THE ROLE OF DIABETIC NEUROPATHY AND HIGH PLANTAR PRESSURES IN THE PATHOGENESIS OF FOOT ULCERATION

Diabetic foot ulceration is currently a serious medical problem and ha s, therefore, attracted much research attention during the last two de cades. Previous foot ulceration, diabetic neuropathy, limited joint mo bility, high plantar pressures, microangiopathy, macroangiopathy and d iabetic nephropathy have already been identified as risk factors for f uture foot ulceration. Neuropathy has clearly been shown to be an esse ntial permissive factor in the development of ulceration in the non-is chaemic foot. Moreover, the pathogenetic role of high plantar pressure s is crucial in the presence of established clinical neuropathy. Nowad ays, our therapeutic efforts clearly aim to prevent than treat foot ul cers. This demands specialist and team work in the setting up of a dia betic foot clinic in an attempt to identify and educate the diabetic p atients at risk and, where possible to use suitable plantar pressure-r educing systems (footwear, hosiery etc.). Then only would it be reason able to postulate that a significant reduction in amputations of diabe tic aetiology could be achieved in the near future.