‘Diabetic holiday foot syndrome’: a preventable complication†

Abstract

Foot ulceration in diabetic patients is a serious complication, with the potentially devastating possibility of lower limb amputation. We describe six patients with type 2 diabetes who all developed significant neuropathic foot ulceration during holidays, mostly in hot countries abroad. All were male, aged 52–62, and one patient developed three ulcers on the same foot on three consecutive holidays, the last one resulting in a below knee amputation. The specific causes of ulceration were often related to walking barefoot (on sand, shingle or hot flagstones), or wearing inadvisable beach footwear. The association of poor educational compliance and a high‐risk environment may lead to this specific ‘diabetic holiday foot syndrome’. Intensive warning education prior to at‐risk patients going on holiday may help prevent this serious complication. Copyright © 2001 John Wiley & Sons, Ltd.

Attempts to prevent holiday‐related diabetic foot ulceration

“…It is known that people with diabetes— particularly those with neuropathy— are at risk from foot ulceration when they go on holiday. In 2001, our unit described 11 cases of ‘ Diabetic Holiday Foot Syndrome’ 1 in eight type 2 diabetic patients. Most holidays were in hot climates abroad, and the ulcers were frequently caused by poorly‐fitting beach shoes or sandals, walking on sand or stones, and walking on hot flagstones (leading to plantar thermal burns).…”

“…The patients described here have typical features of the ‘ Diabetic Holiday Foot Syndrome’ as described elsewhere 1, 3. Also consistent with other reports, the causes of ulceration were mostly related to barefoot walking (especially on hot surfaces), and holiday footwear.…”

“…If the ‘ Diabetic Holiday Foot Syndrome’ is to be reduced in prevalence, new strategies will need to be discovered. Holidays abroad are a particular risk factor (though not exclusively— one ulcer in the originally described series was from the UK1). However, it seems unlikely that we will be able to persuade our patients not to holiday in warm climates!…”

Review: The varied attractions of the diabetic foot

“…Holidays in warm climates are a common time for ulcers to develop, when sand enters open shoes and then acts as an abrasive, or patients with neuropathy walk with bare feet on hot flagstones. This is well recognised and has been labelled the 'holiday foot syndrome', 37 and patients need to be warned and prepared for such risks.…”

The hazards of the holiday foot: persons at high risk for diabetic foot ulceration may be more active on holiday

“…It is increasingly recognized that holiday is associated with the development of diabetic foot ulcer. The term diabetic holiday foot syndrome (DHFS) [5] was first coined by Stanway and Gill. They reported six cases of foot ulceration in patients with diabetes on holiday.…”