As I’m sure you all know diabetic foot problems in this country and most western countries represent the commonest cause for patients with diabetes being admitted to hospital. And I think there is much we can do about this, and I really think that ulceration, as it’s so common and recurrence is so common, we should really redesign what we say when the patient is healed. Healing gives the impression that it’s gone away and will never come back. Thus in a recent review article[1] with my good friend David Armstrong, from the USA, and Sicco Bus from the Netherlands, we brought out the term remission rather than heal, because foot ulcers recur up to 40% in the first year and up to 60% after several more years. So we should be talking about the foot being in remission because it may recur.
Now what can we do about the foot in remission to prevent recurrence? And I think there’s a lot of exciting data coming through recently. First of all, not recently, it was Dr Paul Brand[2] who worked in leprosy, who observed that the insensitive foot in leprosy, and also in diabetes, tends to heat up before it breaks down. Therefore, the foot warms up because it becomes inflamed … read more