The diabetic foot

Neuropathic ulceration and gangrene in the diabetic foot is related to lack of sensation of the foot to painful stimuli, the easy access and development of infection. High pressure areas lead to rapid breakdown of tissue and the presence of abnormally fast blood flow leading to arteriovenous shunting leave peripheral tissues gravely at risk from ischaemia. The knowledge of these basic facts involved in the development of foot ulceration should allow a more logical approach to prevention-indeed with care through medical attention and an understanding of the social background of at risk patients, should lead to a major reduction in the incidence of foot ulceration in the diabetic patient and hence to a lowering of morbidity and on occasions, mortality. Leaving all the medical and scientific matters aside, it should be stated that diabetic foot ulceration in the warm diabetic foot is a failure on the part of the diabetic physician to identify problems, educate his patient and provide correct social services to totally prevent this unhappy complication of diabetes.