Practice Points

• All diabetic patients should have their feet screened annually

• Diabetic patients should be advised to wear suitable footwear so as to prevent subsequent deformity

• Common foot problems should be diagnosed early and treated appropriately

• It is important to achieve good metabolic care with control of blood glucose, blood pressure, blood lipids, smoking cessation and taking antiplatelet therapy when indicated

• All diabetic patients should be educated in good foot care.

FURTHER READING Mechanical control

Caputo R, Veraldi S, Annoni F. Text Atlas of Pathology of the Foot.

Martin Dunitz, London, UK, 2000. Lord M, Pratt DJ. Footwear therapy. In Tollafield DR, Merriman LM (eds). Clinical Skills in Treating the Foot. Churchill Livingstone, Edinburgh, UK, 1999, pp. 249-66. Lorimer D, French G, O'Donnell M, Gordon Burrow J. Neale's Disorders of the Foot. Churchill Livingstone, London, UK, 2002.

Roberts DT, Evans EGV, Allen BR. Fungal Nail Infection. Wolfe Publishing, London, UK, 1993.

Metabolic control

CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348:1329-39.

Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 97786.

Fox C, MacKinnon M. Vital Diabetes: Your essential reference for diabetes management in primary care. Class Health, London, UK, 2002.

Heller S. Diabetic hypoglycaemia. Baillieres Best Pract Res Clin Endocrinol Metab 1999; 13:279-94.

Scandinavian Simvastatin Survival Study Group. Randomised controlled trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344:1383-9.

Sheehan P. Introduction to diabetes: Principles of care in the surgical patient with diabetes. In Veves A, Giurini JM, LoGerfo FW (eds). The Diabetic Foot. Medical and Surgical

Management. Humana Press, New Jersey, USA, 2002, pp. 134.

UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-53.

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. Br Med } 1998; 317: 703-13.

Watkins PJ, Amiel SA, Howell SL, Turner E. Diabetes and its Management, 6th Edn. Blackwell Publishing, Oxford, UK, 2003.

Educational control

Assal JP, Muhlhauser I, Pernet A et al. Patient education as the basis for diabetes care in clinical practice and research. Dia-betologia 1985; 28:602-13.

Edmonds ME, Van Acker K, Foster AVM. Education and the diabetic foot. Diabetic Medicine 1996; 13: S61-4.

Peter-Riesch B, Assal JP. Teaching diabetic foot care effectively. J Am Podiatr Med Assoc 1997; 87:318-20.

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