Foot lesions, ulcers, infections and amputations are considered as major causes of morbidity and disability in people with diabetes, the diabetic foot problems could also cause significant emotional and physical costs. Early detection, preventive measures along with the management of the risk factors for ulcers and amputations can prevent or delay the onset of adverse outcomes.
This position statement provides recommendations for people who currently have no foot ulcers, and outlines the best means to identify and manage risk factors before a foot ulcer occurs or an amputation becomes imminent. These recommendations are based on the technical review of care for the nonulcerated foot in diabetes. Risk identification is fundamental for effective preventive management of the foot in people with diabetes. The risk of ulcers or amputations is increased in people who have had diabetes ≥10 years, are male, having poor glucose control, or already with cardiovascular, retinal, or renal complications. The following foot-related risk conditions are associated with an increased risk of amputation: Peripheral neuropathy with loss of protective sensation , Altered biomechanics in the presence of neuropathy, Evidence of increased pressure like erythematic changes, hemorrhage under a callus, also if someone is having bony deformity and/or peripheral vascular disease detected by decreased or absent pedal pulses , with a history of ulcers or amputation and Severe nail pathology.
The development of neuropathy can be prevented, minimized or at least delayed significantly by maintaining optimal glycemic levels with A1C below 7%. Smoking cessation is crucial to reduce the risk of vascular disease complications Patients with diabetes and high-risk foot conditions should be educated by their health care providers (Diabetes Educators or Podiatrists) regarding their risk factors and appropriate management. Patients at risk should understand the implications of the loss of protective sensation, the importance of foot monitoring on a daily basis, the proper care of the foot, including nail and skin care, and the selection of appropriate footwear. The patient’s understanding of these issues and their physical ability to conduct proper foot surveillance and care should be assessed. Patients with neuropathy should be advised to break in new shoes gradually to minimize the formation of blisters and ulcers. Patients with visual difficulties, physical constraints preventing movement, or cognitive problems that impair their ability to assess the condition of the foot and to institute appropriate responses will need other people, such as family members, to assist in their care. Patients at low risk may benefit from education on foot care and footwear All health care providers of people with diabetes are invited to join this unique to be held, 13 – 14 March 2020 , Cairo , Egypt. Do not miss this opportunity.