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Diabetic ‘holiday' foot: cautionary tales of sun, sandals, and risk Endocrine Abstracts (2015) 37 EP529 |
Diabetic polyneuropathy is the most prevalent complication of diabetes. Diabetic foot lesions become limb threatening from a combination of injury, infection and impaired micro and macrocirculation. When diabetic patients go on holiday they usually change their routine and may become careless in routine care of their feet. We report a case series of seven middle aged Irish born diabetic male patients who developed serious foot lesion on holiday. They were identified from the podiatry services of a regional centre over 3 years. The median age was 59, range 57–68 years. Six of seven had type 2 diabetes duration 1–30 years. HbA1c ranged from 7 to 10.6%, median: 9.6%. One smoked. All had signs of peripheral polyneuropathy. Two had Charcot joint. Six of seven had a holiday in a warmer climate. The median delay to seeking care was 2 weeks, range 1 day–12 weeks. Lesions had a variety of sites, they were bilateral in 5/7. Lesions included: massive blister, ulceration, pressure necrosis, and maceration. Infection was present in six of seven. Two of seven required partial foot amputation. Two had a hospital stay over 60 days. Healing took 4–20 weeks. All walked more than was their customary habit and often on uneven surfaces. One walked barefoot for a week incurring deep planter ulceration. Another wore tight golf shoes incurring pressure necrosis. One walked extensively in an orthopaedic boots. The majority wore sandals resulting in tissue maceration and infection. All reported heat as an aggravating factor. Middle-aged diabetic males with polyneuropathy seem particularly vulnerable on holiday. The common factors were: i) a change in or inappropriate footware, ii) unaccustomed walking and surfaces, and iii) heat causing tissue maceration. Patient education should emphasis the hazards of holidays in high-risk patients.
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