The diabetic foot

Abstract

<h2>Abstract</h2> Foot problems remain a major cause of hospitalization amongst patients with diabetes and the lifetime risk for developing an ulcer for a person with diabetes was recently estimated to be as high as 25%. The main contributory factors that result in foot ulceration include peripheral neuropathy (somatic and autonomic), peripheral vascular disease, trauma, foot deformity and limited joint mobility. Several of these factors combine to complete the causal pathway to ulceration: the commonest triad that results in 66% of ulcers is neuropathy, deformity and trauma. The key components in the management of diabetic foot ulceration are: a) remove pressure from the lesion, b) ensure adequate arterial inflow and c) diagnose and treat any infection appropriately. The presence of diabetes should not deter a thorough assessment of the peripheral circulation with appropriate treatment including distal bypass surgery if indicated. Charcot neuroarthropathy is not uncommon in neuropathic diabetic patients: this diagnosis should be suspected in any neuropathic patient with a unilateral warm, swollen foot in the presence of an adequate arterial circulation. The management of the acute Charcot foot should include offloading in a cast and the use of bisphosphonates. The key to the reduction of amputation in diabetes is to maintain a high index of suspisicion and to examine the feet of every diabetic patient at each consultation. Early identification and education of those at risk of foot problems should be part of routine diabetes care.