The diabetic foot problem--a failed system of health care?

It is evident that there is excess morbidity and mortality as a consequence of foot problems in patients with diabetes mellitus. Most of the data relative to foot lesions is taken from the study of subsets of diabetic patients undergoing lower extremity amputation. Such data probably do not provide accurate information relative to the incidence and/or prevalence of diabetic foot problems. Available evidence does suggest that diabetic foot care may be inadequate and the efficacy of various diagnostic and therapeutic modalities has not been proven. Advances have been made in obtaining a better understanding of the microbiology of lower extremity infected lesions both in hospitalized patients and in those subjects being followed in the outpatient setting. Attention should be directed at developing a systematic classification of foot lesions which can be universally applied. We need to understand and relate to those risk factors contributing to the development and progression of lower extremity lesions in the diabetic patient. In evaluating the efficacy of diverse diagnostic and therapeutic approaches, well-controlled clinical investigations need to be undertaken. Attention should be focussed upon both measures of process and outcome where appropriate. Finally, there needs to be recognition that the problem of the diabetic foot lesion represents a major public health challenge.