[Diabetic foot: from diagnosis to therapy]

Four percent of Italians are affected by diabetes mellitus. There are 120 million diabetics worldwide: it is expected that 15% of them will have wounds on their feet during their lifetime. In industrialized countries diabetes mellitus is the main cause of non-accidental amputation and this risk is approximately 15 times higher in diabetics than in any other population. The vasculopathy and/or the diabetic neuropathy represent the basic pathogenic elements in the development of diabetic foot: 15% of diabetics are affected by arteriopathy after 10 yrs of illness and just <50% of diabetics after 25 yrs; 25% of patients have neuropathy after 10 yrs of illness, >40% have neuropathy after 25 yrs. The infection is the third, and often, concomitant pathogenetic factor in the diabetic ulcera. The diagnostics of the vasculopathic diabetic foot makes use of a careful objective check; doppler ultrasonography and arteriography (with the therapeutic application of the PTCA). In addition to the objective check, EMG and the neuropathy autonomy test are fundamental in the neuropathic diabetic foot. Osteomyelitis represents the most fearful complication in the diabetic foot; it can often be solved only through surgical destructive therapy. Therapy of the diabetic foot must come from careful and synergic team work, in which dietician, vascular surgeon, orthopedist and dermatologist make available their own skill with humility and endless patience.