Diabetes is a leading cause of morbidity and mortality in sub-Saharan Africa (McLarty et al, 1990). As a single complication of diabetes, the diabetic foot is responsible for more hospitalisations than all other complications put together (Boulton, 1990) and it is the most common cause of non-traumatic, non-neoplastic amputation in the lower extremity (Solagberu and Kuranga, 2002). People with diabetes attending an outpatient clinic at the University of Ilorin Teaching Hospital, Nigeria, were prospectively recruited into this study. Clinical assessment of each of the 105 individuals was done by interns and post-graduate doctors (registrars) for evidence of peripheral neuropathy, peripheral vascular disease and foot complications, among others. The age range was 15–88 years (mean age 56.78 years). Various foot complications were observed, with foot ulceration being the most common (29.5%). Diabetic foot complications are of particularly high incidence in the West-African sub-region and the importance of foot care should be emphasised when diabetes is first diagnosed and reinforced at regular intervals. There is a need to establish a multidisciplinary foot clinic to address the special care of people with diabetic foot complications in this sub-region.

Diabetes is a leading cause of morbidity and mortality in sub-Saharan Africa (McLarty et al, 1990). Foot complications are the most common reason for hospitalisations in people with diabetes in Western countries (Boulton, 1990), with an estimated US$500 million spent on the care of diabetic foot problems in the USA in 1988 (Bild et al, 1989). In community surveys in the UK, 5–7% of people with diabetes currently had or had a history of a foot ulcer (Walters et al, 1992; Kumar et al, 1994).
    There is a paucity of information on the prevalence of diabetes in the West-African sub-region. However, there have been isolated reports of its absence or rarity among rural communities, and of increasing prevalence with urbanisation (Johnson, 1971; Teuscher et al, 1987). In 2003, Nauru was reported to have the highest prevalence of diabetes in people aged 20–79 years (30.2%), closely followed by the UAE with a prevalence of 20.1% (Teuscher et al, 1987). One survey in urban Lagos revealed a prevalence of 19% among people in a residential home (Johnson, 1971). Despite the lack of precise information on its epidemiology, the various complications of diabetes have been well documented in Nigeria (Greenwood et al, 1968; Osuntokun et al, 1971). People with diabetes and peripheral neuropathy may present with a myriad of foot complications, such as dry skin, callosity, fungal infections, cracked skin, onycholysis, yellow nails, eczema and ulcers, that may become apparent only during careful physical examination of the feet. These foot complications have been described in European people with diabetes (Borssén et al, 1990). It is important to realise that, although not ranking as one of the ten most common diseases in Africa, the diabetic foot is becoming a significant cause of untold hardships, morbidity and avoidable deaths.
    This study is a hospital-based prospective study of people with diabetes attending an outpatient clinic in a tertiary institution in Nigeria. The study aim was to assess the prevalence and type of diabetic foot complications and their management among those with complications.

Materials and methods
Participants for this study were recruited from the diabetes outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Nigeria, from October to December 2003. Consecutive individuals of more than 14 years of age who attended the UITH diabetes clinic were non-selectively evaluated and questioned by doctors regarding foot symptoms or foot-related problems. With informed consent, individuals were recruited into the study (n=105). A comprehensive history was then taken from each person, followed by a thorough physical examination.  A questionnaire was designed to record the history and physical examination carried out on each individual.

Clinical assessment
The history included data on demography, type and duration of diabetes, the results of the last three fasting blood glucose (FBG) assessments, the treatment the individual was on and their history of diabetes education. Social history of alcohol ingestion and cigarette smoking were also recorded, along with history of footcare knowledge, foot wear and foot hygiene, and history of associated medical conditions including hypertension, hyperlipidaemia, nephropathy and retinopathy. The blood pressure of the person standing and supine, and the weight and height were also measured.

Assessment for peripheral neuropathy
Evaluation for signs of peripheral neuropathy included tests for pain, temperature, vibration sense and ankle reflex. Symptoms of peripheral neuropathy were recorded using a questionnaire similar to that used by Young et al (1993) and showed that people did not always understand questions such as those referring to description of symptoms, site of discomfort, time of worst symptoms and night-time insomnia.

Assessment for peripheral vascular disease
Peripheral vascular disease was determined mainly by the presence or absence of dorsalis pedis. Unfortunately, ankle–brachial pressure index could not be used because most people did not have their ankle blood pressure measured. In addition,  Doppler ultrasonography would have been used but is not readily available in most Nigerian centres.

Foot complications
Modified foot complications similar to those used for assessment at the Muhimbilli Medical Centre, Dar es Salaam, Tanzania (Gulam-Abbas and Archibald 2000), including dry skin, callus, fungal infections, onycholisis, hypopigmentation, ulcer, hallux vagus and paronychia, were used to assess various foot complications in the study population. Clinical and epidemiological data were recorded in standardised clinical assessment forms, entered into a computer and analysed.