Presentations of diabetic feet

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Abstract
Afflicted with diabetes mellitus have high rates of morbidity and mortality ow- ing to the many complications of the disease. The complications can manifest themselves as ophthalmic, renal, vascular, neurologic, and pedal diseases. Unfortu- nately, the most often overlooked or neglected complications involve the feet. It is estimated that in the United States foot disease is five times more prevalent in diabetic patients than in those without diabetes.1 In fact, 20% of all diabetic patients admitted to hospitals in the United States are admitted for foot disease, with foot and ankle ulcers being the most common presentation.2 The amputation rate in diabetic patients in the United States is reported to be as high as 15 times that of nondiabetic patients, and of all nontraumatic amputations per¬ formed, approximately 50% are in pa¬ tients with diabetes.3 More than half of the diabetic patients who undergo limb am¬ putation will require contralateral limb am¬ putation within 5 years, and 60% will die within the first 5 years after amputation.4 For these reasons, it is important that pri¬ mary care physicians thoroughly exam¬ ine the feet and become familiar with the various presentations of the diabetic foot. The American Diabetes Association rec¬ ommends that an examination of diabetic feet be done at every regular visit.5 The increased risk for foot disease in diabetic patients is primarily due to the combined effects of peripheral vascular dis¬ ease and peripheral and autonomie neu¬ ropathies. These may result in decreased sensation, dry, cracked skin, and loss of the intrinsic muscle function of the foot. Patients may have a deformed foot with the inability to sense repeated trauma. This may lead to further deformity, tissue ne¬ crosis, and subsequent ulcération. If not properly treated, soft-tissue infection, os¬ teomyelitis, and sepsis may result. This may necessitate lower-limb amputation.

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