Diabetic feet and neuropathy

Boulton from the Manchester Diabetes Centre,, England writes in the Journal of Americal Podiatric Medical Association (2010 September-October;100(5):349-352) highlights that virtually no time is spent during medical school to teach how to manage patients who have no symptoms because they have lost the ability to feel pain, in case of peripheral neuropathy.

He stipulates that the lifetime incidence of foot ulceration in people suffering from diabetes has been estimated to be as high as 25%.  Most important reason is peripheral neuropathy, the loss of the ability to feel pain, temperature, or pressure sensation in the feet.

He points out that:

Those patients found to have any risk factors for foot ulceration require special education and more frequent review, particularly by podiatric physicians.

And his key message is that the presence of neuropathic symptoms correlate poorly with sensory loss

'and that their absence must never be equated with lack of risk of foot ulceration. If we are to succeed in reducing the high incidence of foot ulceration and particularly recurrent ulceration, we must realize that with loss of pain there is also diminished motivation in the healing and prevention of injury.'  ^[1]

September 2010, Jan M. Keppel Hesselink, MD, PhD 

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