Two unusual predisposing factors for diabetic pedal ulceration in Nigerians

Two unusual predisposing factors to indolent foot ulceration seen in Nigerian diabetic patients are presented. These are guinea-worm infestation (dracontiasis) affecting the dorsum of the foot and lichenification with fissuring of the sole of the foot during the cool, dry weather of the harmattan season. These two preventable and treatable conditions are widely prevalent in sub-Saharan African countries. While there was severe hyperglycaemia in both cases, one was associated with diabetic ketoacidosis and resulted in limb amputation. Both patients stayed 4-5 months in hospital. A case is made for early recognition and specific management of these lesions to prevent undue morbidity and prolonged hospitalisation.