Advances in treatment of diabetic foot ulcers*

Diabetic foot is a major health problem all over the world. Approximately 15% of the 200 million people with diabetes worldwide will develop a foot ulcer during their lifetime. Major amputation is a feared complication of diabetes. Many patients who undergo an amputation have a history of ulceration. More than 60% of non-traumatic amputations in the western world are carried out in diabetes patients. Major amputations increase morbidity and mortality and reduce the patient's quality of life. An important prelude to diabetic foot treatment is the differing diagnosis of neuropathic and neuroischemic foot. Treatment of a neuropathic plantar ulcer must correct pathological plantar distribution of pressures. Surgical treatment of deformities, with or without ulcerations, is an effective therapy. Charcot neuroarthropathy is a particular complication of neuropathy wich may lead to fragmentation or destruction of joints and bones. Additionally, in the diabetic population peripheral vascular disease (PVD) is the main risk factor for amputation. If PVD is not diagnosed, treatment of the ulcer cannot be successful. In diabetic patients PVD is distal, but often fully involves the femoral, popliteal and tibial vessels. It can be successfully treated with either open surgical or endovascular procedures. Finally, infection is a serious complication of diabetic foot. Phlegmon or necrotizing fascitis are not only limb-threatening problems, but also life-threatening ones. In this case emergency surgery is mandatory.