Diabetic foot

Abstract

Diabetic foot problems are eminently preventable and yet represent one of the commonest causes of hospital inpatient admission in Western countries. Realizing the global importance of diabetic foot disease, the International Diabetes Federation focused on the diabetic foot throughout the year 2005, during which there was a worldwide campaign to “put feet first” and highlight the all too common problem of amputation among patients with diabetes throughout the world. To coincide with World Diabetes Day in 2005, The Lancet launched an issue almost exclusively dedicated to the diabetic foot: this was the first time that any major nonspecialist journal had focused on this worldwide problem; however, major challenges remain in getting across important messages relating to the diabetic foot. The late sequelae of diabetic peripheral neuropathy include foot ulceration, Charcot neuroarthropathy, and amputation: likewise, peripheral vascular disease is a major etiological factor in diabetic foot lesions. Today, in many countries, it is neuro-ischemic ulcers which are most commonly seen and which present a major challenge in management. The importance of routine diabetic foot care in very high-risk patients is emphasized by a recent observational study from Arizona where the state decided, as a cost-saving measure, to remove routine podiatry from high-risk diabetic patients. This led to an annual saving of $351,000, but the cost of this action measured by increased hospitalization, length of stay, and amputations was $16.7 million per annum.