[Care of the diabetic foot]

The diabetic foot is the most frequent complication of diabetes requiring hospitalization. According to large sets of patients, as many as 25% of diabetic patients develop damage to their feet during their life. Regarding the growing number of diabetic patients it is necessary to elaborate a prospective conception of the treatment of patients afflicted by this complication.

The study's aim is to respond to the question of differentiation of treatment of patients with the diabetic foot.

A retrospective analysis of two sets of patients hospitalized at the surgical clinic.

The group I (1989-1993) included 264 patients treated by "classical surgical management". The group II (October 1994-January 1996) included 142 patients subdued to "intensified therapy" with maximum possible use of revascularization procedures, 52-57% of patients were admitted with extensive gangrene, 65-68% with ischaemic disease of the lower extremities in the stage of CLI. The proportion of revascularizations was 26% vs 68%, the proportion of large amputations was 60% vs 38%. Despite maximum surgical forcefullness, a large proportion of large amputations reaching 38%, perseveres. The authors additionally surveyed the patients of group II as to the degree of their knowledge on the possible chronic complications of diabetes. The predominant majority of patients (63%) had insufficient knowledge about the prevention of the diabetic foot.

Even a maximum use of surgical procedures is not sufficient in procuring a decrease in the proportion of large amputations of lower limbs in diabetic patients who have been hospitalized with their disease being in a progressed stage caused by neglection. Therefore it is necessary to transfer the emphasis of treatment of the diabetic foot into the period preceding the stage of manifestant infectious and necrotic complications. It would be most appropriate to delegate this "frontman" task to diabetologists. USE IN PRACTICE: Even though the only definitive solution of this dissatisfying situation resides in the establishment of specialized centres focused on the therapy of the diabetic foot, certain progress can be achieved also under current conditions by a consequent use of the existing net of diabetologic out-patients clinics, improvement of the quality of the diagnostic process and enhancement of educational activities. (Tab. 5, Ref. 18.)