The diabetic foot: epidemiology.

The epidemiology of the diabetic foot is still unknown because this heterogeneous pathologic condition is non uniformly classified and described. Lower limb peripheral vascular disease has a preferential distal location strongly associated with the classical factors of cardiovascular risk. Ulcers occur in 15% of diabetics and 6-20% of all hospitalized diabetic patients are affected by ulcers of the foot. There is a predictive feature of the severity of the ulcer in relation to its location. In the USA, ischemia-related amputations are about 200 per million per year for non diabetics as against 3900 per million for diabetics; furthermore the incidence of a second amputation rises to 51% 5 years after first amputation. Risk factors for amputation are: smoking, hypertension, dyslipidemia, elderly age, glycosylated hemoglobin levels. Although mortality has decreased in the last 50 years, the diabetic foot is still a huge economic problem.