Accredited in September 2011
Authors:
Dr Martinus TERBURG
Sophia Revalidatie Rehab Centre
Reinier de Graaf Group Hospital
262AD DELFT (Ther Netherlands)
m.terburg@sophiarevalidatie.nl
Dr Heleen A. BERNDSEN
h.berendsen@sophiarevalidatie.nl
SUMMARY
Diabetic foot complications can have a great impact on quality of life and should be considered as a multi-organ disease and a lifelong condition [3]. International consensus meetings on the diabetic foot provide practical guidelines for management and prevention of the diabetic foot, and specific guidelines for management of infection, wounds, osteomyelitis, footwear and off-loading [2].
Up to 50% of people with type 2 diabetes have significant neuropathy. Foot ulcers usually result from a combination of internal and external factors such as loss of protective sensation due to neuropathy, increased biomechanical stress, impaired skin perfusion and external trauma. They often repeat, are recalcitrant to healing and susceptible to infection [3]. Shoe-related trauma is the most frequent event precipitating an ulcer. Prevention and treatment of foot ulcers can be reached by regular inspection, identification of at-risk feet, education, appropriate footwear and treatment of non-ulcerative pathology.
In patients with both neuropathy and ischemia (neuro-ischemic ulcer), symptoms may be absent, despite severe peripheral ischemia [2,4,5,8]. Micro-angiopathy should not be accepted as a primary cause of an ulcer and a non-healing ulcer is not an indication for a major amputation. Peripheral arterial disease is the most important factor related to outcome of a diabetic foot ulcer. Open bypass and endoluminal therapy is important to achieve healing in a diabetic foot ulcer [5,7].
Up to 70% of all lower-leg amputations are related to diabetes. Up to 85% of all amputations are preceded by ulcers. Also co-morbidities as well as tissue loss/involvement are strongly related to the outcome and the probability of healing [6-8]. Multidisciplinary approach to management and prevention can reduce the amputation rates by 45-85% [1,2].
A multiprofessional diabetic foot team may consist of a vascular surgeon, PRM physician, podiatrist, plaster department, wound nurse, orthopedic shoe technician, diabetologist and dermatologist. Foot examination should be performed at least once a year depending of the risk profile of the diabetic foot. Identification and treatment of patients at risk are the most important aspects of amputation prevention and ameliorating quality of live of patients with diabetic foot problems.