The diabetic foot: an overview for community nurses

Diabetic foot problems are a common complication of diabetes. They can lead to much morbidity and some mortality, with foot disease the leading cause of non-traumatic lower-limb amputation in the developed world. Diabetic foot disease is a result of three main pathologies, which can occur singly or in combination: diabetic peripheral neuropathy, peripheral arterial disease and infection. The consequences of these pathologies are ulceration, Charcot foot, painful diabetic neuropathy, gangrene and amputation. This article offers a podiatrist's view of the management of diabetic foot problems, from initial assessment to the management of complex disease. Patients with a diabetic foot problem must be assessed thoroughly and referred to the local multidisciplinary team where appropriate. Recurrence of ulcers is common, so good foot health education, adequate footwear and regular podiatry (if necessary) must be an integral part of the patient's review process. Community nurses are often the first to detect a diabetic foot ulcer in housebound patients, so they need the necessary skills to manage the ulcer effectively and refer patients appropriately.