Letters Ottawa rules, OK?

Rules are different in diabetes

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3507 (Published 01 September 2009) Cite this as: BMJ 2009;339:b3507
  1. Anthony P Coll, honorary consultant physician1
  1. 1Weston Diabetes and Endocrine Clinic, Addenbrooke’s Hospital, Cambridge CB2 0QQ
  1. apc36{at}cam.ac.uk

    Mayer describes how clinical prediction rules can avoid unnecessary investigation of the injured ankle and foot,1 but users of any set of rules need to know their limitations.

    Patients with diabetes and severe distal sensorimotor neuropathy may present with a bruised and swollen foot as a result of a bony injury but remain free from pain and still fully able to weight bear without complaint. Such injuries may have occurred without any clear antecedent history or after apparently trivial trauma.

    In this context the absence of pain is no reassurance against there being a bony injury. Walking with ease on a red, hot swollen foot is highly abnormal, and a thorough clinical and radiological assessment is essential. Failure to diagnose such an injury early and put in place appropriate off-weight bearing measures may result in severe deformity and disability.


    Cite this as: BMJ 2009;339:b3507


    • Competing interests: None declared.