Practice Points

• The basic approach to the diabetic foot is assessment, classification, staging and multidisciplinary management

• Diabetic feet can be classified into neuropathic and neuroischaemic feet

• The natural history of the diabetic foot falls into six stages: normal, high risk, ulcerated, infected, necrotic and unsalvageable

• Multidisciplinary management consists of mechanical, wound, microbiological, vascular, metabolic and educational control

• The multidisciplinary foot care service should include podiatrist, physician, orthotist, nurse, radiologist and surgeon.

FURTHER READING Practical assessment

Armstrong DG, Jude E, Boulton AJM, Harkless LB. Clinical examination of the diabetic foot and identification of the at-risk patient. In Veves A, Giurini JM, LoGerfo FW (eds). The Diabetic Foot, Medical and Surgical Management. Humana Press, New Jersey, USA, 2002, pp. 163-78.

Booth J, Young MJ. Differences in the performance of commercially available 10-g monofilaments. Diabetes Care 2000; 23:984-88.

Cavanagh PR, Ulbrecht JS, Caputo GM. The biomechanics of the foot in diabetes mellitus. In Bowker JH, Pfeifer MA (eds). Levin and O'Neal's The Diabetic Foot. Mosby, Inc., St Louis, USA, 2001, pp. 125-96.

Lorimer D, French G, O'Donnell M, Gordon Burrow J (eds). Neale's Disorders of the Foot. Churchill Livingstone, Edinburgh, UK, 2002.

Lyons TE, Rich J, Veves A. Foot pressure abnormalities in the diabetic foot. In Veves A, Giurini JM, Logerfo FW (eds). The Diabetic Foot. Medical and Surgical Management. Humana Press, New Jersey, USA, 2002, pp. 127-46.

Mayfield JA, Sugarman JR. The use of the Semmes-Weinstein Monofilament and other threshold tests for preventing foot ulceration and amputation in persons with diabetes. J Fam Pract 2000; 49: S17-29.

Merriman LM, Tollafield DF. Assessment of the Lower Limb. Churchill Livingstone, Edinburgh, UK, 2001.

Zatouroff M, Bouffler LE. A Colour Atlas of the Foot in Clinical Diagnosis. Wolfe Publishing Ltd, London, UK, 1992.

Classification and staging

Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system: the contribution of depth, infection and ischaemia to risk of amputation. Diabetes Care 1998; 21 (5): 855-9.

Foster A, Edmonds M. Simple Staging System: a tool for diagnosis and management. Diabetic Foot 2000; 3: 56-62.

Macfarlane RM, Jeffcoate WJ. Classification of foot ulcers: the S(AD) SAD System. Diabetic Foot 1999; 2:123-31.

Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle 1981; 2: 64-122.

AAultidisciplinary management

Faglia E, Favales F, Aldeghi A et al. Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation. J Diab Comp 1998; 12:96-102.

Holstein P, Ellitsgaard N, Olsen BB, Ellitsgaard V. Decreasing incidence of major amputations in people with diabetes. Diabetologia 2000; 43:844-7.

Larsson J, Apelqvist J, Stanstrom A et al. Decreasing incidence of major amputations in diabetic patients: a consequence of a multi-disciplinary foot care team approach? Diabetic Medicine 1995; 12: 770-6.

Mayfield JA, Reiber GE, Sanders LJ et al. Preventive foot care in people with diabetes: technical review. Diabetes Care 1998; 21: 2161-77.

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