Management of foot burns in a patient with diabetes

a loss of sensation in the area causes abnormal, excessive pressures to be loaded through the wound, which is not recognised by the patient who does not feel pain. This results in trauma to the wound bed and delayed healing. In addition, the presence of motor neuropathy can cause atrophy of the small foot muscles leading to deformity, such as ‘clawing’ of the toes. This causes excess pressure on the digits and metatarsal heads, which are the most frequent sites of neuropathy. Finally, autonomic neuropathy causes arteriovenous shunting leading to compromise of the vascular supply to the wound. Given the long healing time involved, costs can be expensive and the complication rate and morbidity is likely to be higher in patients with foot burns associated with diabetic neuropathy (Dijkstra et al, 1997; Putz et al, 2008).