Watch your step!
CMAJ 1998;159:218-219
Drs. Paul G.W. Woolfrey and R. Lee Kirby should be congratulated for reporting an easily preventable complication associated with diabetic neuropathy, in their article "Hypodermic needles in the neuropathic foot of a patient with diabetes" (CMAJ 1998;158[6]:765-7 [abstract / résumé]). Given that the occurrence of foreign bodies in the skin of people with sensory neuropathy of any type could to a large degree be avoided, it is unfortunate that we have been unable to convince people with these conditions of the value of examining their feet. It is well established that simple foot care and prevention of skin lesions due to foreign bodies and to sites of excessive pressure, such as folds in socks, can substantially reduce the frequency of amputation of insensate limbs.
In a study of patients who underwent unilateral amputation,1 we found not only that people with diabetes mellitus were at significant risk for sensory neuropathy but also that a significant proportion of amputees who presented with only peripheral vascular disease also presented with peripheral nerve impairment in the lower extremity, secondary to their vascular disease.
In considering methods to improve foot care and education for people with diabetes mellitus and known neuropathy, we should extend such efforts to anyone who exhibits significant compromise of the peripheral vasculature.
Patrick J. Potter, MD
Department of Physical Medicine
and Rehabilitation
University of Western Ontario
London, Ont.
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Reference
- Potter PJ, Maryniak O, Yaworski R, Jones IC. Incidence of peripheral neuropathy in the contralateral limb of unilateral amputees. J Rehab Res Devel. In press.
