One small step for diabetic podopathy

Excerpt

The paper by Jeandrot and colleagues in this issue of Diabetologia sets out to provide evidence in the one subspecialty area of diabetes in which evidence is most lacking: disease of the foot. This field is of enormous importance in terms of both cost and suffering, and yet remains grossly neglected. There are three main reasons for this. The first is that no one likes feet, especially those with chronic ulcers, or which are smelly and necrotic. The second is that the response to treatment is poor and often unrewarding, while management tends to be delegated to nurses and podiatrists. The third is that the field is extremely complex, and the overlapping influences of neuropathy, peripheral arterial disease and infection make trial design difficult. The consequence of this neglect is a low general level of knowledge about foot care, and an extremely limited evidence base for treatment strategies. Many patients are managed badly. The response of the medical profession to this, predictably, is one of denial, thus compounding the neglect rather than setting out to rectify it. There was, for example, not a single oral session on feet at the recent meeting of the European Association for the Study of Diabetes. It is time for professional attitudes towards foot disease in diabetes to come of age, and for the problem to attract attention commensurate with the suffering it causes. …