Intended for healthcare professionals


The 10 commandments of the diabetic foot

BMJ 2005; 331 doi: (Published 22 December 2005) Cite this as: BMJ 2005;331:1497
  1. Nikolaos Papanas (papanasnikos{at}, senior lecturer in internal medicine,
  2. Efstratios Maltezos, professor of medicine,
  3. Audrey Edmonds, specialist diabetes research nurse,
  4. Michael Edmonds, consultant physician
  1. Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
  2. Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London SE5 9RS, UK

    Every 30 seconds a leg is still lost because of diabetes somewhere in the world. In order to improve diabetic foot care, we need simple rules—the 10 commandments of the diabetic foot:

    1. I am thy foot forever. Take good care of me, for thou shalt have no foot other than me1

    2. Thou shalt regularly debride me, when I develop callosities and ulcers2

    3. Thou shalt fit me with casts and insoles to offload my high pressure areas3

    4. Thou shalt carefully look for early signs of infection in me and treat it aggressively4

    5. Thou shalt diagnose ischaemia without delay and revascularise me5

    6. Thou shalt educate all patients how to examine me and take care of me6

    7. Thou shalt carefully inspect the shoes that I have to wear and encourage the use of appropriate footwear7

    8. Thou shalt continuously aim to achieve tighter blood glucose control for me8

    9. Thou shalt not commit amputation on me, unless there is a compelling reason9

    10. Thou shalt not covet thy neighbour's amputation rates, but try to improve yours9


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