evaluation and management of diabetic foot ulcers. Effort Open Rev 2018;3(9):513-25. https://101302/2058-52441.3.180010
Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med 1998;158(2):157-62. doi: 10.1001/archinte.158.2.157
Diretrizes SBD 2015-2016. Diretrizes da Sociedade Brasileira de Diabetes 2015-2016, Diagnóstico Precoce do Pé Diabético. Sociedade Brasileira de Diabetes 2016;137-49.
Karino ME, Pace AE. Risco para complicações em pés de trabalhadores portadores de diabetes mellitus. Ciênc Cuid Saúde 2012;11(5):183-90.
Dietrich I, Braga GA, de Melo FG, da Costa Silva Silva AC. the diabetic foot as a proxy for cardiovascular events and mortality review. Curr Atheroscler Rep 2017;19(11):44. doi: 10.1007/s11883-017-0680-z
Asha KR, Vedha pal JS, Divya R, Indhumathi S, Mani VG. Management of diabetic foot ulcer - a pharmacist perceptive. J Clin Endocrinol Metab Disord 2018;(1):1-4. doi: 10.29011/JCEMD-109.100009
Mishra SC, Chhatbar KC, Kashikar A, Mehndiratta A. Diabetic foot. BMJ 2017;359:j5064. doi: 10.1136/bmj.j5064
Caiafa JS, Castro AA, Fidelis C, Santos VP, Silva ES, Sitrângulo CJ. Atenção integral ao portador de pé diabético. J Vasc Bras 2011;10(4-Suppl 2):1-32. doi: 10.1590/S1677-54492011000600001
Brandão RA, Weber JS, Larson D, Prissel MA, Bull PE, Berlet GC, Hyer CF. New fixation methods for the treatment of the diabetic foot: Beaming, external fixation, and beyond. Clin Podiatr Med Surg 2018;35(1):63-76. doi: 10.1016/j.cpm.2017.08.001
Al-Rubeaan K, Derwish MA, Ouizi S, Youssef AM, Subhani SN, Ibrahim HM et al. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One 2015;10(5):e0124446. doi: 10.1371/journal.pone.0124446.ecollection2015
Patil SJ, Ruppar T, Koopman RJ, Lindbloom EJ, Elliot SG, Mehr DR, Conn VS. Effect of peer support interventions on cardiac disease risk factors in adults with diabetes: a systematic review and meta-analysis. BMC Public Health 2018;18(1):398. doi: 10.1186/s12889-018-5326-8
Mikael LR, Paiva AMG, Gomes MM, Souza ALL, Jardim PCBV, Vitorino PVO et al. Vascular aging and arterial stifness. Arq Bras Cardiol 2017;109(3):253-58. doi: 10.5935/abc.20170091
Röhling M, Strom A, Bönhof GJ, Roden M, Ziegler D. Cardiorespiratory fitness and cardiac autonomic function in diabetes. Curr Diab Rep 2017;17(12):125. doi: 10.1007/s11892-017-0959-z
Johnson CE, Takemoto JK. A review of beneficial low-intensity exercises in diabetic peripheral neuropathy patients. J Pharm Pharm Sci 2019;22(1)22-7. doi: 10.18433/jpps30151
Ulhoa LS, Lima RCO, Cunha VNC, Gomes EB, Campbell CSG, Pedrosa HC. Mobilidade articular de idosos diabéticos e não diabéticos e influência da fisioterapia. Fisioter Mov 2011;24(1):99-106. doi: 10.1590/S0103-51502011000100011
Cubas MR, Santos OM, Retzlaff EMA, Telma HLC, Andrade IPS, Moser ADL et al. Pé diabético: orientações e conhecimento sobre cuidados preventivos. Fisioter Mov 2013;26(3):647-55. doi: 10.1590/S0103-51502013000300019
Ernandes RC, Scherrer Júnior G, Alonso AC. Equilíbrio postural e sarcopenia em idosos com e sem neuropatia diabética. Fisioter Bras. 2018;19(1):96-109. doi: 10.33233/fb.v19i1.2189
Silva BF, Gama CHS. Avaliação sensório-motora do tornozelo e pé entre idosos diabéticos e não diabéticos. Rev Bras Geriatr Gerontol 2010;13(1):93-10.
Published
Issue
Section
License
Copyright (c) 2019 Mayara Bueno Récchia, Ana Valéria de Souza, Claudia Mirian de Godoy Marques
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
