Diabetic foot ulcers: etiology, treatment, and prevention.

The role of neuropathy, structural changes, and ischemia in the development of foot ulcerations in diabetic patients is well established. As a result, it is now possible to determine which patients are at risk for ulceration and to place them in education programs or clinics with multidisciplinary care. In such situations, a high rate of ulcer healing and a decrease in amputation can be achieved. However, the roles of specific therapeutic interventions, particularly local wound healing agents and antibiotics, are not yet understood. Well-characterized patients need to be studied in comparative antibiotic trials for infection and in double-blind, placebo-controlled trials of wound-healing agents. Until such trials are completed, dogmatic advocacy or condemnation of a given therapy should be avoided.