A GLOBAL PERSPECTIVE ON DIABETIC FOOT PROBLEMS

Professor Andrew JM Boulton

Professor of MedicineUniversities of Manchester, UK and

Miami, Fl, USA.

Director, Extra-European Educational Activities, EASD.

Who is at Risk of Foot Ulceration?

• Neuropathy • Peripheral Vascular Disease • Past history of foot ulceration• Microvascular Complications• Elderly, living alone• Foot deformity• Unilateral amputees

Diabetic Neuropathy

‘PAIN – God’s greatest gift to mankind’

Paul Brand

‘Coming Events cast their shadows before.’

Thomas Campbell

Do you know which of Do you know which of these these people will develop a will develop a

diabetic foot ulcer?diabetic foot ulcer?

The ‘at-risk’ patient may be completely asymptomatic: risk cannot be assessed without a clinical exam of the foot

How can we reduce foot ulcers and amputation in diabetes?

Remove the patients’ shoes and socks and examine the feet every time you see someone with diabetes

Paul Brand MD, 1980

Causal Pathways for Foot Ulceration

• Neuropathy most important component cause (78%)

• Critical triad: neuropathy, deformity, and trauma present in 63%

• Ischemia component cause in 35%• >80% of ulcers potentially preventable

Reiber, Vileikyte et al, 1999.

The Most Common Causal Pathway to Incident Diabetic Foot Ulcers

“If I were to choose between pain and nothing ….. I would choose pain”

William Faulkner

“For one mistake made for not knowing, ten mistakes are made for not looking.”

J A Lindsay