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Abstract
Elderly diabetic patients are particularly burdened by foot disease. The main causes
for foot disease are peripheral neuropathy, foot deformities and peripheral arterial
disease (PAD). Other risk factors include poor vision, gait abnormalities, reduced
mobility an medical co-morbidities. The risk of major amputations increases with age,
along with the increased prevalence of these risk factors. Th true risk of amputation
and other burdens of foot disease in the elderly are likely underestimated by current
epidemiological data. Th prevalence of neuropathy, foot deformities and PAD as well
as the risk of amputation all increase with age even in non-diabetic patients. The
principles of prevention and management of diabetic foot disease may also apply to
large segments of the elderly non-diabetic population. Foot ulcer prevention relies
on the identification of high risk patients and avoidance of triggering events, such
as ill-fitting shoes, walking barefoot or poor self-care. PAD is a major cause of
amputation and should be prevented by lifelong attention to glycaemic control, treatment
of hypertension and dyslipidemia, and avoidance of smoking. The treatment of foot
ulcers relies on pressure relief (off-loading), wound debridement, and treatment of
infection and ischemia. It requires an individualized approach considering the patient's
co-morbidities and functional status. Off-loading remains essential, but devices such
as total contact casts or crutches can only rarely be implemented. However, providing
adapted standard foot-wear and insisting on its consistent use even at home is often
effective. The benefits of aggressive vascular or orthopaedic surgery should be weighed
against the risks of prolonged hospitalisation and resulting functional decline. Greater
attention to prevention and individualized care are needed to reduce the burden of
diabetic foot disease in the elderly.