Diabetes: Never Fail to Examine The Foot

According to Andrew Boulton, MD, University of Manchester, UK, University of Miami, Florida, the most important take home message for doctors regarding the diabetic foot and reducing amputations, is to remove their patients’ shoes and socks and look at their feet.

Boulton recounted that nearly 3 decades ago, he gave the founding launch lecture set-up of the American Diabetes Association Foot Council in Indianapolis, so he can clearly see the progress that’s been. For example, in treatment of then neuropathic foot ulcer, which we still see a lot of in this country, especially in the southern states, there is now solid evidence that off-loading with a removable device from a systematic review is really excellent in healing plantar neuropathic ulcers.

In terms of foot care teams, he believes it’s well established now from many centers in the US and Eastern and Western Europe. The creation of a multi-disciplinary diabetic foot-care team with podiatrist, the nurse educator, the shoe fitter, and doctor working together has shown to lead to a reduction in amputation. A mix of regular screening, regular education, and regular podiatry good foot care helps.

Boulton did admit there are areas that haven’t seen much advancement, “I think it’s fair to say that it terms of antibiotic treatment for infections, there are no good randomized trials to advise us of which antibiotic we should use.” And surprisingly, Boulton said everyone inherently believes that education should work to reduce foot ulcers. But there have been two meta-analysis, systematic reviews that actually show there is no evidence from randomized controlled trials that education of high-risk patients actually reduced ulcers. “Now, I think that’s not evidence of no effect, it’s a statistical finding, but we still, of course have to educate our patients. But, it may be that the team education plus the foot care plus podiatry plus good footwear all works together, but education alone may not,” Boulton concluded.