01652nas a2200205   4500000000100000008004100001653001300042653001500055653001200070653001900082653002100101653001500122653001300137100001700150245004800167300001100215490000700226520119900233022001401432       2013                            d10aTraining10aNeuropathy10aleprosy10aHealth workers10aHealth Education10aFoot Ulcer10aDiabetes1 aBoulton AJ M00aThe pathway to foot ulceration in diabetes.  a775-900 v973 a<p>It should now be possible to achieve a reduction in the incidence of foot ulceration and amputations as knowledge about pathways that result in both these events increases. However, despite the universal use of patient education and the hope of reducing the incidence of ulcers in high-risk patients, there are no appropriately designed large, randomized controlled trials actually confirming that education works. It has been recognized for some years that education as part of a multidisciplinary approach to care of the diabetic foot can help to reduce the incidence of amputations in certain settings. Ultimately, however, a reduction in neuropathic foot problems will only be achieved if we remember that the patients with neuropathic feet have lost their prime warning signal—pain—that ordinarily brings patients to their doctor. Very little training is offered to health care professionals as to how to deal with such patients. Much can be learned about the management of such patients from the treatment of individuals with leprosy: if we are to succeed, we must realize that with loss of pain there is also diminished motivation in the healing of and prevention of injury.</p>
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