Lower limb amputations of diabetic patients is the leading cause of limb loss in the UK and many overseas countries other than limb amputations caused by accidents. It is estimated that around 3,000 lower limb amputations are carried out each year in the UK alone and this is a major burden on the NHS. Ongoing rehabilitation costs and payment of disabled allowances is a further burden on the NHS and Social Services as very few diabetic patients who have undergone lower limb amputations are able to continue in employment.

There are an estimated 450,000 insulin dependent diabetic patients in the UK along with probably 2 million non-insulin dependent diabetic patients and probably another 1 million undiagnosed potential patients. Many of these patients could be vulnerable to encountering diabetic foot problems in the future.

Diabetes can affect the nerves in the feet by distorting the messages which go from the foot to the brain causing numbness, loss of pain sensation and temperature perception, burning shooting pains and pins and needles. This nerve damage is neuropathy.

Diabetes can also affect the blood supply to the feet and legs causing sores or cuts to be slow to heal. Minor cuts or sores can be easily infected if not properly treated and lead to serious long term foot problems.

Many patients with diabetes develop ischaemic or neuropathic ulcers leading to haemorrhagic changes.

From a clinician's point of view diabetic foot syndrome is defined as legions in connection with diabetes. The condition is characterized by multiple aetiology.

- Ischaemic or neuropathic ulcers leading to haemorrhagic changes

- Mechanical factors

- Metabolic stimulation of growth factors with an increase in glycosylated end products

- Increased permeability of the vessels

-The prognosis for diabetic foot syndrome is very poor without therapy however neuropathy in many diabetic patients often advances out of control and leads quickly to acute diabetic foot syndrome often requiring lower limb amputation.

Prepared by Derek C. Beatty, BSc, DipM.