Diabetic foot

Foot disease affects nearly 6% of people with diabetes 1 and includes infection, ulceration, or destruction of tissues of the foot. 2 It can impair patients' quality of life and affect social participation and livelihood. 3Between 0.03% and 1.5% of patients with diabetic foot require an amputation. 4 Most ulcers can be prevented with good foot care and screening for risk factors for a foot at risk of complications. 5 We provide an update on the prevention and initial management of diabetic foot in primary care. What causes diabetic foot?Uncontrolled diabetes contributes to the development of neuropathy and peripheral arterial disease by complex metabolic pathways. 6 Loss of sensation caused by peripheral neuropathy, ischaemia due to peripheral arterial disease, or a combination of these may lead to foot ulcers.A systematic review (78 studies from 84 cohorts) reports a prevalence of 0.003-2.8%for diabetes related peripheral neuropathy and 0.01-0.4% for diabetes related peripheral arterial disease. 4 Figure 1 depicts factors that contribute to foot complications.Diabetes is also implicated in Charcot arthropathy, which involves progressive destruction of the bones, joints, and soft tissues, most commonly in the ankle and foot.Diabetes related Charcot's arthropathy has a reported prevalence between 0.08% and 13%, but there are no high quality epidemiological studies on Charcot's foot. 7 8A combination of neuropathy, abnormal loading of foot, repeated micro trauma, and metabolic abnormalities of bone leads to inflammation, causing osteolysis, fractures, dislocation, and deformities. 9What you need to knoW• Diabetic foot can be prevented with good glycaemic control, regular foot assessment, appropriate footwear, patient education, and early referral for pre-ulcerative lesions on 17 July