M. ANNERSTEN GERSHATER,
Foot problems in people with diabetes are common, expensive, and life-threatening. Eighty-five per cent of all amputations in diabetic patients are preceded by an ulcer, deteriorated to a severe infection or gangrene. The complexity of diabetes foot ulcers necessitates an intrinsic knowledge of underlying pathophysiology and a multi-factorial approach to achieve and effective strategy with regard to prevention and treatment. The most important factors related to development of foot ulcers are peripheral neuropathy, minor foot trauma, foot deformity and
decreased tissue perfusion. The International Working Group for the Diabetic Foot Consensus Group has suggested
a simple risk classification with regard to prevention of diabetes related amputations and foot ulcers. Identification of the high risk patient can only be detected from history and clinical examination of the feet, as many foot ulcers in diabetes can potentially be prevented by regular foot inspections, access to foot care for non ulcer pathology and use of adequate foot wear. The feet of diabetic patients should be inspected at every visit to primary health care and specialist care providers and also at every visit from the home care service. Assessment of the feet, education of the patient to perform daily foot inspections, washing the feet daily, use of foot cream, and use of appropriate shoes requires a multidisciplinary approach including appropriate education of involved health care professionals and patients.