[Foot ulcers in patients with diabetes. Preventive measures reduce the number of amputations]

Reports of preventive management resulting in reduction, by 50 percent or more, of the incidence of major amputation due to foot ulceration in diabetics have now been published from seven different localities, five in Europe (Umeå, Kisa, Lund, London and Geneva) and two in the USA (Tucson and Louisville). The methods used to achieve the reduction are remarkably similar, being based on systematic check-ups for incipient foot ulceration and its putative risk factors. In all three Swedish reports, the work has entailed close liaison with community health centres in the respective areas, which is considered to be of the utmost importance in reaching all diabetics at risk of foot ulcers. Another important prerequisite is a specialised foot clinic for diabetic patients in each area, where the skills of a chiropodist, a physician specialised in diabetes, an orthopaedic surgeon and an orthopaedic shoemaker are available.