Interdisciplinary diabetic foot clinics

Abstract

Patients who attend multidisciplinary diabetic foot clinics have an increased limb survival rate. Advances in the care of the neuropathic foot have come from efficient techniques to relieve high plantar pressures and from frequent debridement as well as from advances in the management of infection. The fundamentals of treatment of the neuroischaemic foot are relief of pressure, debridement, revascularisation and control of infection. Tissue necrosis results from atherosclerotic narrowing of the leg arteries, septic occlusive vasculitis and intimal hiperplasia of the digital arteries. Revascularisation (angioplasty and by pass) can be very succesful. Infection in the diabetic foot is often difficult to detect and may progress rapidly to necrosis. The immune response of the diabetic patient to infection is poor. Preventative foot care and educational programmes in high risk patients may avert amputations but at present they do not prevent ulceration. The number of patients with diabetic foot problems in Poland and all over the world is increasing and global programmes for treatment and prevention have to be introduced.