One Pair Must Last A Lifetime – The Diabetic Foot (1/2)

The foot has been referred to as "the mirror of the diabetic state," but amongst health professionals mention of the diabetic foot usually produces visions of ulceration, infection, gangrene, and amputation. For someone with diabetes, foot problems are very significant because they can be life threatening. There are two main reasons for this.

  • Nerve damage may cause numbness of the feet, so that the warning signals of pressure and pain no longer function properly – this is neuropathy.
  • Circulation to the feet can be poor, causing slow healing – this is peripheral vascular disease (PVD)

The so-called diabetic foot develops because high blood glucose levels – hyperglycemia – damage nerves and blood vessels. Looking after your feet could save a limb and possibly your life, particularly if you are over 40 years old or if you have had diabetes for more than ten years.

Many serious and costly complications can affect the health of people who have diabetes. These can affect the heart, kidneys, and eyes, but it is the foot complications, which take the greatest toll. It has been reported that 40-70% of all lower extremity amputations are related to diabetes mellitus.

The diabetic foot is also a significant economic problem, especially if amputation results in prolonged hospitalization, rehabilitation, plus an increased need for social services and home care. In addition there is loss of income and emotional stress. Fortunately there is increasing evidence from countries such as Brazil, Sweden and the United Kingdom that amputations can be reduced considerably (in some cases by 50%), by implementing certain strategies. These include:

  • Regular inspection of feet & footwear by trained people
  • Preventive foot & shoe care for high risk feet
  • Teamwork between patient, family and carers – getting informed
  • Early detection of & intervention for PVD
  • Continuous follow-up of patients with previous ulcers
  • Registering amputations and ulcers

These strategies are important in today’s health care environment, because avoiding amputation can save large amounts of money. A British report estimated that for each amputation avoided, 4000 British pounds were saved, excluding indirect costs (e.g. loss of productivity, increased need for social services, etc.). There are good reasons to "take care of your pair" since research has shown that during their lifetime 1 in 10 people with diabetes will develop a foot problem.

More to follow….


Andrew has taught at the University as well as providing podiatry services in South Africa since 1977. Twice chair of the Podiatry Association of South Africa and a commentator on care of your feet on both radio and television he now works in private practice in Cape Town and Hout Bay.