Risk factors in the diabetic foot. Recognition and management

The most frequently reported diabetic foot complication is plantar ulceration. Neuropathic fractures occur less often than plantar ulcers but usually result in major structural deformities of the feet. The primary risk factors for plantar ulceration are believed to be loss of protective sensation and the presence of high plantar pressures. Principal etiologic factors in the development of neuropathic fractures are hypothesized to be loss of protective sensation and bone demineralization. Major diabetic foot injuries are preventable by the use of comprehensive screening examinations and patient education. Patients at highest risk of injury should be seen more frequently and receive more extensive therapy. Successful management of plantar ulcerations is dependent on reduction of pressures under the foot and control of infection. Neuropathic fractures require long-term immobilization to promote healing followed by careful monitoring after removal of casts to prevent reinjury. Future research needs include prospective studies on risk factors and validation of treatment techniques.