Managing complications of the diabetic foot.

Fifteen per cent of patients with diabetes will develop a foot ulcer in their lifetime. Foot complications (box 1) account for more hospital admissions than any other complication of diabetes, with considerable morbidity and mortality.1 People with diabetes are eight to 24 times more likely than those without diabetes to have a lower limb amputated.2 Around 85% of these amputations could be avoided by early detection of foot complications, timely intervention, involvement of a diabetic foot care team, good diabetes control, and patient education.3 4 Although we review the various complications separately, patients often have multiple problems. In 1989 the St Vincent Declaration set out the aim of reducing lower limb amputations in people with diabetes by half. In 1992, the Department of Health and Diabetes UK set up a task force to facilitate this aim. Despite this, in the United Kingdom around 0.5% of people with diabetes have a limb amputated each year.5 But because amputation rates vary between centres, it is unclear whether improvements have occurred since the task force was established. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for the diabetic foot (box 2).5