The Diabetic Foot

Management of foot problems in the patient with diabetes mellitus requires attention to each system affected by the disease. Appropriate treatment of common clinical problems affecting the foot in diabetic patients, such as ulcerations and fractures, depends on a thorough understanding of the pathophysiology of the disease. Treatment of neuropathy is directed at pressure relief and prevention of deformity. Infection is addressed with antibiotics, debridement, and improvement of the vascularity and oxygenation of the tissues. Amputation should be viewed, not as evidence of treatment failure, but as a reconstructive procedure, the goal of which is to regain energy-efficient ambulation. The orthopaedic surgeon can play a critical role in the team approach to the care of the diabetic patient with foot problems.