VASCULAR ASSESSMENT DIABETIC FOOT ULCERS: PALPATION

One of complicated factor in diabetic patients are calcification on peripheral vascular foot which can lead to development of Peripheral Vascular Disease (PVD). Thus adequate foot assessment can be meaningful to screen and identify these risk factors. 

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 Palpation of foot pulses are recommended as screening tool for development of diabetic foot ulcers (Abbott et al., 2002). While palpation of dorsalis pedis and posterior tibial pulses should be performed (American Diabetes Association, 2010) and its recommended to palpate both of feet (Abbott et al., 2002). Even of that its seem that practitioners ignored palpation as part of foot assessment.

Palpation is not costly, no need electric supply, can be done by self without assistance, quickly and no need preparation for patients.

However we have to aware from subjective results result of palpations can be very subjective since it influenced by experience of  observer (Brearley, Frcs, & Frcs, 1992).  A study has been confirmed low reproducibility of palpation at dorsal pedal area (0.57) and posterior tibial pedal pulses (0.52) (Edelman, Sanders, & Pogach, 1998). Furthermore assessment settings also influence the result, for example comparison between laboratory and outpatient clinic. (Lundin, Wiksten, Pera, Lepa, & Ph, 1999).

This become challenge for practitioners especially in developing country where vascular diagnostic (such as ABPI or TBI) not well available, to improve palpation technique and put it as part of standard assessment as recommended by ADA.

References:

Abbott, C. a, Carrington, a L., Ashe, H., Bath, S., Every, L. C., Griffiths, J., … Boulton, a J. M. (2002). The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabetic medicine : a journal of the British Diabetic Association, 19(5), 377–84. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12027925

American Diabetes Association. (2010). Standards of medical care in diabetes--2010. Diabetes care, 33 Suppl 1, S11–61. doi:10.2337/dc10-S011

Brearley, S., Frcs, M., & Frcs, M. H. S. (1992). Peripheral pulse palpation : an unreliable physical sign, 74, 169–171.

Edelman, D., Sanders, L. J., & Pogach, L. (1998). Reproducibility and accuracy among primary care providers of a screening examination for foot ulcer risk among diabetic patients. Preventive medicine, 27(2), 274–8. doi:10.1006/pmed.1998.0263

Lundin, M., Wiksten, J., Pera, T., Lepa, M., & Ph, D. (1999). Distal Pulse Palpation : Is It Reliable ?, 252–255.