Meticulous attention to foot care improves the prognosis in diabetic ulceration of the foot.

Ulceration of the foot is a major cause of morbidity in patients with diabetes, and its treatment has become a significant part of general surgical practice. It is, therefore, important to develop an efficient and effective approach to the care of this complication. We established a clinic dedicated to the care and prevention of foot ulcers in diabetic patients and since its inception in 1985, 343 patients have been seen. We provide regular prophylactic care and education to patients without ulcers, as well as treating those with ulcers. To assess the effectiveness of the clinic, we compared two groups of patients. Group 1 contained those who had ulcers while attending our prophylactic care program. Group 2 comprised those who were referred to us with lesions already present. There were 21 patients in group 1 and 150 in group 2. There were no statistical differences between the two groups with respect to age, sex, type and duration of diabetes, smoking history, prevalence of peripheral neuropathy, peripheral vascular disease, renal impairment and retinopathy. The sites and sizes of lesions were also no different between the groups. In spite of these similarities, however, patients in group 1 had a significantly better prognosis than those in group 2. The over-all number of lesions per patient was lower (1.52 +/- 0.98, compared with 2.06 +/- 1.33, p less than 0.05), the mean time required for lesions to heal was shorter (111.9 +/- 80.5 days compared with 160.5 +/- 151.3 days, p less than 0.05). The major amputation rate was lower and fewer patients required partial foot amputation. Prior to the opening of the clinic, the mean length of inpatient treatment was 30 days. This now has been reduced to 12.9 +/- 12.8 days. We conclude that the improved prognosis for those in group 1 can be attributed to the earlier detection and treatment of both potential and actual foot lesions. These results support the contention that the establishment of a dedicated diabetic foot care clinic and regular patient review can reduce the morbidity associated with diabetic foot ulceration.