The diabetic foot

  • Andrew J.M. Boulton
    Affiliations
    Andrew JM Boulton MD DSc FRCP is a Professor of Medicine at the University of Manchester, UK and the University of Miami, USA, and Consultant Physician at Manchester Royal Infirmary, UK. Competing interests: none declared
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Published:December 24, 2018DOI:https://doi.org/10.1016/j.mpmed.2018.11.001

      Abstract

      Foot ulceration in diabetes mellitus is common. Foot problems remain the most common cause of hospital admission among patients with diabetes mellitus in developed countries. The lifetime risk of a patient with diabetes developing an ulcer may be as high as 30%, and up to 85% of all lower limb amputations in diabetes are preceded by foot ulcers. Up to 50% of older patients with type 2 diabetes have risk factors for foot problems, and regular screening by careful clinical examination is essential; those found to be at risk should attend more regular follow-up, with education in foot self-care. The key to management of diabetic neuropathic foot ulceration is aggressive debridement with removal of callus and dead tissue, followed by application of some form of cast to offload the ulcer area. Most ulcers heal if pressure is removed from the ulcer site, arterial circulation is sufficient, and infection is managed and treated aggressively. Patients with a warm swollen foot without ulceration should be presumed to have acute Charcot neuro-arthropathy until proven otherwise. The optimal approach to reducing ulceration requires regular screening, patient education and a team approach to management, both in the community and in hospital.

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