Podiatric care in the prevention and treatment of the Diabetic Foot

Diabetes mellitus (DM) leads to disturbances in glucose levels, which can result in both microvascular complications (such as retinopathy, nephropathy and neuropathy) and macrovascular complications (such as accelerated atherosclerosis). This can sometimes lead to very serious complications in the feet. Worldwide, DM is the most important cause of amputations of parts of the lower limbs, often preceded by non-healing foot ulcers. Mortality after amputations is high: >60% of patients die within five years.
In the Netherlands, thanks to well-structured care for foot problems in DM, the number of amputations is lower than in many other countries. Nevertheless, foot ulcers and amputations remain a major problem with high personal and social costs. The DUDE studies analyses amputation and survival rates in people with DM in the Netherlands. For example, it appears that people with DM have a much higher risk of amputations than people without DM.
Furthermore, minimally invasive treatments have been investigated, such as laser therapy for fungal nails; this turned out to be ineffective. Research has also been done on spiculectomy and orthonyxia for ingrown nails; this proved to be safe and successful, even in high-risk patients.
In order to provide even better care, it is necessary to work on faster access to foot care, task delegation to specialized podiatrists and more attention to lifestyle interventions and psychosocial factors. Prevention, accessible care and collaboration between disciplines are crucial to reduce the risk of amputations and complications in DM.