Complications > Foot


High costs, low awareness and a lack of care - the diabetic foot in Nigeria

Nigeria, with a population of about 128 million people, is Africa’s most populous country. Life expectancy at birth is 47 years; about 60% of the population live below the poverty line. While healthcare structures and institutions are inadequate, and there is a chronic lack of skilled healthcare personnel, diabetes is on the increase. Uncontrolled urbanization is the driving force behind rising obesity levels and a subsequent boom in levels of type 2 diabetes.

Protecting eyesight, feet, and the nervous system

Classically, diabetes complications are thought of as damaging the heart and blood vessels, eyes, kidneys and nervous system. Blood vessel damage, together with nerve damage, leads to foot problems. Protection of the heart, blood vessels and kidneys is dealt with in an earlier article, as is protection of all of these by control of blood glucose levels. Here we describe how disabling problems which are developing in the eyes, feet, and nervous system despite those measures can be managed optimally.

Appropriate footwear: sandals or shoes?

From the moment they are diagnosed with the condition, people with diabetes receive all kinds of advice – or at least they should – ideally from others with the condition or family members who are ‘experts’ in living with diabetes, and professional health-care providers. Of all of these recommendations, one that is often misinterpreted is that relating to ‘appropriate footwear’. The key to this lies in the word ‘appropriate’.

Managing the diabetic foot: treatment, wound care and offloading techniques

Foot ulcers are caused by an imbalance between excessive pressure on the sole of the foot and repetitive stress from walking. It does not take much pressure to provoke an ulcer, so the skin has a built-in protection system. Normally, harmful pressure or motion against the skin will set off a protective pain alarm. Unfortunately, in people with diabetes nerve damage (neuropathy), this pressure goes undetected and can cause serious injury. Having lost the ‘gift of pain’, people with diabetes neuropathy often do not notice the problem until an ulcer has formed.

Multidisciplinary care: saving Mr L's toe

This is the story of ‘Mr L’, a man in Australia with type 2 diabetes and severe diabetes nerve damage (peripheral neuropathy). He developed neuropathy-related ulcers on one of his toes, which remained untreated for a number of months. He faced the prospect of having his left foot amputated. However, this was prevented because Mr L was linked to a multidisciplinary hospital-based diabetic foot clinic.

The year of the diabetic foot and beyond

The increasing global incidence of diabetes continues to provoke a corresponding increase in numbers of disabling and potentially life-threatening complications. Those affecting people’s feet are among the most feared. The amputation of a limb is one of the most costly of the diabetes complications in terms both of health economics and the devastating impact it has on people’s lives.

This is where we stand: the IDF position statements

The International Diabetes Federation (IDF) continues to prepare and release the Federation’s position statements. Requests are received regularly for the opinion of IDF on topics as varied and, at times, controversial as sucrose and alcohol consumption. Martin Silink and Anne Pierson offer us an update on the position of IDF on the current diabetes issues.

Footcare education for people with diabetes: a major challenge

Although diabetes-related amputations are preventable, for too many people around the world, losing a limb or part of a limb is a tragic consequence of having diabetes. The high rates of these amputations are an indication of inadequacies in the delivery of health care, which create enormous challenges for those attempting to access high quality foot education and care. In this article, Margaret McGill focuses on current recommendations for health-care providers and makes a call for an individualized approach to diabetes foot care.

Screening for the diabetic foot: how and why

Given the dimensions of the current global diabetes pandemic, the number of people who are at risk of developing a diabetes-related foot complication is enormous – and growing. Everybody with the condition is at risk, irrespective of the type or severity of their diabetes. The aim of screening is to identify the people who are at greatest risk in order to allocate to them limited medical resources. Several simple screening techniques exist that can help to distribute therapeutic and preventive foot care to those in greatest need. Edgar Peters reports.

Cause for concern: the pathology of the non-ulcerative foot

Those people with diabetes who are aware of the threat that is posed by diabetes foot complications are right to be terrified by the worst-case scenario: the loss by amputation of one of their feet or legs. People with diabetes are at risk of developing a series of common conditions that can represent a conduit for infection to their vulnerable feet. Andrew Clarke describes the apparently minor conditions that in fact require adequate attention or need to be prevented before chronic ulcers develop and the consequences become tragic.