PubMed1999
Diabetic neuropathy, osteoarthropathy, macro- and microangiopathy and susceptibility to infection are the major factors that contribute to the diabetic foot syndrome. Therefore, these patients benefit from a multidisciplinary treatment by the general practitioner, diabetologist, orthopaedic surgeon and shoemaker, angiologist and vascular surgeon. The role of the dermatologist is to recognize early diabetic foot lesions when the diabetic patient comes for a skin problem on his feet and more specifically to manage dermatologic aspects in diabetic foot patients. These should include recommendations for general skin care, examination and treatment for onychomycosis, patch testing in contact eczema or treatment of other dermatoses, such as plantar psoriasis. Therefore, dermatology has an important impact on the prevention of complications of the diabetic foot syndrome by keeping the skin intact and avoiding potential lesions of entry for bacterial soft tissue infection. The dermatologist must educate the diabetic patient to control his feet daily, to avoid foot-baths with hot water, to use hypoallergenic moisturizers for skin care. "Bathroom surgery" with sharp instruments for nail care or trimming of corns should be discouraged. Diabetics should wear wide, well-fitting shoes without sutures on the inner side. The inside of the shoes should always be checked for foreign bodies or irregular surfaces before they are put on. Diabetics should not walk barefoot. Callosities (calluses, corns) should be shown to the podologist or to the doctor. They are always a sign of increased mechanical stress and therefore, require an adjustment of footwear. Trimming of callosities can only aim at giving symptomatic relief and does not replace an appropriate correction of the mechanical stress. Semi-occlusive synthetic dressings have facilitated the treatment of non-infected chronic wounds. When probing of the bone is positive, however, osteomyelitis has to be assumed and empirical antibiotic therapy started. With the development of catheter-based interventional procedures and of cruro-pedal arterial bypasses the potiential of revascularization in diabetic foot with peripheral arterial occlusive disease has greatly improved. Retrograde intravenous antibiotic therapy under Bier's arterial arrest and the use of G-CSF improve the chance of healing bacterial soft tissue infection in a diabetic foot. In summary, optimization of prevention and treatment of the diabetic foot syndrome should allow for substantial reduction of amputations.