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Assessing and managing the diabetic foot in primary care

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Among patients with diabetes, the lifetime risk of Among patients with diabetes, the lifetime risk of acquiring a foot ulcer is 25%

Why do foot problems occur in diabetes?

Peripheral neuropathy is a major factor predisposing the individual with diabetes to foot problems and represents the principal underlying cause of around 60% of diabetic foot ulcers.1 Motor, sensory and automomic nerves can all be affected.

Impairment of the motor nerve supply to the foot muscles can cause muscle atrophy and imbalance of toe flexors and extensors leading to foot deformity, such as claw foot and pes cavus. In the presence of a sensory neuropathy (which most commonly presents in a stocking distribution in the legs, although ultimately hands may be affected) the abnormally high pressure points on the foot arising from deformity are not perceived and there follows a build-up of callus over prominent weight-bearing areas. Under these circumstances necrosis of soft tissue under the callus can occur and the risk of foot ulceration is hugely increased.2

If the automomic nerve supply to the foot is damaged then lubrication from skin sweat and oil gland secretion is compromised and the resulting dry skin is less able to deal with the frictional forces that accompany foot movement, increasing the risk of ulceration.

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