The diabetic foot

Diabetic foot lesions most commonly result from a combination of neuropathy and vascular disease in the lower extremity, and may be the presenting feature of diabetes in the older patient. Insufficient attention previously has been given to the careful clinical assessment of the foot, which enables the physician to recognize those patients who are at particular risk of ulceration. The high-risk patient requires education and frequent follow up to reduce the risk of lesions developing. If ulceration develops, healing is likely to occur if the vascular supply is adequate, infection and the blood glucose are controlled, and pressures that may have caused the ulcer are relieved. The ischemic foot requires full vascular assessment, involving colleagues from vascular surgery. The key to a future reduction in the incidence of diabetic foot ulceration is the setting up of a foot care team in which the skills of nurses, podiatrists, orthotists, physicians, and surgeons are combined. The most important members of the team, however, are the patients, who must be convinced that regular foot care will reduce their chances of developing ulceration and other catastrophic consequences, such as amputation.