BAKERDEBRIDEMENT OF THE DIABETIC FOOT Debridement of the Diabetic Foot: A Podiatric

Highplantarpressures are a risk factor fordiabetic foot ulcers that are commonchronicwounds. Inpatientswithperipheral neuropathy, plantar ulcers may be managed by debridement of callus, a process that has been shown to reduce peak plan-tar pressures. Callus debridement is clearly an important ul-cer prevention strategy. The scalpel skills used by the podia-trist to remove callus are best suited to achieve safe, local sharp wound debridement. Current podiatric practice in the United Kingdom is based on sound theoretical principles. However, good scientific data recommending its efficacy are scarce. The role of podiatry in debridement andwoundman-agement needs careful examination, a major aim of this article. Key words: foot ulcer, debridement, callus, diabetes, neurop-athy, ischemia Diabetic foot wounds impose an enormous burdenupon health service resources1,2 and affect the quality of life of those affected tremendously.3,4 It has been estimated that foot ulcerationmay affect approxi-mately 15%of patientswith diabetes;5,6 this is set to in-crease in consonance with the increasing incidence of diabetes.7 It has been demonstrated that foot ulcers fre-quently lead to lower extremity amputations and mor-bidity and mortality are also high.8 Approximately 50 % of all nontraumatic lower extremity amputations occur in patients with diabetes.9,10 The major causal pathways of foot ulceration have been identified and well documented. These include peripheral neuropathy, ischemia, and infection.11-13 The St Vincent’s declaration called for a 50 % reduction in diabetes-related amputations,14whichmaybe achieved by amultidisciplinary specialist team approach to dia-betic foot care and ulcer management.15,16 One member of this multidisciplinary team is the podiatrist, whose skills and expertise are used to provide comprehensive foot assessments, foot care, foot health education, and wound care. The skilled use of scalpel techniques, whichare taught andperfectedduring the3years ofpo-diatry education leading to state registration in the UnitedKingdom, aremost important for the successful prevention and management of diabetic foot ulcers. Current podiatric practice and some evidence relating to certain aspects of such practice are presented in this article