ABC of diabetes: The diabetic foot

doi:10.1136/bmj.326.7396.977

BMJ 2003;326:977-979 ( 3 May )

Clinical review

ABC of diabetes

The diabetic foot

Peter J Watkins.

The first 150 words of the full text of this article appear below.

Foot ulceration, sepsis, and amputation are known and feared by almost every person who has diabetes diagnosed. Yet theseare potentially the most preventable of all diabetic complicationsby the simplest techniques of education and care. If lesions dooccur, the majority can be cured by immediate and energetic treatment,for which good provision must be made.

This article is adapted from the 5th edition of the ABC of Diabetes, which is published by BMJ Books (www.bmjbooks.com)

Table Removed (Available Only in the Full Text)

Diabetic foot disorders

Neuropathy and ischaemia are the principal disorders underlying foot problems. Whenever a patient presents with an activelesion, it is essential to decide at an early stage whether thefoot problem is:

Precipitating causes of foot ulceration and infection

Friction in ill fitting or new shoes
Untreated callus
Self treated callus
Foot injuries (for example, unnoticed trauma in shoes or when walking barefoot)
Burns (for example, excessively hot bath, hot water bottle, hot radiators, hot sand on holiday)
Corn plaster
Nail infections (paronychia)
Artefactual (self inflicted foot lesions are rare; occasionally failure to heal is due to this cause)
Heel friction in patients confined to bed
Foot deformities (callus, clawed toes, bunions, pes cavus, hallux rigidus, hammer toe, Charcot's foot, deformities from previous trauma or surgery, nail deformities, oedema)

Neuropathic with an intact circulation
Ischaemic with (usually) or without neuropathy (neuroischaemic foot), or
Critically ischaemic needing urgentattention.

A combination of ulceration and sepsis in an ischaemic foot carries a higher risk of gangrene, and early arterial assessmentand management are key to avoiding majoramputation.

Men of low socioeconomic class are most prone to diabetic foot disorders, and Asian . . . [Full text of this article]

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

This article has been cited by other articles:

Meijer, J.-W. G., Smit, A. J., Lefrandt, J. D., van der Hoeven, J. H., Hoogenberg, K., Links, T. P. (2005). Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!. Diabetes Care 28: 2201-2205 [Abstract] [Full text]

Rapid Responses:

Read all Rapid Responses

Metformin and X-ray contrast medium: Dominic M D Fay
bmj.com, 3 May 2003 [Full text]
Serious foot ulcer infections in diabetic patients - consult an infection specialist: Ronan McMullan, et al.
bmj.com, 7 May 2003 [Full text]
Diabetic foot ��.a �western form� of leprosy foot ?: I.A. Hassan
bmj.com, 16 May 2003 [Full text]