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• W1566563283 abstract "Never in the history of diabetes has there been so much known about the diabetic foot and yet the number of amputations continues to rise in England, Scotland, Europe1 and the USA.2 Indeed, in the USA the number of amputations has increased from 36,000 in 1980 to 54,000 in 1990 and 86,000 in 1996. Doubtless the increase in the incidence of diabetes has played a role in these rather depressing statistics but the question remains: how can we reduce both the relative and absolute numbers of diabetes-related amputations? In fact, a number of major advances have taken place in the last decade. Diabetic foot programmes that enthusiastically promote preventive foot care, professional protective footwear, education of patients and staff, a multidisciplinary approach to healing ulcers with aggressive management of infection and ischaemia have achieved a substantial decrease in amputation rates.3 But the widespread application of these programmes has been hindered by misunderstandings, misconceptions and simple lack of awareness of advances in foot care. Accurate diagnosis of the neuropathic and the neuroischaemic foot; Efficient relief of the mechanical forces that have led to ulceration; Early diagnosis and aggressive treatment of infection; Regular debridement of ulcers and urgent removal of necrotic tissue from the infected foot; Revascularisation of the neuroischaemic foot with either angioplasty or bypass, if there is extensive tissue deficit or if ulceration does not respond to conservative treatment; The use of modern active wound healing techniques if ulcers do not respond to standard treatment; Tight control of blood glucose to accelerate healing and reduce infection; Early diagnosis of the Charcot foot and immobilisation of same to prevent deformity; Screening all diabetic patients for neuropathy, ischaemia, deformity and oedema, and education of those at risk to protect them from ulceration; The provision of diabetic foot care within a multidisciplinary foot clinic. How can we organise services such that there will be equitable access to a multidisciplinary clinic for all patients? What are the possibilities for an annual foot check for every patient? How can we make distal bypass surgery and distal angioplasty readily available to all patients? Is it right that in one instance a patient with a neuroischaemic foot can have a successful distal bypass and return to full mobility, and another with a similar foot have a below-the-knee amputation and possibly never walk again? Offloading of high pressures in the neuropathic foot is fundamental and the total contact cast may be regarded as a gold standard treatment. Why then is it used so infrequently within Europe and the USA? How far have we progressed with appropriate insoles and footwear? What educational strategies have been developed and proven to work in the diabetic foot? Should diabetic foot patients be admitted to the medical or surgical ward and, after admission, who should look after them? Who is responsible for the overall provision of footwear to all people with diabetes in a health district? The crucial task now is to address these and other questions and to debate how guidelines and consensus can be implemented and transformed into best clinical practice for all diabetic foot patients. We hope this will be facilitated by an ongoing Best Practice Round Table discussion to be held within the diabetesonestop.com website, in association with Practical Diabetes International. As a further step in the process, this year's Practical Diabetes International Foot Conference, to be held at the Royal College of Physicians, London, on 29 November 2001*, will be devoted to the theme of “How can we reduce amputations?” and the results of this debate will be published in the journal and on the web. We hope readers of this journal will attend the meeting and participate in the website discussion. There is good evidence that amputations can be reduced. There is a way, but it requires effort, time and resources. Do we really have the will or shall we just admit that the diabetic foot is too great a burden to bear?" @default.
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• W1566563283 date "2001-01-01" @default.
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• W1566563283 title "How can we reduce amputations?" @default.
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• W1566563283 doi "https://doi.org/10.1002/pdi.223" @default.
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