Diabetic ulceration of the foot represents a major global medical, social and economic problem. It is the commonest major end-point of diabetic complications. Diabetic neuropathyand peripheral vascular disease are the main etiological factors in foot ulceration and may act alone, together, or in combination with other factors such as microvascular disease, biomechanical abnormalities, limited joint mobility and increased susceptibility to infection.
Ulceration rarely results from a single pathology. It is the interaction of contributory causes which leads to the breakdown of the foot at risk . The neuropathic foot, for example, does not spontaneously ulcerate. It is the combination of insensitivity and either extrinsic factors e.g. walking barefoot and stepping on a sharp object, or simply wearing ill-fitted shoes, or intrinsic factors such as diminished sensation and the development of a callosity which progresses to an ulcer on walking. Neuropathy is the most significant pathology in the pathway to ulceration.
Diabetic foot disease is an important problem confronting the diabetologists, internists and surgeons. The advent of insulin overcame the acute problems of ketoacidosis and infection, but could not prevent the vascular and neurological complications. Foot is the most vulnerable part in a diabetic. It is exposed to frequent trauma and requires a sensitive sensory protection, which is often lacking in a diabetic. The foot, being farthest away from the central nervous system and hemodynamically disadvantageously placed, becomes the common site of complicated lesions. Foot ulceration in persons with diabetes is the most frequent precursor to amputation . Overall, patients with diabetes are more likely to have an amputation than patients without diabetes.
