Practice Points

• Throughout the world, health-care systems are symptom-led and they often fail to respond to the needs of the diabetic foot patient

• Diabetic foot problems are frequently underestimated: there is no such thing as a trivial lesion of the diabetic foot

• Diabetic foot patients are unfairly regarded as 'feckless'

• Increased interest in the diabetic foot over the last 25 years has resulted in major advances in the care of the diabetic foot patient

• The multidisciplinary diabetic foot service has been developed as a successful model of care throughout the world.

FURTHER READING The scope of the problem

Boulton AJM, Vileikyte L. Diabetic foot problems and their management around the world. In Bowker JH, Pfeifer MA (eds). Levin and O'Neal's The Diabetic Foot. Mosby Inc., St Louis, USA, 2001, pp. 261-72.

The Global Lower Extremity Amputation Group. Comparing the incidence of lower extremity amputations across the world: the Global Lower Extremity Amputation Study. Diabetic Medicine 1995; 12:14-18.

Historical background

Bliss M. The Discovery of Insulin. University of Toronto Press, Toronto, Canada, 2000.

Joslin EP. The menace of diabetic gangrene. N Engl J Med 1934; 211:16-20.

Lawrence RD. The Diabetic Life. JA Churchill, London, UK, 1925.

McKeown KC. History ofthe diabetic foot. Foot 1992; 2:179-82.

Advances in diabetic foot care

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

Boulton AJM, Connor H, Cavanagh PR (eds). The Foot in Diabetes, 3rd Edn. Wiley and Sons Ltd, Chichester, UK, 2000.

Brand P, Yancey P. The Gift of Pain. Zondervan Publishing House, Grand Rapids, Michigan, USA, 1997.

Edmonds ME, Blundell MP, Morris ME et al. Improved survival of the diabetic foot: the role of a specialised foot clinic. QJMed 1986;232:763-71.

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

The International Working Group on the Diabetic Foot. International Consensus on the Diabetic Foot. The International Working Group on the Diabetic Foot, Amsterdam, The Netherlands, 1999.

Larsson J, Apelqvist J, Agardh CD et al. Decreasing incidence of major amputation in diabetic patients: a consequence of a multidisciplinary foot care team approach? Diabetic Medicine 1995; 12:770-6.

Payne C. Increased frequency of diabetic foot publications. Diabetic Medicine 1997; 14:407.

Tovey FI. The manufacture of diabetic footwear. Diabetic Medicine 1984; 1:69-71.

Warren G, with Nade S. The Care of Neuropathic Limbs, a Practical Manual. Parthenon Publishing Group, London, UK, 1999.

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