[General principles of medical care of the diabetic foot]

In diabetic patients the foot is the focal point of neurologic, arterial and infectious complications. Affections of the foot are generally synonymous with a diabetic trophic disorder: the risk of gangrene is 17 times greater in diabetics than in non diabetics. Trophic disorders can affect the functional prognosis when they lead to amputation with subsequent altered weight bearing. They can provoke worsening of a subjacent arteriopathy, until then partially or totally asymptomatic, when the excision wound lacks the hemodynamic capacity for healing because of the associated arteriopathy. They can also induce local, regional (cellulitis) or even general (septicemia) infectious complications. They have a major socio-economic effect, by the loss of quality of life, the inability to work, and the cost of hospital and general care they engender. Finally, they have to be experienced by the patient and the treating team as a failure since, in the majority of cases, they imply an insufficient a priori knowledge of the predisposing factors: arteriopathy of legs and neuropathy with loss of sensitivity depriving the patient of the pain alarm signal if cutaneous lesions develop, and a delay in the recognition of triggering factors represented by microtrauma caused by shoes, particularly burns, frostbite or infections.(ABSTRACT TRUNCATED AT 250 WORDS)