INTRODUCTION: Identifying peripheral arterial disease (PAD) during diabetic foot screening (DFS) is crucial in reducing the risk of diabetic foot ulcerations and lower limb amputations. Screening assessments commonly used include absolute systolic toe pressure (ASTP) and toe-brachial index (TBI). There is a lack of research defining the threshold values of both assessment methods. We aimed to compare the accuracy of ASTP and TBI and establish optimal threshold values of ASTP and TBI with reference to the internationally accepted ankle-brachial pressure index (ABPI) screening test, for a multiethnic diabetic population in Singapore. METHODS: A retrospective, observational study of DFS results from January 2017 to December 2017 was conducted. Receiver operating characteristic analysis was conducted for ASTP and TBI using the internationally accepted ABPI cut-off value of ≤0.9 to indicate PAD. RESULTS: A total of 1,454 patients with mean (standard deviation) age of 63.1 (12.4) years old were included. There were 50.8% men and 49.2% women, comprising 69.7% Chinese, 13.5% Indian, 10.1% Malay and 6.7% other ethnicities. Areas under the curve for ASTP and TBI were 0.89 (95% confidence interval [Cl] 0.85-0.94) and 0.94 (95% Cl 0.90-0.98), respectively, and the difference was statistically significant (P<0.001). Derived optimal threshold values to indicate ABPI≤0.9 for ASTP and TBI were <95.5mmHg (specificity 0.86, sensitivity 0.84) and <0.7 (specificity 0.89, sensitivity 0.95), respectively. CONCLUSION ASTP or TBI may be used to detect ABPI-determined PAD in DFS. The optimal threshold values derived from a multiethnic Asian diabetic population were <95.5mmHg for ASTP and <0.7 for TBI.
Ankle Brachial Index/methods* ; Diabetes Mellitus/epidemiology* ; Diabetic Foot/diagnosis* ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/diagnosis* ; Retrospective Studies ; Toes

Diabetic peripheral neuropathy(DPN),a chronic diabetic microvascular complication with a high incidence among diabetic patients,increases the risk of diabetic foot and amputation.Many methods are available for screening and evaluating DPN,including traditional 10 g monofilament,tuning fork and vibration perception,and tendon reflex tests,which should be combined with some nerve function score systems to improve the detection rate and accuracy for DPN.In recent years,a number of noninvasive new techniques have been developed for the evaluation of nerve injury,such as corneal confocal microscopy,quantitative sensory testing,current perception threshold test,sympathetic sudomotor function evaluation,and quantitative detection of skin advanced glycation end products.This paper reviews these noninvasive methods for screening and evaluating DPN to help clinicians detect and focus on DPN early.
Cornea ; Diabetes Mellitus ; Diabetic Foot ; Diabetic Neuropathies/diagnosis* ; Humans ; Mass Screening ; Microscopy, Confocal

BACKGROUND: This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team. METHODS: In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched. RESULTS: Of the 338 patients with DFU, 229 were first admitted until the year 2011 (group A), while 109 were first admitted since the year 2012 (group B). Mean age was higher in group B, and ulcer size was larger than those of group A. Whereas duration of diabetes was longer in group B, glycemic control was improved (mean glycosylated hemoglobin, 9.48% vs. 8.50%). The proportion of minor lower extremity amputation (LEA) was increased, but length of hospital stay was decreased (73.7±79.6 days vs. 39.8±36.9 days). As critical ischemic limb increased, the proportion of major LEA was not decreased. CONCLUSION: Improved glycemic control, multidisciplinary strategies with prompt surgical treatment resulted in reduced length of hospital stay, but these measures did not reduce major LEAs. The increase in critical ischemic limb may have played a role in the unexpected outcome, and may suggest the need for increased vascular intervention strategies in DFU treatment.
Amputation ; Diabetic Foot* ; Diagnosis* ; Electronic Health Records ; Extremities ; Hemoglobin A, Glycosylated ; Humans ; Korea ; Length of Stay ; Lower Extremity ; Observational Study ; Patient Care Team ; Retrospective Studies ; Tertiary Care Centers ; Ulcer*

This paper presents a case of an early malignant transformation of untreated ulcers in a patient with diabetes. This case shows that Marjolin's ulcer can occur not only after chronic injury, but can also develop in the early stages after the onset. Hence, an early biopsy for diabetic foot ulcers that fail to heal with acute treatment can enable an earlier diagnosis and treatment without amputation, resulting in a better quality of life for the patient.
Amputation ; Biopsy ; Diabetic Foot* ; Diagnosis ; Humans ; Quality of Life ; Ulcer*

Diabetic foot is one of the most significant and serious complications of diabetes, and is defined as the foot of diabetic patients with ulceration, infection and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. The most significant risk factors for foot ulceration are diabetic neuropathy, peripheral arterial disease, and consequent traumas of the foot. Most diabetic ulcers can be prevented with good foot care and screening for risk factors for a foot at risk of complications. Active foot examination and foot care education are methods to prevent diabetic foot at a minimum cost. I will focus on the recommendations for diagnosis and treatment of diabetic foot.
Diabetic Foot* ; Diabetic Neuropathies ; Diagnosis* ; Education ; Foot ; Foot Ulcer ; Humans ; Lower Extremity ; Mass Screening ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Ulcer

