It was over 20 years ago that Henry Connor and I first talked of the need for a regular national meeting to discuss pathogenetic, diagnostic and management issues of diabetic foot disease. Two decades later we have just witnessed one of the most successful of these biennial meetings. No longer can the meetings be regarded as national; on 12th May, we welcomed speakers and delegates from over 25 countries from all continents with the exception of South America. To maintain the optimal size of the practical workshops, we decided to restrict the number of delegates to no more than 250. In view of the huge demand for places, we are currently negotiating with the venue to see if we might use the main theatre in 2006, which would enable us to accommodate more participants.
Sue Roberts, National Clinical Director of Diabetes, started the meeting discussing the diabetic foot in the context of NSF for Diabetes, stating that the foot deserves more attention in future diabetes healthcare planning. Three excellent reviews on vascular disease (micro and macro) and neuropathy followed.
During the second day, plenary lectures by Ben Lipsky (Seattle, USA) and Anthony Berendt (Oxford, UK) covered the increasingly important area of infection and resistant organisms. The international guidelines on antibiotic therapy for infected diabetic foot ulcers were presented (Lipsky, 2004), and with respect to resistance it is clear that personal hygiene with hand washing between patients, donning gloves, and use of protective aprons remains crucial in the battle against MRSA.
The oral abstract presentations included a timely reminder from Canada of the frequency of foot problems among patients with end-stage renal disease. Interesting data from Tanzania focused on hand and foot infections in patients with diabetes Whereas neuropathy (and only occasionally vascular disease) was the main cause of foot ulcers, it was not implicated in hand ulcers, which tended to follow a well defined acute event (i.e. trauma). Data from London confirmed that in the infected neuropathic foot, toe pressures remain low during healing, suggesting persistent arterial occlusion. Other talks emphasised the dangers that exist in the home for at-risk feet, promoting the need for a ‘house shoe’, and demonstrated in neuropathic patients that depression is most commonly associated with unsteadiness. Other oral presentations confirmed that the instant total contact cast is equally efficacious to the traditional total contact cast, and suggested a new treatment for MRSA – the ‘Biogun’, which acts by producing a stream of superoxide radical anions leading to bacterial lysis. Finally, the potential of an outpatient needle (bone punch) biopsy was described in the management of osteomyelitis.
The workshops proved extremely popular and included discussions on antibiotic use, footwear and clinical trial design, whereas practical workshops described use of larval therapy and new casting techniques.
The last day of the conference focused on newer therapies in wound healing. Fascinating data on sex hormones and wound healing were presented by Gillian Ashcroft (Manchester). Although it is clear that oestrogens may promote healing and testosterone might have the opposite effect, it is unlikely that castration will ever be adopted as a therapy!
Thanks must go to my fellow Co-Chairman, Gerry Rayman, and to Anne Roscoe for her superbly efficient organisation of this meeting. Please put the 11th Malvern Diabetic Foot Conference (17–19 May 2006) in your diary. More details to follow soon…
