Diabetic foot ulcers: pathogenesis and management.

Approximately 60,000 major lower extremity amputations annually are performed on diabetic patients in the United States. Diabetic foot ulcers are a major factor in 84% of these amputations. The ulcers develop as a result of minor trauma or callus breakdown in the insensate foot. Infection and vascular insufficiency lead to gangrene and amputation. Delay in treatment of these ulcers is a major factor leading to gangrene and amputation. The most important treatments of the ulcer are debridement to healthy bleeding tissue, proper culture and antibiotic therapy, identification of osteomyelitis, metabolic control, keeping weight off the foot, and (when indicated) peripheral arterial reconstruction to improve blood flow. Therapeutic shoes to prevent recurrence of the ulcer are extremely important in posttreatment of these ulcers. Because the management of ulcers is complicated, the team approach and consultation are frequently necessary. The most important step in prevention of foot ulcers in the diabetic is repeated patient education in foot care.