Clasificacion de pedis para pie diabetico Like a bar Mustafa aroused, your splint nothing. Wilt snorty unadorned and brooms its currency or continue behind. ¿Es válida la nueva clasificación WIfI? Por: Unidades Multidisciplinares para la atención del pie diabético. Sistema de clasificación PEDIS. Plan para la asistencia integral del paciente diabético en la Co- munidad Valenciana de sensor de glucemia), prevención secundaria, pie diabético, diabetes y . Actualmente la clasificación de la diabetes mellitus se basa en la etiología y pies y de los pliegues interdigitales de los mismos (tiña pedis), es más fre-.

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To classify clasificcacion level of risk for foot ulcers in people with diabetes mellitus and identify their main predictive risk factors. Data were descriptively analyzed. The data found indicate the importance of careful feet examination in people with diabetes by the nursing staff to identify future risks of ulcers and, thus, prevent them.

Clasificar el grado de riesgo para las ulceraciones en los pies de las personas con diabetes mellitus e identificar sus principales factores de riesgo predictivos.

Los datos fueron analizados descriptivamente. Currently, million people have clasigicacion mellitus DM with worldwide prevalence of 8.


Byit is predicted that about million people will have diwbetico new cases of the disease. The impact was such that, in5 million deaths by DM occurred, which implies saying there was a death every six seconds 1. Brazil is the fourth country with the largest number of people with DM in the world.

It clasifocacion estimated that, currently, This scenario asks for urgent measures to control and prevent DM, as well as its complications, otherwise, the country is clasuficacion to have a significant number of people with severe sequelae and with reduced life expectancy by the high rate of mortality caused by the disease 2. It is one of the most common complications inherent to long-term progression DM, with the aggravation of inadequate glycemic control 3 – 5.

DNP can be considered a precursor in the development of foot ulcers in people with DM, since, once installed, it is responsible for alterations in the protective sensitivity of the feet, and can make them insensitive to painful, pressure, thermal and tactile stimuli.

In addition, it can also cause musculoskeletal disorders and alterations in skin integrity 5. In this sense, people with DM and DNP have great potential for the appearance of foot ulcers, which can lead to the amputation of a limb or part of it. The training of the interdisciplinary team is consensual and mandatory for the management of people with DM, including foot management 6 – 7.

The nurse has a fundamental role within this group, acting in order to identify risk factors that lead clasificadion complications, to develop educational programs, interventions and continuous monitoring 8. Nursing consultation is a private activity of the nurse and must be performed to identify with high accuracy people with DM that pose a risk of ulceration 8. In this way, the thorough evaluation of the feet is a critical step in tracking the risk of complications in these limbs.

When performing the consultation, the nurse must seek to identify, through a rigorous inspection ddiabetico palpation, dermatologic, musculoskeletal, vascular and neurological alterations 8 – 9. In the musculoskeletal evaluation, they must investigate the presence oara hallux valgus, claw or hammer toes, overlapping toes, hallux rigidus and decreased mobility, areas of plantar hyper dr, changes in the curvature of clasificacuon feet, Charcot foot, intrinsic muscle atrophy evidenced by apparent tendons, which occur due to diabetic neuropathy 9 To identify possible vascular alterations, it is important to inspect the skin, which might be atrophic and shiny, with hairs diminished or absent, cold extremities, thick and involute ds.

The LL lower limbs may present pallor at elevation and declivity flushing. The presence of claskficacion claudication or pain at rest, tibial and feet pulses decreased or absent to palpation suggest Peripheral Artery Disease PAD 9 To detect neurological changes, some tests already validated to identify the risk of future injury should be conducted. Among the listed tests, pra stands out: After thorough examination of the feet, the classification of the detected risk must be performed, through scores, which ranges from low risk to high risk.

In addition to point out the risk score for ulcerations, the risk classification system allows to define the clawificacion of follow-ups and feet evaluation 6 – 79 Pedix collection was performed after approval on the Ethics Committee and upon the consent of the participants through signing the Informed Consent Form ICF. Exploratory-descriptive study with quantitative approach. Data were collected from November to December The study population was composed of 50 individuals who agreed to participate of the study and who fit in the following inclusion criteria: Individuals who were bilaterally amputated and those who were attending the outpatient clinic for the first time, because they did not have a confirmed diagnosis of DM.

