Management of the diabetic foot

Treatment of diabetic foot pathology requires an accurate assessment of the etiologic factors involved. Dysvascular deterioration may be amenable to vascular reconstruction. When the vascular status cannot be improved, however, amputation is preferable to continued conservative care. Neuropathic ulceration is the product of decreased sensation, deformity, and increased pressure at the site of the ulcer. Pressure relief by conservative or surgical means is required for healing. Neuroarthropathy is increasing in frequency and results primarily from autonomic denervation. Protection from weight bearing and orthotic control usually minimize deformity and ultimately restore the patient to an ambulatory status. Surgical intervention in neuroarthropathy may be effective when conservative means fail. All efforts at treatment may be undermined by poor compliance. Patient education, reinforced at each clinic visit, makes the patient a part of the treatment team.