In diabetes, feet must be put first. This may sound self-explanatory, common sense and trivial — but it is not.
Indeed, diabetic foot lesions remain very common worldwide, and amputations are still performed. More distressingly, the major breakthroughs and achievements in science are mostly utilised in the expert setting and applied to relatively few patients by even fewer healthcare professionals.
There is huge inequality in the standards and outlooks of foot care from continent to continent and from country to country. Even within the same country, there may be unacceptable inequality. For instance, in June 2019 a publication in The International Journal of Lower Extremity Wounds highlighted such inequality in England.
This situation may be anticipated to deteriorate for three reasons:
First, a scarcity of doctors is emerging in many parts of Europe. Consequently, other medical conditions receive more attention, while feet may not be examined and their pathology may be detected late and even underestimated.
Secondly, the treatment of large-vessel atherosclerosis has improved, ensuring prolonged survival of subjects with diabetes. While this can only be received with enthusiasm, it increases the likelihood of developing foot lesions later in life.
Finally, and we have probably not begun to realise this, war and immigration may play a role, increasing the burden on health systems.
But, ladies and gentlemen, a foot is not a mere footnote. By all means, we must ensure broad implementation of today’s therapeutic modalities. To this purpose, education of both healthcare providers and people with diabetes on the diabetic foot has become a more paramount than ever priority, and we must all unite in this endeavour.
Nikolaos Papanas is Head of the Diabetes Centre-Diabetic Foot Clinic at the Democritus University of Thrace, Alexandroupolis, in Greece and Vice-Chairman of the Diabetic Foot Study Group of the European Association for the Study of Diabetes (EASD) .