PREVENTION The two most significant risk factors for foot complications are social deprivation and limited access to health care.
Motivation, education and action by diabetic patients are essential for protecting the feet from complications.
In industrialised countries, numerous clinical studies have demonstrated that special diabetic foot clinics reduce the incidence of serious foot prob- lems and that patient education results in unequivocal reduction in the occurrence of ulcers and amputations among diabetic patients.
In contrast, relatively little outcomes research has been performed to study the effectiveness of various primary and secondary interventions in the prevention of diabetic foot ulcers or infection in Africa.
The golden rules of prevention are maintenance of glycaemic control to prevent or delay the onset of peripheral neuropathy, podiatric care that includes regular feet inspection, making an effort not to walk barefooted or cut foot callosities with razors or knives at home and avoidance of delays in presenting to hospital when a foot lesion, however minor, has developed.
These simple rules, if followed, will go a long way in reducing adverse events associated with the diabetic foot in Africa.
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CONCLUSION While it may be impossible to totally prevent foot ulceration, it is certainly feasible to prevent the progression of small ulcers to infection, sepsis, osteomyelitis or gangrene.
Education remains the most important preventive tool in Africa and should be an integral part of preventive programmes: simple and repetitive, and targeted at both health care workers and patients alike.
Diabetic patients must be educated on the importance of foot care and of consulting a doctor during the early stages of foot-related symptoms.
Ultimately, success will depend on the ability of health care providers to inculcate the motivation and self-help that are essential for the well-being of diabetic patients.