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and is diagnosed as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes. The prevalence of DPN was reported at 33.5% of type 2 diabetes patients by the Korean diabetes neuropathy study group. Early diagnosis is recommended to prevent diabetic foot ulcers, amputation, or disability. A questionnaire asking about symptoms and neurologic examination of feet is commonly used as a screening tool. However, complete diagnostic tests for DPN are not well established because of incomplete understanding of the pathogenetic mechanisms leading to the nerve injury, the various clinical manifestations, and the unclear natural history. Therefore, DPN has not been paid sufficient attention by clinicians. The roles of glycemic control and management of cardiovascular risk factors in the prevention and treatment of neuropathic complications are well known. Pathogenetically oriented or symptomatic agents are other options, though such treatments do not always produce a satisfactory outcome. Therefore, DPN remains a challenge for physicians to screen, diagnose, and treat. There have been recent advances in understanding the mechanisms underlying DPN and in the development of new diagnostic modalities and treatments. In this review, diagnosis and management of DPN will be discussed.
Amputation ; Diabetes Complications ; Diabetic Foot ; Diabetic Neuropathies ; Diagnosis* ; Diagnostic Tests, Routine ; Early Diagnosis ; Foot ; Humans ; Mass Screening ; Natural History ; Neurologic Examination ; Peripheral Nerves ; Peripheral Nervous System Diseases* ; Prevalence ; Risk Factors ; Ulcer

Diabetic neuropathy is a complex and common disorder with multiple etiologies and affects about 43.1% of the Korean diabetes population. Good glycemic control slows progression of diabetic neuropathy in subjects with type 1 diabetes but seems to provide little benefit in subjects with type 2 diabetes. Moreover, neuropathy has been shown to develop in humans at stages of prediabetes and in the absence of overt hyperglycemia. Given the increasing incidence of both type 1 and type 2 diabetes and obesity and the impact of diabetic neuropathy on the quality of life of patients, a strategy for early diagnosis and discovery of an effective treatment is important for prevention and progression of diabetic neuropathy. Approximately 14.4% of Korean diabetics with neuropathy have associated pain, and management of this pain has been unsuccessful for many clinicians and patients. Choice of the correct drug(s), dosage, and patient management seems to be based on individualized conditions and needs. Overall, for good management and prevention for diabetic foot morbidities, early and proper diagnosis of diabetic neuropathy is essential, and simple and precise diagnostic methods must be developed.
Diabetic Foot ; Diabetic Neuropathies* ; Diagnosis ; Early Diagnosis ; Humans ; Hyperglycemia ; Incidence ; Obesity ; Pain Management ; Prediabetic State ; Quality of Life

Polyneuropathy includes a lot of diseases damaging peripheral nerves. It shows roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain. Polyneuropathy is known to usually begin in the hands and feet and progress to the arms and legs. Sometimes it can involve other parts of the body such as the autonomic nervous system. Lots of causes can induce acute or chronic polyneuropathy, so finding the original cause is most important for the treatment of polyneuropathy. There are too many different types of polyneuropathies to be discussed in this review, so we will discuss some of various acquired polyneuropathies such as diabetic neuropathy, vasculitic neuropathy, alcoholic neuropathy, Vitamin B12 deficiency neuropathy, and drug-induced neuropathy, with special focus on symptoms, pathogenesis, diagnosis, treatment, and prognosis.
Alcoholic Neuropathy ; Arm ; Autonomic Nervous System ; Burns ; Diabetic Neuropathies ; Diagnosis* ; Foot ; Hand ; Hypesthesia ; Leg ; Peripheral Nerves ; Polyneuropathies* ; Prognosis* ; Vitamin B 12 Deficiency

Most common peripheral neuropathy around foot and ankle is diabetic neuropathy, but there are another cause of peripheral neuropathy, such as rheumatoid arthritis, metabolic disease, genetic disease, toxic material, and so on. The main symptom of peripheral neuropathy is pain. The disturbance of sensory and balancing, weakness of muscle, deformity of foot and neuropathic arthropathy are also the symptoms of the peripheral neuropathy. History taking is most important to identify the cause of peripheral neuropathy. Neurological exam have to include the pin prick test, vibration test, 10 g-monofilamant test and ankle reflex test. Simple radiography is essential to observe the deformities or neuropathic arthropathy at foot and ankle. The presence of peripheral neuropathy, involvement and severity can be identified from nerve conduction study. The study of occlusive arteritis is essential for diabetic neuropathy. The medical treatment of associated disease is important but the pain of peripheral neuropathy should be controlled simultaneously. Medicine include the antidepressants, anticonvulsants, opioids and topical agents. The surgical treatment of peripheral neuropathy include lengthening of Achilles tendon, correction of deformity, the total contact cast and arthrodesis. Surgical decompression of specific nerve might helpful in pain control of peripheral neuropathy.
Achilles Tendon ; Analgesics, Opioid ; Ankle* ; Anticonvulsants ; Antidepressive Agents ; Arteritis ; Arthritis, Rheumatoid ; Arthrodesis ; Congenital Abnormalities ; Decompression, Surgical ; Diabetic Neuropathies ; Diagnosis ; Foot* ; Metabolic Diseases ; Neural Conduction ; Peripheral Nervous System Diseases* ; Radiography ; Reflex ; Somatoform Disorders* ; Vibration

Skin and soft tissue infection (SSTI) is common and important infectious disease. This work represents an update to 2012 Korean guideline for SSTI. The present guideline was developed by the adaptation method. This clinical guideline provides recommendations for the diagnosis and management of SSTI, including impetigo/ecthyma, purulent skin and soft tissue infection, erysipelas and cellulitis, necrotizing fasciitis, pyomyositis, clostridial myonecrosis, and human/animal bite. This guideline targets community-acquired skin and soft tissue infection occurring among adult patients aged 16 years and older. Diabetic foot infection, surgery-related infection, and infections in immunocompromised patients were not included in this guideline.
Adult ; Cellulitis ; Communicable Diseases ; Diabetic Foot ; Diagnosis ; Erysipelas ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Immunocompromised Host ; Impetigo ; Methods ; Pyomyositis ; Skin* ; Soft Tissue Infections*