The Diabetic Foot - A Review
AbstractOBJECTIVE: The aim of this paper is to highlight the epidemiology, aetiopathogenesis and management of this serious challenge in medical practice
BODY: Foot lesions occur in both type 1 and 2, but 50% of the older type 2 patients have risk of foot lesions. These are more common in males over 60 years and also associated with social deprivation. 17% of all amputations in Nigeria are from Diabetis Mellitus constituting the second largest cause of amputations in the environment. About 40% of non trauma related amputations in British hospitals are from diabetic complications. The presence of foot ulcers in the diabetic increases the risk of lower extremity amputations, accounting for approximately 67,000 lost limbs annually. In the USA also, estimated total expenditure for treated diabetic foot ulcers was $16 million in a database of 7 million patients followed for 2 years.
The presentation of diabetic foot spans the spectrum of sensory changes to frank gangrene. Skin changes range from bullae on the sole of the foot or blisters on the dorsum of the foot, and subsequent rupture due to scratching or trauma. Some toes may be involved, part or whole of the foot might get progressively involved. Dark coloration signifying ischaemic compromise might progress to frank gangrene. Symptoms of DM might include polyuria, polydypsia and polyphagia
CONCLUSION: Careful annual foot review of diabetic patients should be done and reliance should not be on symptoms, because 50% of insensitive feet give no past history of neuropathic symptoms. Foot care education team, a multidisciplinary group, is established in some centres, which includes diabetologists, surgeons (vascular and/or orthopaedic), podiatrists, specialist nurses and shoe fitters. High risk patients should be advised to wash and inspect their feet daily, use creams and lotions to prevent dry skin and callus formation, use adequate foot wear, avoid barefoot gait and thermal injury, and seek early medical attention in the event of injury, however trivial. Pedicure must be done by another person
Nig Jnl Orthopaedics & Trauma Vol.2(1) 2003:4-10