Foot lesions in diabetic patients: pathogenesis and management

Vascular disease is the major factor in the development of many lesions in diabetics, although the independent role of neuropathy has been increasingly recognized. The major problem in assessment is to decide the severity of ischaemia and neuropathy present in a particular patient. Healing after local surgery can be expected in those lesions which are painless, and peripheral (that is, are situated on the toes or forefoot), especially if the ankle pulses are present. Operation must provide adequate drainage and wound care must be meticulous. The problem of prevention of recurrences remains unsolved, but recurrences can probably be delayed or prevented by a careful follow-up.