The diabetic foot management – Recent advance

• Diabetic neuropathy and peripheral vascular disease are the main etiological factors in foot ulceration.
• Wagner's classification is one of the most widely used and universally accepted grading systems for DFU.
• Assessment of peripheral neuropathy and evaluation of peripheral arterial status are the two important investigations in a diabetic foot.
• Management of diabetic neuropathic ulcer by appropriate and timely removal of callus, control of infection and reduction of weight bearing forces.
• Management of diabetic ischaemic foot is medical management, surgical management and percutaneous transluminal angioplasty.

Diabetic ulceration of the foot represents a major global medical, social and economic problem. It is the commonest major end-point of diabetic complications. Diabetic neuropathy and peripheral vascular disease are the main etiological factors in foot ulceration and may act alone, together, or in combination with other factors such as microvascular disease, biomechanical abnormalities, limited joint mobility and increased susceptibility to infection. In the diabetic foot, distal sensory polyneuropathy is seen most commonly. The advent of insulin overcame the acute problems of ketoacidosis and infection, but could not prevent the vascular and neurological complications. Management of diabetic neuropathic ulcer by appropriate and timely removal of callus, control of infection and reduction of weight bearing forces. Management of diabetic ischaemic foot are medical management, surgical management and percutaneous transluminal angioplasty of stenosed and occluded lower extremity arteries. Foot ulceration in persons with diabetes is the most frequent precursor to amputation.