Addressing the Inertia: A Holistic Approach to Diabetic Foot Evaluation

Diabetic foot is a well-known complication with considerable morbidity and mortality related to the diabetic population. Neuropathy, deformity, infection and ischemia are important contributors to the pathogenesis of diabetic foot ulcers. A multidisciplinary team approach by physicians, nursing staff, diabetic educators and the caregiver as well as close monitoring of feet by the patient himself can prevent foot-related complications. Proper foot care, foot hygiene, annual foot examination and the correct choice of footwear are the main elements in preventing foot problems like deformity, ulceration and amputations. Physicians play a key role in the early detection and prevention of foot problems. Foot evaluation is the most neglected part of physical examination in diabetic patients. This inertia is evident in both physicians and patients. Emphasis on visual inspection and physical foot examination at every visit may address the morbidity and mortality due to diabetic neuropathy and vasculopathy. This article will highlight extensively history taking and foot examination in the diabetic foot clinic. Optimal glycemic control, simple foot care practices, knowledge and appropriate footwear use play an important role to reduce the disease burden.