The diabetic foot : editor's comment

Many years ago - I can't remember whether as a student or an intern - I was at an outpatient clinic for Immelman firm at Groote Schuur Hospital. At the time Ed Immelman was one of the foremost vascular surgeons in Cape Town, so his outpatient clinics were full of diabetics. An older black man was accompanied into the room by his son - along with a smell that made sitting in the confined space difficult. The old man eased his foot out of his shoe. The entire foot was black, wet and smelly. It didn't seem to be particularly painful, but both the son and the patient were obviously very worried about the appearance of the foot. I remember wondering just how the man and his family had left it so long to go to the doctor. I presume this catastrophe, which resulted in a below-knee amputation, had started with the classic problems associated with the diabetic foot. I have no idea whether or not the man was under the care of a GP or a day hospital in his area - I hope not, because if he was, someone had been grossly negligent.