Diabetic foot ulcerations: biomechanics, charcot foot, and total contact cast.

Diabetes is the seventh leading cause of death in the United States; approximately 6% of the US population has been diagnosed with diabetes. Fifteen percent of all people with diabetes will develop a foot ulceration, and 14% to 20% of them will require an amputation. During the past 25 years, much has been learned and written about lower extremity complications associated with diabetes. The single most significant discovery relative to diabetic foot ulceration is the role of peripheral sensory neuropathy. Once the correlation between the absence of sensation and foot breakdown was made, treatment algorithms began to develop. For the first time, the concept of biomechanics and the role of weight-bearing stress were considered when applying different treatments to the patient with a diabetic foot ulcer. Wound classification systems developed to aid the physician in treating what had been a very frustrating group of patients; those with diabetic foot ulcerations. From that, a myriad of treatments developed. In fact, the technology of wound management became a billion dollar business and, to this day, continues to present the clinician with unending options to effectively manage and heal wounds on the diabetic lower extremity.