Barriers to implementing foot care.

The foot of diabetic patients can be affected by ulceration, infection, and gangrene and is a source of major morbidity and mortality; yet, it has been neglected by health-care services. In recent years, however, the level of interest and knowledge has grown considerably, with an improving evidence base for clinical practice and the development of international consensus and guidelines that define strategies for diagnosis and appropriate treatment. Nevertheless, there are numerous barriers to the implementation of universal good care, involving attitudes and beliefs of doctors, other health-care professionals, and patients, and the structure of health-care systems, which conspire to prevent diabetic patients from receiving the appropriate multidisciplinary care they desperately need. Before diabetic foot care reaches the level desired by specialists in the field, these many barriers must be recognized and overcome. Sound and cost-effective strategies need to be developed. Policymakers and health-care professionals should work together to remove the obstacles and facilitate the provision of adequate diabetic foot care. The effect of diabetic foot disease and amputations will only be reduced if sufficient attention is paid to the necessary preventive measures.