Changes in the care of the diabetic foot: Part two

Abstract

This two-part paper (the first part is in the previous issue of Practical Diabetes International) describes how specialised foot care for people with diabetes has developed over the ages. Until the 1980s, uncontrolled infections, 'salami' procedures (where patients first lost a toe, then more toes, then a foot and then a leg), major amputations and deaths were alarmingly common. The last two decades of the 20th Century saw an upsurge in interest in the management of the diabetic foot, and the development of new treatments delivered by multidisciplinary teams led to halving of major amputations in a number of centres. New approaches included the development of modern podiatry offering preventive foot care and ulcer debridement, antibiotics to control infections, shoes, insoles and casts to relieve abnormal mechanical forces, preventative education and surgical and radiological procedures to re-perfuse the ischaemic limb. However, the new tecniques are not universally applied and the diabetic foot remains a major public health problem. All over the world, public health systems have failed the diabetic foot and many patients have no rapid access to expert care from experienced teams. The incidence of diabetes is increasing epidemic proportions, and amputations are also on the increase. Copyright © 2001 John Wiley & Sons Ltd.