The diabetic foot: diagnosis and prevention

Diabetes remains the world's leading cause of amputation. Like many other major health problems, prevention is the key to successful management. Patient education efforts coupled with a team approach of aggressive early management represent the optimum current strategy. Multidisciplinary physician teams consisting of orthopaedic and vascular surgeons, supported by consultation, serve as the focus for leadership and decision making. Their efforts are supported by allied health personnel, nurses, physician's assistants, and physical therapists trained in foot evaluation, pedicare, and nail trimming, assisted by competent trained shoe technicians, orthotists, or pedorthists. At each visit the patient is examined, footwear is evaluated, and ongoing education is provided. Visits are scheduled according to a risk protocol, and treatment is based on problem classification. This regimen should result in increased patient compliance and overall improved patient care.