DIABETIC FOOT ULCERS - PREVENTION, DIAGNOSIS AND CLASSIFICATION

Diabetic ulcers are the most common foot injuries leading to lower ext remity amputation. Family physicians have a pivotal role in the preven tion or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk fact ors for amputation, frequent routine evaluation and meticulous prevent ive maintenance. The most common risk factors for ulcer formation incl ude diabetic neuropathy, structural foot deformity and peripheral arte rial occlusive disease. A careful physical examination, buttressed by monofilament testing for neuropathy and noninvasive testing for arteri al insufficiency, can identify patients at risk for foot ulcers and ap propriately classify patients who already have ulcers or other diabeti c foot complications. Patient education regarding foot hygiene, nail c are and proper footwear is crucial to reducing the risk of an injury t hat can lead to ulcer formation. Adherence to a systematic regimen of diagnosis and classification can improve communication between family physicians and diabetes subspecialists and facilitate appropriate trea tment of complications. This team approach may ultimately lead to a re duction in lower extremity amputations related to diabetes.