**Part 2**

**Diagnostic Considerations in Diabetic Foot Complications** 

24 Global Perspective on Diabetic Foot Ulcerations

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**3** 

*Japan* 

**Screening of Foot Inflammation in Diabetic** 

Takashi Nagase1, Hiromi Sanada1, Makoto Oe1,

*Graduate School of Medicine, The University of Tokyo* 

*Graduate School of Medicine, The University of Tokyo* 

*3Department of Metabolic Diseases,* 

Kimie Takehara1, Kaoru Nishide2 and Takashi Kadowaki3 *1Department of Gerontological Nursing/Wound Care Management* 

*2Department of Nursing, St. Marianna Medical University Hospital* 

**Patients by Non-Invasive Imaging Modalities** 

Diabetic foot is defined as infection, ulceration and/or destruction of deep tissues associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb of the patients with diabetes mellitus (DM) (the International Working Group on the Diabetic Foot, 1999). Foot disorders are among the most serious and costly complications of DM (Apelqvist et al., 2008). When uncontrolled, diabetic foot can result in ulcer formation and subsequent amputation of the lower limb. Foot ulcers occur in 12 to 25 % of DM patients, and precede 84 % of all nontraumatic amputations in the growing DM population (Brem et al., 2006). It is thus quite urgently needed to prevent diabetic ulcer formation in the

How can we identify "at risk" foot in the DM patients? According to the guidelines by the International Working Group of the Diabetic Foot, "at risk" foot should be identified by inspection and examination according to symptoms such as non-sensory or sensory neuropathy, foot deformities, bony prominences, signs of peripheral ischemia, previous ulcer or amputation (Apelqvist et al., 2008). The patients are categorized according to the risk classification system. Based mainly on Lavery et al. (Lavery et al., 1998), these categories include the following: no sensory neuropathy (category 0); sensory neuropathy (category 1); sensory neuropathy and signs of peripheral vascular disease (PAD) and/or foot deformities (category 2); and previous ulcer (category 3) (the International Working Group on the Diabetic Foot, 1999). Clinical effectiveness of this risk classification system was indeed substantiated by Peters et al. (Peters & Lavery, 2001), where ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in categories 0, 1, 2, and 3, respectively during three years of follow-up. More recently, the International Working Group on the Diabetic Foot revised the risk classification system more focusing on the associated PAD (Lavery et al., 2008). However, we consider that there should be some limitatons in these approaches of risk assessment only based on conventional clinical examination. Although the report by Peter et al. (Peters & Lavery, 2001) showed clinical effectiveness of these approaches, occurrence rate

"at risk" foot by multi-disciplinary team approach (Apelqvist et al., 2008).

**1. Introduction** 
