The diabetic foot

Foot disease is a common complication of type-1 and type-2 diabetes. The term ‘diabetic foot’ refers to a spectrum of disease that includes the foot at risk of ulceration, the ulcerated foot, and the Charcot foot. Risk of ulceration is conferred by peripheral neuropathy and peripheral vascular disease. The ulcerated foot can be classified as neuropathic, neuroischaemic or ischaemic. The principles of ulcer management include diagnosis and treatment of infection, establishment and treatment of vascular insufficiency, off-loading and optimization of the wound environment. The Charcot foot is a rare complication of the neuropathic foot and off-loading in the acute phase is important to prevent destruction of joint architecture. Long-established multidisciplinary foot clinics have achieved up to 50% reductions in major amputations in the UK.