Year: 2005
Type: article
Abstract: World Diabetes Day 2005 is focusing on diabetes and foot complications, but the campaign ‘Putting feet first — preventing amputation’ organised by the International Diabetes Federation is not limiting its activities to 14 November 2005: the campaign is continuing throughout 2005. Of all the complications of diabetes, foot ulcers and amputations, especially if associated with neuropathy, are potentially the easiest to prevent.1 In her report in this issue, Adeleye presents depressing statistics from Ibadan, Nigeria. Foot amputation and ulceration tended to occur more commonly in those with neuropathy and from poorer backgrounds, and were associated with a high morbidity and mortality. Such findings are common from developing countries — Morbach et al.2 reported on regional differences in foot ulcer patients from Germany, India and Tanzania: neuropathy was much more likely to be the primary contributory factor in ulceration in patients from India and Africa. This presents us all with a great opportunity for preventative medicine. As neuropathic lesions are preventable, then surely in this Year of the Diabetic Foot this is the time to increase awareness of foot ulceration amongst health care professionals and patients? As Brand pointed out, so much can be achieved with minimal expenditure.3 When addressing a US Department of Health conference many years ago, Brand was asked to recommend how amputations might best be reduced in patients with diabetes. Expecting an answer promoting vascular surgery or modern medications the questioner was surprised at the answer: ‘Remove the shoes and socks and examine the feet every time you see a patient with diabetes.’3 The problem we all face as health care professionals is that rarely if ever do we receive education on the management of the patient with sensory loss. Many have difficulty comprehending the diabetic foot syndrome and find it difficult to take the initiative and look for early lesions or warning signs of imminent breakdown. Many doctors regard some patients as stupid — how can a sensible individual walk on a swollen red foot with an active ulcer? What we must realise is that an insensitive foot is not only painless, but also does not feel as if it belongs to the individual. In screening for ‘at risk’ feet, it is our job to identify patients at risk of ulceration and help them understand and cope with this health state and thus avoid exposure to environmental hazards that might result in injury (often unperceived) and eventual breakdown. There is increasing evidence that national diabetic foot programmes can work. Pedrosa and colleagues4 recently reported from Brazil on the ‘Save the diabetic foot — Brazil’ programme. Working together with health authorities, a network of foot clinics has now been set up right across Brazil and currently totals over 50. There is beginning to be evidence that screening programmes with simple education can be useful in reducing amputations.4 In this Year of the Diabetic Foot it behoves us all to remember that many patients with diabetes have lost their warning signal — pain — that ordinarily brings patients to their doctors. Thus the campaign this year is to increase awareness of the potential to prevent many devastating foot problems by remembering that every time you see a patient with diabetes, examine their feet having removed their shoes and socks and assess their risk status and, if necessary, provide some simple education and preventative care.
Source: Practical Diabetes
DOI: 10.1002/pdi.810
Author: Andrew JM Boulton
Institutions: Manchester Royal Infirmary, University of Manchester
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1547283992