The 10 commandments of the diabetic foot
========================================

* Nikolaos Papanas
* Efstratios Maltezos
* Audrey Edmonds
* Michael Edmonds

Every 30 seconds a leg is still lost because of diabetes somewhere in the world. In order to improve diabetic foot care, we need simple rules—the 10 commandments of the diabetic foot:

1.  I am thy foot forever. Take good care of me, for thou shalt have no foot other than me1

2.  Thou shalt regularly debride me, when I develop callosities and ulcers2

3.  Thou shalt fit me with casts and insoles to offload my high pressure areas3

4.  Thou shalt carefully look for early signs of infection in me and treat it aggressively4

5.  Thou shalt diagnose ischaemia without delay and revascularise me5

6.  Thou shalt educate all patients how to examine me and take care of me6

7.  Thou shalt carefully inspect the shoes that I have to wear and encourage the use of appropriate footwear7

8.  Thou shalt continuously aim to achieve tighter blood glucose control for me8

9.  Thou shalt not commit amputation on me, unless there is a compelling reason9

10. Thou shalt not covet thy neighbour's amputation rates, but try to improve yours9

## References

1.  Edmonds ME. The diabetic foot, 2003. Diabetes Metab Res Rev 2004; 20(suppl 1):S9–12.
    
    

2.  Steed DL, Donohoe D, Webster MW, Lindsey L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg 1996; 183: 614.
    
    [PubMed](http://www.bmj.com/lookup/external-ref?access_num=8673309&link_type=MED&atom=%2Fbmj%2F331%2F7531%2F1497.atom) 
    
    [Web of Science](http://www.bmj.com/lookup/external-ref?access_num=A1996UV69700009&link_type=ISI) 

3.  Boulton AJM. The diabetic foot: from art to science. The 18th Camillo Golgi lecture. Diabetologia 2004; 47: 134353.
    
    [PubMed](http://www.bmj.com/lookup/external-ref?access_num=15309286&link_type=MED&atom=%2Fbmj%2F331%2F7531%2F1497.atom) 
    
    [Web of Science](http://www.bmj.com/lookup/external-ref?access_num=000223261500002&link_type=ISI) 

4.  Lipsky BA. International consensus group on diagnosing and treating the infected diabetic foot. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes Metab Res Rev 2004; 20(suppl 1):S68–77.
    
    

5.  Faries PL, Teodorescu VJ, Morrissey NJ, Hollier LH, Marin ML. The role of surgical revascularization in the management of diabetic foot wounds. Am J Surg 2004; 187: 34–7S.
    
    

6.  Valk GD, Kriegsman DM, Assendelft WJ. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2005; 1: CD001488.
    
    

7.  Busch K, Chantelau E. Effectiveness of a new brand of stock “diabetic” shoes to protect against diabetic foot ulcer relapse. A prospective cohort study. Diabet Med 2003; 20: 6659.
    
    [CrossRef](http://www.bmj.com/lookup/external-ref?access_num=10.1046/j.1464-5491.2003.01003.x&link_type=DOI) 
    
    [PubMed](http://www.bmj.com/lookup/external-ref?access_num=12873296&link_type=MED&atom=%2Fbmj%2F331%2F7531%2F1497.atom) 
    
    [Web of Science](http://www.bmj.com/lookup/external-ref?access_num=000184316500010&link_type=ISI) 

8.  Jeffcoate WJ, Price P, Harding KG, for the International Working Group on Wound Healing and Treatments for People with Diabetic Foot Ulcers. Wound healing and treatments for people with diabetic foot ulcers. Diabetes Metab Res Rev 2004; 20(suppl 1):S78–89.
    
    

9.  Van Houtum WH, Rauwerda JA, Ruwaard D, Schaper NC, Bakker K. Reduction in diabetes-related lower-extremity amputations in the Netherlands: 1991–2000. Diabetes Care 2004; 27: 10426.
    
    [Abstract/FREE Full Text](http://www.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NzoiZGlhY2FyZSI7czo1OiJyZXNpZCI7czo5OiIyNy81LzEwNDIiO3M6NDoiYXRvbSI7czoyMzoiL2Jtai8zMzEvNzUzMS8xNDk3LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)