For the nursing consultation, a form was used, based on the guidelines of the International Consensus on the Diabetic Foot and the protocol of the Prohibited Wounds program, containing questions on sociodemographic variables and risk factors related to DM, life style and precursors signs of foot ulcerations, and non-invasive neurological tests, collected during the physical exam, which were asked to the study participants and written by the interviewer.


To perform the tests, a monofilament was used Semmes-Weinstein 10gchopsticks with blunt and pointy tips, Hertz turning fork and neurological hammer to assess the protective, pain and vibratory sensitivity and the Achilles tendon reflex, respectively.

The degree of risk classification of the participants was performed according to Chart 1and the following criteria were adopted. It is worth to emphasize that the objective of this study was to assess the degree of risk for foot ulcerations in parx with DM trough LOPS investigation, and not through neuropathy investigation, which is researched upon other scores.

On the above, the applied tests proposed to only research LOPS. Thus, in the chart above, the risk factor neuropathy was replaced by LOPS, based on recommendations from the guidelines of the Brazilian Society of Diabetes that guides risk screening considering the LOPS, and not the neuropathy Therefore, diabeticoo LOPS was considered absent when the individual was sensitive to the monofilament in the four sites tested.

LOPS was considered present when the individual had altered monofilament in one of more tested sites, associated to one or more of the altered tests described above 6. Pedis and posterior tibial pulses that were absent or difficult to palpate in the same laterality were considered a sign of PAD, because, if these pulses are present, it is unlikely that the PAD is installed in a way to cause hemodynamic repercussions 6. However, the last guidelines guide the calculation of the ABI to confirm or rule out PAD regardless of whether the pedis pulses are present on palpation or not 7.

Before the specific examination of the feet and neurological tests, all individuals were properly oriented and positioned in a stretcher, the procedure was demonstrated, so they could interpret the stimuli that they should feel or not when having their feet examined. They were requested to keep their eyes closed during the exam to avoid erroneous diabeticl. The places selected to apply the monofilament were: The monofilament was applied pke to the skin hard enough to bend it, for no more than two seconds.

While applying the monofilament, the individuals were asked if diabstico felt the applied pressure and which limb was being tested.

The monofilament was applied twice in the same place, alternated with a random simulated application, totaling three questions per application site 6 – 7. To test pain sensitivity, the chopsticks were used, one with a blunt tip and other with a pointy tip, and the individual should identify when the stimulus was being conducted with the blunt tip or with the pointy tip. The pedix of the chopstick were applied on the back of the hallux with enough pressure to deform the skin without penetrating it.

To test vibratory sensitivity, the examination held the tuning fork by the handle and stroke the distal extremity of the object in the palm of the opposite hand so that the instrument would vibrate, then, the handle was placed perpendicular to the bone of the anterior region of the distal phalanx, with constant pressure.

The test was performed three times, one of them simulated. The test was considered positive when the individual showed sensitivity to the vibration of the object at least twice out of three attempts 6 – 7. To test the reflex of the Achilles tendon, the individual was positioned sitting on the stretcher with the legs hanging.

The examiner performed a discrete ds dorsiflexion and stroke the Achilles tendon insertion with the flat part of the neurological hammer. The test was considered positive when the individual performed plantar flexion, and negative when there was no movement The results were obtained through a descriptive analysis with tables of distribution and simple frequency of discrete values in absolute and percentage numbers, obtained through databases of Microsoft Excel spreadsheets powered by double tying of the variables.

Table 2 shows data that identify the risk factors for foot ulceration related to clinical variables and to signs detected in the specific feet examination. Regarding the classification of foot ulcers, it is possible to verify, in Table 3the diwbetico installed presence of factors predisposing to ulceration, because the following was identified: In this research, the literature on the topic in question corroborates the predominance of feminization that can be justified by the fact that, still, women seek health services more often than men, with well discussed findings in studies on morbidity 15 – As for age, prevalence studies support the manifestation of type 2 DM in young adults, in which half the people with clasifiicacion disease have from 40 to 59 years-old 2.

It is worth noting that this age group includes people who are in a productive phase to exercise remunerated activity, but, due to DM complications, they leave their activities, suffering emotional and economic losses. In addition, the economic burden of these complications such as absenteeism at work, medical licenses, missing work for medical consultations, low productivity, rehabilitation and early retirements are problematic for the Health System 2 – 6.

With regard to education level, low schooling was detected, including illiterates. In a study with the objective of characterizing individuals with type 2 DM registered in a Basic Health Unit in the city of Porto Alegre, RS, it was identified that These data confirm the socioeconomic and intellectual fragility of great part of the affected, demonstrating the importance of considering the level of potentiation for self-care of this population in prevention and education problems.


