Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

Abstract Number : 32
THE DIABETIC FOOT

Andrew JM Boulton MD FRCP

Diabetic foot problems are responsible for much morbidity and mortality amongst patients with both type 1 and type 2 diabetes, and yet remain potentially the most preventable of all the late complications of diabetes. Foot ulceration usually results from the combination of a number of component causes including somatic and autonomic peripheral neuropathy, peripheral vascular disease, and abnormalities of pressures and loads under the feet, limitation of joint mobility and unrecognised repetitive trauma. Only when several of these component causes occur together in the same patient does ulceration result. Thus the identification of patients with risk factors for foot ulceration particularly peripheral neuropathy, peripheral vascular disease, abnormalities of foot shape and most of all a past history of ulceration, should enable preventative education to take place in order to lessen the risk of subsequent ulceration. Patients with neuropathy and adequate arterial inflow are also at risk of developing Charcot neuroarthropathy. Recent evidence suggests that simple tests of peripheral nerve function such as a neuropathy disability score, use of monofilaments to identify the insensate foot or simple quantitative sensory tests such as vibration perception, enables us to identify patients at risk of ulceration to whom more attention should be paid to in terms of regular foot care and education. Those patients developing foot problems require management by a foot care team, which might comprise a number of the following specialities:

Diabetes specialist, general practitioner, general physician, general surgeon, vascular surgeon, orthopaedic surgeon, podiatrist, nurse, shoe fitter and others according to their availability. Amongst this list probably the most important are the foot care nurse and the podiatrist. Those patients developing neuropathic foot ulceration require treatment, which should include adequate sharp debridement of the ulcer and offloading of any plantar ulcer. Again recent evidence suggests that a total contact cast or some similar device is the most efficacious manner in which to offload the neuropathic ulcer. Only those ulcers with clinical infection require antibiotic treatment and care should be taken in the prescribing of antibiotics because of the increased incidence of resistant infections in diabetic foot ulcers. Patients with neuro-ischaemic or ischaemic ulcers require full assessment of the peripheral vascular tree which would normally include a non-invasive assessment and if indicated, arteriography. Case series suggests that diabetic patients respond well to proximal and distal bypass, which should be performed if indicated. The key to a reduction of diabetic foot problems in the future is to have a well organised system of screening those high-risk patients who should then have regular appointments with the foot care team for preventative foot care and education.

OnlineDiabetes Journal, All rights reserved