Preventing diabetic foot problems.

Complications of diabetic foot disease may be prevented through regular office followup that includes inspection of the feet and patient education. Peripheral vascular disease and neuropathy are the pathophysiological factors underlying the development of ulcers and gangrene. Evaluation should include careful assessment of the neurological and vascular integrity of the legs and feet, risk factors for underlying disease and self-care abilities. When ulceration occurs, management includes bed rest, appropriate antibiotic therapy, topical care and treatment of any underlying large vessel disease. Worthwhile goals in caring for the diabetic individual's feet include: appropriate choice of shoes; good nail and skin care; excellent blood sugar control; smoking cessation; regular exercise; and maintaining normal blood pressure, cholesterol and triglyceride levels; and infection-free feet. Involving the family, the visiting nurse and/or the podiatrist may be helpful in achieving these goals.