Glycated hemoglobin count is one of the main pedos of glycemic control, and, according to the guidelines of the Brazilian Society of Diabetes, it must be requested routinely for all individuals with DM every three months, however, health professionals must determine the periodicity individually, according to the clinical conditions of the individual and the aimed glycemic target Associated comorbidities, such as systemic arterial hypertension and dyslipidemia, were the most mentioned.

Individuals with DM showed cardiovascular risk twice or four times higher when compared with people without the disease, which demonstrates the importance of the treatment and control of these comorbidities Concerning the practice of physical activity, only a minority referred to regular practice. The practice of aerobic exercises is recommended, such as walking, dancing, swimming, running and cycling, at intervals of three to five times per week, lasting 30 to 60 minutes.

Physical exercise provides the body with better control of glycemic levels, including reduction of glycated hemoglobin and clsificacion risks, in addition to contributing for weight reduction and raising self-esteem Most of the participants never received orientations from a health professional about foot care.

Educating these individuals is still a challenge for health professionals, either for the lack of scientific knowledge, time in light of several assignments, or even if it was not effectively performed. In this sense, we highlight dizbetico educating means to teach people to learn or relearn something.

Changing is necessary, and the act of changing is difficult, modifying old habits occurs gradually and requires constant stimuli, which certainly justifies the inclusion of individuals with DM in continuous monitoring programs 7.

The use of adequate footwear is one of the orientations that health professionals must provide to the person with diabetes.

Gabriela Rojas –

Inadequate shoes are a major cause of ulceration A shoe considered adequate should have thick soles, wide and deep enough to hold an insole and the foot comfortably, the interior of the shoe must be soft and without seams, adjustable with shoelaces or Velcro, offer full protection to the toes round or square toecapsole pediis to three centimeters, and made with soft raw-material 9 Regarding LL skin integrity, the majority had dry skin. Autonomic neuropathy causes sudomotor changes, leading to skin dryness, making it necessary to externally lubricate it regularly.

Dry skin is susceptible to cracks and, consequently, loses its protective barrier, facilitating the penetration of microorganisms and the development of infections 9. When asked if they would inspect their feet regularly, the diaabetico stated that they did not perform the inspection of those limbs or only performed it sporadically. Feet inspection should be exhaustively viabetico for all people with DM, who must be educated and encouraged to adopt the habit to look diabetco their feet regularly and seek help from a health professional if they find any changes such as cracks, maceration, blisters, calluses, ulcers, interdigital mycosis, edema, hyperemia and onychomycosis 6.

Many of the individuals had calluses and callosities, which were considered pre-ulcerative lesions, therefore, predictive of ulcerations. They occur due to musculoskeletal alterations that, associated to insensitive feet, are an important way to ulceration A descriptive study, performed with the objective to characterize people with diabetes in the primary health care network in relation to factors that may trigger diabetic foot, pointed out that the individuals had risk factors for the development of foot complications, such as poor hygiene, cracks, interdigital mycosis, calluses and callosities, toenails trimmed inappropriately and altered protective sensitivity These risk factors can be controlled and modified through a contingency plan to guide, teach and monitor the expected results 7.

A study conducted in the United States to verify direct medical costs in people with DM due to the reduction of vibratory sensitivity detected that, when this was absent, the expenses were greater, approximately five times more for the treatment of ulcers and amputations when compared with those with normal vibratory sensitivity This number was close to the result of the study that investigated the prevalence sensory-motor DNP in people from the Agreste region in Pernambuco, which found areflexia of the Achilles tendon in Tendon areflexia constitutes important musculoskeletal alterations and raises the risk of ulcers in people with DM 9.

This finding is extremely worrying, because the monofilament is considered the gold standard test to early identify a foot with risk of ulceration. It is a simple, cheap and easily reproducible test.


Individuals with DM should have their feet examined at least once a year, and the ones considered at risk should be examined more often 6 – 7. Finally, it is necessary to raise which are the difficulties faced so that health professionals may have adequate conditions to examine the feet of people with DM habitually. It is noteworthy that examining feet is a valuable form of prevention, and the BHU is part of Basic Health Care, focusing on working on prevention, health promotion and recovery.

If the result of this exam is negative for ischemia below 1. However, individuals with DM may have Monckeberg sclerosis — thickening of the middle layer of the arteries.

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